The average age in the United States for having a first heart attack is 65.8 years for men and 70.4 years for women. Thus, a huge percentage of deaths from coronary disease — about 85 percent — occur in people over age 65.

Yet, studies continue to show that many physicians are failing to order diagnostic tests for older persons, treat them for coronary disease, or attempt to lower their cholesterol levels.

It's easy to understand why doctors initially tended to ignore elevated cholesterol levels in their older patients. Population studies showed that high cholesterol is a much greater risk for young people than for older ones.

Moreover, the first cholesterol-lowering drugs were difficult to take, had troublesome side effects, and were not very effective. And people over 65 had been largely excluded from the early clinical trials that showed the impressive benefits of lowering LDL cholesterol.

Those excuses, however, are now gone. Several large statin trials have included older subjects and the reductions in heart attacks and strokes among older participants have been comparable to those of their younger counterparts. The statins work very well to lower LDL cholesterol and they are well tolerated by most older people.

I advise all of you, but especially older readers, to ask your doctors about your LDL cholesterol, HDL cholesterol, and triglycerides levels, and to find out what targets they would like you to achieve for each. Healthy levels for these blood lipids are readily available from the American Heart Association.

If your doctor is not working with you to reach these goals, ask why not. While I am not enthusiastic about patients asking their doctors to prescribe a medication that was extolled on TV or in a media ad, I do believe that patients need to take an active role to ensure they are getting the best possible advice and treatment to prevent heart attacks and strokes.