Your Good Health: Statins still beneficial, even if cholesterol levels are OK

Dear Dr. Roach: I’m 80 years old. My doctor ordered a fasting blood test, which showed that my LDL cholesterol is 119 mg/dL; my HDL is 68 mg/dL; my cholesterol/HDL ratio is 3-to-1; my total cholesterol is 208 mg/dL; and my triglyceride level is 104 mg/dL. A recent CT scan of my neck that was done for other reasons showed some plaque buildup. He wants me to start on 10 mg of atorvastatin and follow up in three months.

In people who are known to have blockages in their arteries, the benefit almost always outweighs the small risks of taking these drugs. In people without known blockages, we examine cholesterol numbers, including non-HDL cholesterol levels and HDL levels, but sometimes other risk factors such as Lp and C-reactive protein levels. Various calculators exist that can estimate a person’s risk using age, sex, blood pressure, cholesterol levels, smoking history, and other risk factors.

In my opinion, the most important finding you told me is not your cholesterol numbers, but the fact that you have plaque buildup in the arteries of your neck. In this situation, statin drugs are likely to have such a significant reduction in your risk of heart attack and stroke. I strongly recommend taking medication to prevent them, even though your cholesterol numbers are pretty good.

I can say that multiple randomized, controlled trials found that probiotics did not have a statistically significant benefit in returning normal bowel function after a colonoscopy. But it’s possible you were helped by kefir or other probiotic sources.

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