August 1, 2014
Cholesterol has gotten a very bad rap over the last decade. Many older people (even those in their 80s and 90s) are being started on statin drugs to lower their cholesterol level. Unfortunately, there are no scientific studies that included people in these age groups. So the decision is being made based on extrapolating the results of studies on younger people, sometimes much younger.
Cholesterol is a critically important substance in our blood. It is involved in producing many hormones and in the structure of cell membranes, like brain cells. However, high cholesterol, especially when found in combination with other risk factors like high blood pressure or diabetes, increases the risk of heart attacks or strokes. Studies have looked at the benefit of lowering cholesterol after a stroke or heart attack and there is reasonable evidence that such treatment helps to prevent a second heart attack or stroke. There also is some evidence that treating high cholesterol levels prior to any heart attacks or strokes may help people who are more at risk—especially when high blood pressure or diabetes are present. But that is mostly seen in people below age 65. And there is no evidence that treating low-risk elders is beneficial. The fact is that for people up to age 75, 99.3% of those not at risk who are taking a statin will have no benefit. Also, after age 70, having a low cholesterol level is associated with a shorter lifespan.
So why are so many doctors putting so many elders on cholesterol medications? Many factors go into that decision. Doctors often believe that older adults will not make major lifestyle changes, like starting an exercise regimen or eating a healthier diet. Regular daily exercise of 30 minutes or eating a Mediterranean diet—that means eating lots of fruits and vegetables, using olive oil, and eating more fish and less red meat—will lower risk of an early death better than statins. Doctors are sometimes afraid that they will be sued if they don’t start a medication. And many times older patients won’t question a doctor’s decision by asking, “Is there anything that I could do to lower my risk, other than taking medicine?”
Another strike against statins is that it also appears that they may increase the risk of developing diabetes. And a recent study showed that patients eat more calories and fat after they are prescribed a statin. Maybe the drug is making them feel protected from these less healthy lifestyles?
If you’re over age 70 and you haven’t had a stroke or a heart attack, the best treatment you could do is to start walking 30 minutes every day, and to start eating a Mediterranean diet. Always consult with your medical doctor before attempting a new diet or exercise regime, but if he concurs, choosing a natural, rather than chemical, remedy to your problem is more often a choice that will benefit you the most.
Source: Kenneth Brummel-Smith, MD, Department of Geriatrics, Florida State University College of Medicine