Cholesterol: Should You Go Lower?

By:
National Women's Health Resource Center

New research into cholesterol and the cholesterol-lowering medications called statins is leading doctors to reconsider how much LDL cholesterol (the so-called "bad cholesterol") is too much.

Studies already have proven that statins such as atorvastatin (Lipitor), pravastatin (Pravachol), simvastatin (Zocor), lovastatin (Mevacor), fluvastatin (Lescol), and rosuvastatin (Crestor) are quite effective in lowering LDL cholesterol levels and reducing cardiovascular disease risk. These medications work by blocking the production of low-density lipoproteins, which lead to the plaque buildup that raises a person's risk of heart attack and stroke. But new research by the Cleveland Clinic suggests that the recommended healthy target level for LDL (100) may not be low enough, especially for people with other risk factors for heart disease.

The study found that, in one group of heart disease patients, any new buildup of plaque in the arteries stopped when LDL cholesterol levels were lowered to around 80. Patients achieved this by taking the highest dose of Lipitor. In the second group of patients, who took a lower dose of the statin Pravachol, LDL levels hovered around 110 and the plaque buildup actually worsened. This is significant because, according to current guidelines, a level of 110 is not necessarily considered "high."

"There is just a tremendous amount of data showing that statins reduce cardiovascular risk by as much as one-third with just five years of use," says Daniel Rader, MD, director of the preventive cardiology and lipid clinic at the University of Pennsylvania. "The question now for people with heart disease, diabetes, or very high risk factors is whether the target LDL level should be even lower than 100. Some doctors are already starting to target as low as 80 for these individuals."

Other risk factors include age, smoking, diabetes, being obese or overweight, high blood pressure, a family history of heart disease, and an HDL cholesterol level under 40 (unlike LDL, HDL, or high-density lipoprotein, is considered "good cholesterol" because it actually cleanses cholesterol from the body).

According to the National Cholesterol Education Program, an LDL level of 100 is considered optimal, up to 130 is healthy, and over 130 high. But each person has to consider her or his own level in relation to the other risk factors. If there are no risk factors, lifestyle changes such as diet and exercise may be enough. But risk factors combined with moderate to high cholesterol suggest that medication may be needed.

Dr. Rader also stresses that, while LDL cholesterol level is important, having multiple risk factors creates compelling enough reason for a person to consider a statin -- even in the absence of high cholesterol. "The trend with these medications is to use them based on overall risk, rather than cholesterol levels alone," he says.

"Patients really should ask their doctors for a quantitative assessment of their ten-year risk for cardiovascular disease," adds Dr. Rader. "Then they should ask, 'Do you think I am a candidate for statin therapy'? A doctor might not suggest it, but being asked gets him to stop and think, 'Hey, maybe you should be.'"

Fortunately, the benefits far outweigh the risks. Rare but serious side effects can include muscle and liver damage, but doctors monitor for these and most people do not experience them. Women who are pregnant or might become pregnant cannot take statins, nor can people who are taking certain medications (check with your health care professional). But in most cases, statins can help women and men reduce their risk of falling victim to this nation's number-one killer.

Here is a list of questions that can help you start a conversation about cholesterol with your health care professional:

1. What is my overall risk for heart disease or cardiovascular disease? Can we review what risk factors I have or may have?

2. Can we run a test for my cholesterol levels, and can you report my levels to me?

3. If I have high LDL cholesterol, what lifestyle and dietary changes can I make to lower it?

4. When and how often should I have my cholesterol level checked from now on?

5. Based on my cholesterol and other risk factors, am I a good candidate for statin use? What are the risks and benefits of using a statin? 6. Are there alternative medications I can take if I cannot or do not wish to use a statin?

From the National Women's Health Resource Center. Copyright 2003-2004 by the National Womens's Health Resource Center, Inc. (NWHRC). All rights reserved. Reproducing this content in any form is prohibited without written permission. For more information, please contact info@healthywomen.org.