Statins are very effective. They can lower LDL (“bad”) cholesterol by up to 25-55%, lower levels of blood fats called triglycerides, reduce inflammation, and may help prevent heart attacks and strokes.
However, there may be some confusion about when to start taking statins, especially for older people. We become more vulnerable to heart attacks and strokes as we age, but the data showing that statins reduce such risk is strongest in adults in their 70s and becomes less apparent after age 80. ,” said Daniel Forman, director of the U.S. Geriatric Cardiology Division. University of Pittsburgh Medical Center. Concerns about statin side effects also increase with age, he says.
Last year, the U.S. Preventive Services Task Force reconfirmed There is not enough evidence to recommend or discourage starting statin use in people over the age of 76 to prevent their first heart attack or stroke. “The USPSTF isn’t saying you shouldn’t do it. There just aren’t enough studies to say definitively that you should,” said Icahn Medical School, Mount Sinai, New York. says Robert Rosenson, director of cardiometabolic disease at the university. .
Ardeshir Hashmi, director of the Center for Geriatric Medicine at the Cleveland Clinic, said that whether you rely on lifestyle measures alone or a combination of drugs to achieve your ideal cholesterol levels, It says that it should be set to suit the individual. “We are no longer just making recommendations automatically based on age,” he says. Therefore, it is wise to discuss your overall health goals and preferences and the scientific evidence with your doctor. Learn more about the cholesterol issue here.
What is the healthy level for people in their 70s and 80s?
Here are the numbers doctors usually ask for:
- total cholesterol: Less than 200 milligrams per deciliter (mg/dL). Cholesterol between 200 and 239 mg/dL is considered borderline. Above 240mg/dL is high.
- LDL (“bad”) cholesterol: Less than 100 mg/dL. “If you already have heart disease, your doctor will want your LDL to be below 70,” says Michael Nanna, a cardiac interventionist at Yale University School of Medicine in New Haven, Connecticut.
- HDL (“good”) cholesterol: At least 40 mg/dL, 60 mg/dL and above are considered excellent.
- Triglycerides (associated with increased risk of heart disease): Less than 150 mg/dL is considered within the normal range and 150-499 mg/dL is considered slightly elevated. 500 to 886 mg/dL, moderately increased. Over 886 mg/dL, very high.
Who Should Start Medication?
If you are under the age of 75 and have high LDL cholesterol or an increased risk of heart attack or stroke (due to a combination of risk factors), organizations such as the American Heart Association recommend statins to reduce your chances of heart attack or stroke. I’m here. I recommend this method with or without heart disease.
The same is true if you are over 75 and have been diagnosed with heart disease. Mr Nanna said: “The evidence is clear that if you have heart disease, you need to prevent it. [statins], including individuals aged 75 and over. ” a A study published in The Lancet in 2019For example, statin therapy for people with pre-existing heart disease has been found to reduce the risk of heart attack and stroke in all age groups.
What if I am over 75 and do not have heart disease?
As with any age group, it is necessary to consult a doctor. “If you have other risk factors, such as type 2 diabetes or an inflammatory disease such as rheumatoid arthritis, you are in a higher risk category and may need to discuss the use of statins with your doctor.” says Rosenson.
Some studies suggest that statin use in this age group may be beneficial. Research published in JAMA in 2020 About 327,000 of them are veterans over the age of 75. None had been diagnosed with heart disease at the start of the study. Veterans who started taking statins were 20% less likely to die of heart disease than veterans who didn’t take statins, when the researchers followed them for an average of seven years.
“If you’re in doubt, you might want to ask your doctor for a test to reveal your heart’s calcium score,” said George Farnine, chief of cardiology at New York University Langone Hospital in Brooklyn. talk. The higher the score, the more likely you are to have plaque in your heart’s arteries, which “may require a stricter diet, exercise, or possibly additional medication.”
I started taking statins, but they are not effective enough. So?
It may be reasonable to increase the dosage, depending on your health and response to the drug. Note, however, that statin side effects can be more pronounced in older adults who take higher doses, says Rosenson. People over the age of 65 should start at the lowest possible dose, Hashmi said, in part because “their bodies are less able to metabolize the drug.” Hashmi added that if a statin isn’t working well enough or the side effects are bothersome, you have the option of trying a different statin.
The American College of Cardiology and the American Heart Association argue that adding ezetimibe (Zetia), which reduces cholesterol absorption, to people at very high risk of cardiovascular disease makes sense. If that doesn’t work, your doctor may recommend injections to lower your LDL levels. These include alirocumab (Praluent), evolocumab (Repatha, Repatha SureClick), and inclisiran (Lequio). Another alternative to statins is bempedoic acid (Nekretol), which reduces the amount of cholesterol produced by the liver.
Suppress the side effects of statins
About 10 to 15 percent of people experience side effects such as muscle pain and weakness. Studies show that this is often due to the “nocebo” effect. That is, when negative effects are expected to occur as a result of negative beliefs, expectations, or treatment experiences.
Exercise can help. In one study, when he did three sessions of about one hour a week, the side effects of statins were significantly reduced.
A review of 12 studies suggests that: coenzyme Q10 supplementmay also help. But these can interfere with certain medications, so check with your doctor, says Nika Goldberg, a clinical associate professor at New York University’s Grossman School of Medicine.
If these strategies don’t work, talk to your doctor about possible changes, such as taking your medicine every other day or switching to another medicine.
Effective lifestyle procedures
- Eat heart-healthy meals. a A diet rich in whole grains, produce, seafood, beans and nuts That’s ideal, says Hashmi. Regular consumption of unsaturated fats (olive oil, avocados, nuts, seeds) and soluble fiber (oats, barley, psyllium) can lower LDL cholesterol by approximately 7-15 mg/dL. Saturated fat can raise LDL, so limit full-fat dairy, red meat, and fried foods, says Donald Lloyd-Jones, chief of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. said. high triglycerides? Be careful with refined carbohydrates. “Foods like white rice, bread, pasta, and sweets all raise triglycerides,” Hashmi says.
- Get some physical activity: The AHA recommends at least 150 minutes of moderate-intensity exercise (brisk walking, swimming, biking) per week to reduce cholesterol. This is especially important if you’re trying to raise your HDL levels, as there are no drugs that do this safely, says Lloyd-Jones.
- Make other healthy choices. Quit smoking, lose excess weight, and drink alcohol only in moderation.
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