DEAR DR. GOTT: I am a 73-year-old white male, non-smoker, in what I think is good health. Shortly after my birthday a few months ago I decided to find a cardiologist so when/if I had a heart attack, he would have my information.
My overall cholesterol was 152 with my HDL being low at 33. Triglycerides 155. All other blood work was normal. After the initial interview, I had a stress test which I failed because I only lasted a bit over four minutes. No shortness of breath, no chest pain, no discomfort other than my legs got tired. Also, an EKG was done which showed something abnormal, but he said “no event”. He then scheduled me for a heart cath which I had done. The results showed a 10% blockage throughout my system. He said because I had three risk factors – mother died of a heart attack at 85 after a lifetime of smoking, my BMI is 26 and my HDL was low, he prescribed Zocor 2 mg. I am reluctant to start a cholesterol lowering drug unless it is necessary. I would like your thoughts on this.
DEAR READER: Total cholesterol is an indicator of potential risk for developing heart disease. A physician may choose to focus on a patient’s low density lipoprotein (LDL) figure because this number is considered to be a better measure for cardiac-related issues than is the total cholesterol number. Simply put, total cholesterol without other factors is considered good at below 200. Low density lipoproteins (LDL) should be below 70 for those individuals at very high risk of developing heart disease. High density lipoproteins (HDL) should be 60 or higher, while triglycerides, a type of fat in the blood, should be below 150.
Cholesterol figures are measured in milligrams (mg) of cholesterol per deciliter (dL). In our country and for healthy individuals, readings between 200 and 239 are considered to be borderline high. Figures above 240 are high. HDL (good cholesterol) are ideal at 60 and considered poor below 40 for men and 50 for women. LDL (bad cholesterol) should be below 70 for those individuals at very high risk of developing heart disease; below 100 for those at average risk of heart disease; near ideal between 100-129; borderline high between 130-159; high between 160-189; and lastly very high at 190 and above. Triglycerides are most desirable below 150; borderline if the numbers range from 150-199; high between 200-499; and very high at 500 and above. I must interject here that the American Heart Association endorses an optimal triglyceride level of 100 mg/dL; however, they do not recommend drug treatment to get to that level since lifestyle modifications such as weight loss and dietary changes can bring figures down substantially.
Without periodic laboratory testing, a patient might never know he or she has a problem with cholesterol numbers and one of the biggest issues we must face (which is out of our control) is genetics. We might eat right, exercise, discontinue smoking, and do all the right things but fall into a bracket of being high simply because of our genetic makeup. Risk factors for development of a cardiac condition include a family history of heart problems, a prior history of heart attack or stroke, a history of smoking, diabetes, high cholesterol (especially the LDL), advanced age, and hypertension.
All that said, I don’t believe that you require a statin medication. Your family history is based on one individual with a long history of smoking, your BMI is barely above normal, meaning that while you may be a few pounds over ideal, you are by no means overweight and finally, although your HDL is low, you make no mention of your LDL and statins are designed to lower the bad cholesterol, not raise the good. Zocor (simvastatin) is not available in a 2 mg dose. It is available as 5-40 mg pills so the smallest amount you could conceivably take is a half a 5 mg for 2.5 mg but this is far from the norm with 10-20 mg the common starting dosage. And, finally, you didn’t fail your stress test because of a heart problem, but rather from physical conditioning. A 10% blockage found during your heart catheterization (in my opinion, an unnecessary test in your case) is insignificant.
My recommendation is to find a new cardiologist and in the interim, make some lifestyle and dietary changes. Avoid high fat foods and red meats. Include more fish and omega-3 fatty acids in your diet. Don’t forget to include fresh fruits, vegetables and whole grains. Try to exercise at least 30 minutes a day by walking, biking, jogging or other heart-healthy cardiovascular activities.
Readers who would like related information can order my Health Report “”Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
