A visit to the doctor does not always mean that you have to begin treatment right away. As hypercholesterolemia can be contributed by unhealthy diet and sedentary lifestyle, your doctor may simply prescribe lifestyle modifications first instead of statins to bring down your cholesterol level. After all, you don’t want to be hooked on to meds for the rest of your life without trying out the alternatives first.
Should you be on medications?
Your doctor will access your condition and that includes your blood lipid levels, your risk factors for heart disease and if you have other illnesses like diabetes, hypertension and etc. The assessment will determine the severity of your condition before a treatment decision is made.
List of risk factors of heart disease
Below is a list of risk factors associated with heart disease which your doctor may consider before initiating you with statins.
- Family history
Men over the age of 40 years old and women in their post-menopausal years are more prone to getting heart disease.
Men generally have a higher risk of getting heart disease compared to women, mainly because of the cardio-protective effect of estrogen in women.
If there is a known history of hypercholesterolemia and heart attack in your family, your risk of getting heart problems is increased too.
The harmful nicotine raises your LDL cholesterol and causes atherosclerosis besides straining your heart.
Being on the high side on your weighing scale can increase your risk as well.
Having diabetes has been regarded as a risk equivalent to getting heart disease.
If you have high cholesterol level without risk factors of heart disease:
You may begin adopting a healthy lifestyle which comprises less fatty diet, increasing fish intake, exercising for at least 5 times a week, stop smoking and moderate drinking. Give yourself a trial of a few months to change your habits before giving in to statins. For most people without any risk factor of heart disease, their target LDL level would be 100 mg/dL.
If you have high risk of heart disease, initiation of medications will depend on your cholesterol level as below:
- LDL level of 100-129 mg/dL
- LDL level above 130 mg/dL
Lifestyle modification is certainly indicated for this group of patients with concurrent administration of statins to better control LDL level. If you insist on withholding statin and focus on lifestyle changes first, you may do so for 3 months before treatment is considered again based on your latest lipid readings. If your LDL level still stubbornly persists above 100 mg/dL after 3 months, you will need to begin treatment right away.
Medications like statins will be indicated if your LDL level is over 130 mg/dL. Lifestyle changes and treatment is important to bring down your LDL level by about 30% to prevent the risk of heart attack and stroke. If you have very high risk of heart disease, your cholesterol control needs to be stricter by aiming for an LDL level less than 70 mg/dL.
Initiation of treatment
Statins are the first line treatment indicated for patients who need to reduce their LDL level. The dose of statin which you may be started on may vary from as little as 5mg to the higher dose of 80mg. Dose of medication will depend on the percentage of LDL reduction which you need and your health condition. As statins are associated with side effects like myopathy which causes sore muscles, patients who experience these side effects may need to be given a lower dose of statin to control cholesterol. You may also need to undergo liver tests to determine if you are suitable to be started on statin or not. This is because statin may raise levels of liver enzyme and cause liver problem.