High Cholesterol? When to Say ‘Yes’ to Medication

More than half of American adults have high cholesterol. If you’re among them, you’ve probably talked with your cardiologist about cholesterol-lowering medications called statins. These are prescription drugs that improve blood flow, heart health, and can add years to your life. But if statins are so effective, why do studies show that 50% of high-risk patients opt out of this proven treatment? And why are women 20% more likely than men to reject their doctor’s recommendation?

Anjali Dutta, MD, a cardiologist at Atlantic Health System outlines the variables that contribute to high cholesterol and clarifies when it’s time to consider medication. She explains that your medical history, family genetics, bloodwork, lifestyle, diet, and the environmental factors all contribute.

“I talk with so many men and women in their 20s and 30s who already have high cholesterol, and seeing a cardiologist really opens their eyes,” says Dr. Dutta. “Many people can lower their cholesterol numbers just by focusing on diet and weight loss. Small changes can bring their levels into a range which, although may not perfect, will allow them to avoid or at least postpone lifelong medication.”

If you’ve been told that you have high cholesterol and may benefit from a statin -- or you’re simply looking to minimize your risk for heart disease -- here’s what you should know.

1. Know Cholesterol’s Highs and Lows

Ideally, you’re striving for total cholesterol less than 200 and LDL (the bad cholesterol) below 100. If your ratio of total cholesterol to HDL (the good cholesterol) is low, meaning your HDL is very high, your overall risk for heart disease is low because good cholesterol fights off bad cholesterol. Your doctor is monitoring all of this -- blood pressure, cholesterol, body mass index (BMI), glucose levels and diabetes risk, along with your family health history. It provides the information they need to assess whether you need medical intervention.

2. Know That You’re in Control

The foods you eat make a huge difference in your heart health. Maintaining good cholesterol levels begins with healthy and nutritious meals -- maybe even following a Mediterranean diet -- along with daily exercise and smart choices. Seeing your doctor regularly will also help you manage your heart health and blood fats. But, if your numbers creep beyond a safe range despite your best efforts, it is likely your doctor will want to discuss a cholesterol-lowering medicine as an appropriate next step.

3. Know Your Screening Options

Your cardiologist may recommend a deeper dive into testing before recommending a statin. A specialized cholesterol test is available if you have diabetes, premature heart disease or family members who have had a heart attack or stroke at a young age. Testing positive for this marker known as lipoprotein-A (LPa) puts you at greater risk for stroke and cardiovascular disease.

Another clinical tool that helps determine if you would benefit from a statin is the ASCVD 10-year risk score, which factors in your age, history of high blood pressure, diabetes risk, and exposure to cigarette smoke.

4. Know That Medications Help

If you already have vascular disease or are at risk for heart disease, a statin is strongly recommended. These medications effectively lower your risk for heart attack and stroke. They help reduce the amount of cholesterol in your blood stream – specifically the ‘bad’ cholesterol or LDL (low-density lipoprotein). So if your doctor is recommending a statin, it is because your potential risk for heart attack and stroke is reaching a concerning level. Although a common statin side effect is muscle pain, most people find the lifelong benefits outweigh any compromises.

“The incidence of heart disease and stroke grows higher as people age,” says Dr. Dutta. “We can typically manage a younger patient’s high cholesterol with lifestyle modifications to avoid medicines that could have long-term side effects. But there comes a point where, based on age, test results and genetics, the risk becomes too great and statins are an excellent alternative.”

“For patients who prefer not to take this recommendation, I encourage them to do a little research and bring their questions to me so we can discuss the risks and benefits. Once they understand the important role these medications can play in their long-term quality of life, they typically have a change of heart.”