What should be my cholesterol goal with a family history of heart disease?
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Q. I'm a 70-year-old man with a family history of coronary artery disease. I currently take a low-dose statin. My recent LDL number is 105. Should I aim for a lower number?
A. My situation is similar to yours. I have some family members who died young secondary to coronary heart disease, and I run a high total and "bad" LDL cholesterol. I exercise regularly and try to follow a Mediterranean-style diet.
About 15 years ago, my doctor recommended starting a statin. Even at a low dose, I experienced more aches and pains than I had previously. I stopped the statin, but in retrospect, I now doubt that the muscle aches were related to the drug.
Eight years ago, I had a chest CT scan unrelated to any heart issues. My lungs were fine, but the scan showed calcium deposits in my arteries, including the coronary arteries that feed oxygen and nutrients to the heart. That was a game changer. Calcium gets deposited into fatty plaques that accumulate in the arteries. I knew this indicated that my risks of heart attack, heart failure, and stroke were significantly elevated. I immediately began taking the maximum dose of rosuvastatin (Crestor). Interestingly, I had no muscle aches, even with the high dose.
In general, the lower your LDL cholesterol number, the lower your risk of developing heart disease. My high risk and need for a high-dose statin became apparent after the CT scan. But what about you and the millions of men with a similar family history or a somewhat elevated LDL level?
Here's the discussion I would have with a man like you, who has a higher-than-ideal LDL level and is asking about increasing his statin dose or might not be on a statin yet.
If you desire to maximally reduce your risk of heart disease and stroke, aim for an LDL level of less than 70 milligrams per deciliter (mg/dL). This means lifestyle changes, including a healthier diet and more physical activity. But you might also want to talk with your doctor about starting a low-dose statin or raising the dose if you already take one.
An alternative is to have a coronary artery CT scan to get your coronary artery calcium (CAC) score. The test calculates the amount of calcium deposited in your coronary arteries. A zero score means a very low risk of trouble, and a high score means you might aim for an LDL level of 55 mg/dL or lower (the European Society of Cardiology recommendation for people at very high risk).
Image: © Olivier Le Moal/Getty Images
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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