Our knowledge of the role of blood fats in the development of heart and vessel disease has grown exponentially since the original publication of the first comprehensive Framingham study. In spite of our best education efforts, obesity is more prevalent and diabetes is on the rise with type II predicted to afflict 30% of our over 55 population by the year 2025, while sadly, Cardiovascular events continue to rank as the number one killers of our adult population. For me as a long time clinician the red flag is the Canadian Medical Association Journal of April 2015 research review indicating public and private sector prescriptions costs for all classes of cholesterol lowering drugs annually top ONE BILLION dollars; surpassing prescription writing for all respiratory diseases by 150 million and only superceded by the 1.3 billion spent on blood pressure controls– begging the question what is wrong with this picture?
The answer in part is we have become a Dickens of a country, “ the best of times and the worst of times“. We have more people biking, walking, jogging, attending aerobics than ever but the rest of the population is taking the more easily travelled pharmaceutical path while skipping dietary controls and exercise necessities. One of the most frequently asked questions by seniors is whether they should be on lipid medication. I know many fit seniors with normal blood pressure, no diabetes, non-smokers, no genetic family history and with or without evidence of cardiovascular disease; but who have a mild to moderate elevation of cholesterol who have been advised to initiate STATIN therapy.
The first part of my answer is to review current and potential medication usage realizing most seniors are already taking 3 to 5 prescriptions daily. Statins are the gold standard but there are risks. Diabetics on glyburide may experience precipitous drops in blood sugar. Statins definitely interfere with dilantin levels for seizure control and digoxin levels for heart disease. They also interfere with anticoagulant therapy with the warfarin group and interact adversely with several antibiotics and anticancer treatments. They are contraindicated in the presence of advanced liver disease and kidney disease and have been associated with destructive muscle breakdown known as myopathy, though only rarely.
My preferred reference is the 2012 update of the Canadian Cardiovascular Society onlineguidelines for the diagnosis and treatment of high cholesterol. The assessment stage is a simple two-step process of history and physical followed by lab work which allows patients to be placed in low, intermediate and high risk algorithms. For low risk groups, health behaviour modification and follow up in 3 years should suffice. For men, this initial assessment should be done at age 40, for women age 50 (postmenopausal).There have been occasions when I even considered it appropriate to test preteen children. The next step should be a face to face with your physician to review your HDL, LDL and triglycerides–the new kid on the block in what is called a lipid panel. There should also be measures of kidney and liver functions, the ratio of LDL to HDL with further secondary testing to include C reactive protein and apo-B for higher risk patients
Whatever decision is reached regarding treatment; you as an individual have a far greater likelihood of success and longer lifespan with a commitment to 30 minutes of exercise five times weekly and some realistic dietary changes away from sugar and animal source fats adding more vegetables, whole grains, fish and substitute protein sources such as soy and nuts. These lifestyle changes can average a 30% reduction in cholesterol in the majority of patients with non-genetic lifestyle lipid elevations. To me, this is a healthier starting point.
Written by: Dr. David Carll