Q: At 93 my mother-in-law was failing terribly. No appetite, could barely get out of bed, legs hurt so much she couldn’t walk, sleeping all the time. I suggested to the staff at her assisted living facility that they stop giving her statins. Why worry about cholesterol levels in someone so old who hardly eats anything? Two months later she is a changed person. She gets up, eats all three meals, takes walks all the time, responds to us, and knows who we are for the first time in years. Maybe it’s time doctors started rethinking prescribing live-long medications to the elderly.
A: Cholesterol is found in every cell of the human body and is essential for normal function. Its purpose is to build healthy cells and some vital hormones. However, excessive amounts of it in the blood are linked to plaque that develops in blood vessels. Plaque build-up makes it increasingly difficult for adequate amounts of blood to travel through the arteries that, in turn, deprives the heart of oxygen-rich blood. This causes an increased risk of heart attack, other symptoms of coronary artery disease and stroke, and unless a person progresses to the stage of plaque build-up in the arteries, there are no outward symptoms of the condition known as hypercholesterolemia. The only means of diagnosis is through laboratory testing.
If an individual is found to have high levels of cholesterol in their blood or because of cardiac concerns, physicians may initially instruct patients to modify their diets, exercise, try over-the-counter niacin, and cease smoking. When these steps fail to lower numbers sufficiently, prescription medication follows and statin drugs are generally recommended because they work by blocking a substance the liver requires to make cholesterol. Some reports indicate statins might assist the body in reabsorbing cholesterol from plaque build-up on arterial walls. There is also evidence that statins decrease inflammation in the body and studies suggest a link to decreasing cancers, improving kidney function, assisting in fighting infections, decreasing the risk of blood clots, and decreasing the risk of dementia. They problem is, statins are not free of side effects that can include liver damage and muscle aches.
A senior citizen, especially one your mother-in-law’s age, likely already suffers from muscle and joint pain. When a physician feels she should continue a statin drug because of her heart or for other reasons, that pain can increase in intensity and little consideration is given to the fact that the elevation may be from taking a statin drug. If the muscle pain continues for an extended period, it can lead to serious muscle loss and weakened bone density, and increase the risk of having a fall. As you have pointed out, if there is no compelling reason to treat high cholesterol, it is often best not to subject them to the treatment and its possible side effects.
Another concern in individuals 85 and older on statins is loss of memory and brain function. Dementia is common in this age group. Studies indicate lowering cholesterol readings late in life might not be good for brain function. Fortunately, not everyone will experience memory loss but no one wants to run the risk and medical professionals become faced with whether or not there is sufficient data to make a judgment for seniors over 85 whose risk for dementia is at least 50%.
You were fortunate to have recognized what was going on and chose to do something about it. Many others would attribute those unwanted changes to her advanced age. My hat is off to you for taking an active role in her care and I’m sure you enlightened her physician and care givers that there comes a time for family intervention from those that know the patient best.
Other readers who would like related information can order Dr. Gott’s Health Report “Understanding Cholesterol” by sending a self-addressed #10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
