Understanding Cholesterol

Most people understand that having a high cholesterol level in the blood can lead to a heart attack. But our patients often ask, “How high is too high?” Like a lot of things in medicine, the answer is, “It depends.”

It may help to first talk about what a person can do about their cholesterol. If the cholesterol is okay, we will generally advise a person to eat a balanced diet, get regular exercise, maintain a healthy weight and blood pressure, and quit (or don’t start) smoking. However, if the cholesterol is too high, we will advise to eat a balanced diet, get regular exercise, maintain a healthy weight and blood pressure, don’t smoke, and… take a cholesterol medication.

Now of course all medications have cost and side effects. So, the real question is: At what cholesterol level do the benefits of cholesterol medicine outweigh the costs and the side effects? The answer to that varies greatly from one person to another.

The standard cholesterol medicines, “statins” (like atorvastatin/Lipitor, rosuvastatin/Crestor), lower the chance of having a heart attack by about 20-30%. For everyone. But how important that is depends on a person’s chance of having a heart attack in the first place. In a healthy 20-year-old who has no other heart attack risk factors (like smoking, diabetes, high blood pressure), the risk is not zero, but is very, very small. Lowering that 20-30% would not justify the cost and side effects of the medicine. On the other hand, for a 65-year-old person who has multiple risk factors and already has had a heart attack, the risk of having another one is very high, and the benefits of medication will far outweigh the costs.

So, since the benefits of cholesterol medicine are not the same for everyone, the cholesterol level where we start to get concerned is not the same for everyone. To be specific, most experts agree that if a person’s chance of having a heart attack in the next 10 years is more than 7-10%,then the benefits of medicine are justified. You can estimate your risk by using what is called the “Pooled Cohort Risk Calculator”. It is available online on a number of websites, including:

https://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx

Categories