DEAR DR. ROACH: I’m 80 years old. My doctor ordered a fasting blood test, which showed that my LDL cholesterol is 119 mg/dL; my HDL is 68 mg/dL; my cholesterol/HDL ratio is 3-to-1; my total cholesterol is 208 mg/dL; and my triglyceride level is 104 mg/dL. A recent CT scan of my neck that was done for other reasons showed some plaque buildup. He wants me to start on 10 mg of atorvastatin and follow up in three months.
My original primary care physician who recently retired said my HDL level was so good that he gave me an A- and wasn’t concerned about my cholesterol. I’d appreciate your thoughts on this, as I’m not sure which course of action I should take. — D.L.
ANSWER: The reason to use statin drugs, or other drugs for high cholesterol, is not to make numbers look better, but to reduce a person’s chances of getting a heart attack or stroke. The higher the person’s risk, the more benefit they will get from taking a statin.
In people who are known to have blockages in their arteries, the benefit almost always outweighs the small risks of taking these drugs. In people without known blockages, we examine cholesterol numbers, including non-HDL cholesterol levels (or calculated LDL) and HDL levels, but sometimes other risk factors such as Lp(a) and C-reactive protein levels. Various calculators exist that can estimate a person’s risk using age, sex, blood pressure, cholesterol levels, smoking history, and other risk factors. My practice is to use the best possible estimate and discuss the expected benefit of a statin with my patient.
However, most of the data we have on statins are in people younger than 75. From what data there are — and our understanding of the biology of arterial atherosclerosis — we expect that older people are as likely to benefit from statins as younger people.
In my opinion, the most important finding you told me is not your cholesterol numbers, but the fact that you have plaque buildup in the arteries of your neck. In this situation, statin drugs are likely to have such a significant reduction in your risk of heart attack and stroke. I strongly recommend taking medication to prevent them, even though your cholesterol numbers are pretty good.
DEAR DR. ROACH: I had a colonoscopy in January, and my digestive health didn’t seem to bounce back after the prep. The colonoscopy was normal, and I didn’t have any polyps. I should add that I am an 80-year-old male. I have been drinking a cup of kefir for about six weeks now and feel a tremendous difference in my health. Is this just psychological, or is kefir quite beneficial? — M.N.
ANSWER: In your specific case, neither of us will ever know whether you would have gotten better just as quickly if you hadn’t had the kefir (a fermented milk drink similar to thin yogurt that contains bacteria thought to be beneficial to the colon).
I can say that multiple randomized, controlled trials found that probiotics (not necessarily kefir) did not have a statistically significant benefit in returning normal bowel function after a colonoscopy. But it’s possible you were helped by kefir or other probiotic sources.
Traditionally made kefir (from raw milk) has been shown to contain harmful bacteria. But kefir made in North America is usually made from pasteurized milk, and there have been very few reports of people getting ill from it.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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