Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Lowering your high cholesterol can help you prevent a heart attack or stroke. Consider the following when making your decision:
- High cholesterol is only one of several risk factors for heart disease. To reduce your risk of coronary artery disease (CAD) and heart attack, you need to reduce all of your risk factors, not just high cholesterol.
- Guidelines from the U.S. National Cholesterol Education Panel recommend more intensive treatment with statins for people who are at moderate to very high risk of CAD.1 It is important, however, that you discuss with your doctor whether statins are appropriate for you individually, based on your condition and medical history.
- The choice is less clear for people who have moderately high cholesterol and few risk factors for CAD and heart attack. This group may find this decision point most helpful.
- Therapeutic lifestyle changes are as important as medicine in reducing your risk for CAD and heart attack. For some people, quitting smoking, reducing blood pressure, losing weight, or getting more exercise can have the same or greater impact on reducing the risk of heart disease than taking medicine.
Medical Information
What is cholesterol, and why is high cholesterol dangerous?
Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But too much cholesterol in your blood increases your chances of heart attack and stroke.
What raises my chances of getting CAD and having a heart attack or stroke?
Your chances are higher if you:
- Are a man age 45 or older or a woman age 55 or older.
- Have a family history of CAD: CAD in your father or a brother younger than 55 or in your mother or a sister younger than 65.
- Have smoked any cigarettes within the past 30 days.
- Have high blood pressure (140/90 mm Hg or above) or are taking medicine for high blood pressure.
- Have a low HDL cholesterol level (below 40 mg/dL or 0.91 mmol/L).
- Have diabetes.
What are other risk factors?
Other factors that put you at risk for CAD and heart attack include high homocysteine levels, obesity and lack of regular exercise, menopause and the drop in estrogen that follows it, and metabolic syndrome.
Your Information
An important part of your decision about whether to take statins is determining your risk for coronary artery disease and heart attack.
Use this Interactive Tool: Are You at Risk for a Heart Attack?
Along with medical guidelines for taking medicines, your decision about whether to take statins to lower your cholesterol level includes your personal feelings.
| Reasons to use statin medicines | Reasons not to use statin medicines |
|---|---|
Are there other reasons why you might want to use medicines to lower cholesterol? |
Are there other reasons why you might not want to use medicines to lower cholesterol? |
Medicine choices
Statins and statin combinations are the most effective and widely prescribed cholesterol-lowering medicine. They include:
- Atorvastatin (Lipitor).
- Atorvastatin with amlodipine (Caduet).
- Ezetimibe with simvastatin (Vytorin).
- Fluvastatin (Lescol).
- Lovastatin (Mevacor).
- Pravastatin (Pravachol).
- Rosuvastatin (Crestor).
- Simvastatin (Zocor).
Other medicines also lower cholesterol, and some may be used to lower triglycerides or raise HDL. They include:
- Bile acid sequestrants: cholestyramine (Questran) and colestipol (Colestid).
- Fibric acid derivatives: gemfibrozil (Lopid) or fenofibrate (Tricor).
- Nicotinic acid: (Nicolar, Niacor, Niaspan, and Slo-Niacin).
These medicines are sometimes used in combination with a statin.
These personal stories may be helpful in making your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you will have a better idea of how you feel about taking medicine to lower cholesterol levels. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| My doctor has told me that my risk for CAD is high. | Yes | No | Unsure |
| My LDL cholesterol level is above 190 milligrams per deciliter (mg/dL). | Yes | No | Unsure |
| The NCEP guidelines recommend that I take medicine. | Yes | No | Unsure |
| I have the finances and/or insurance to pay for medicine. | Yes | No | Unsure |
| I worry about my cholesterol levels. | Yes | No | Unsure |
| I worry about getting CAD or having a heart attack. | Yes | No | Unsure |
| I believe that medicine can help me. | Yes | No | Unsure |
| I am comfortable with taking medicines long-term or for the rest of my life. | Yes | No | Unsure |
| I feel I can cope with the side effects of cholesterol-lowering medicine. | Yes | No | Unsure |
| Having to take regular blood tests for liver function doesn't bother me. | Yes | No | Unsure |
| Medicine that I'm currently taking does not interfere with medicine to lower cholesterol. | Yes | No | NA* |
| Diet and exercise have helped me lower my cholesterol. | Yes | No | NA |
| I have difficulty staying on a diet. | Yes | No | NA |
| I have difficulty staying with an exercise program. | Yes | No | NA |
*NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicines.
Check the box below that represents your overall impression about your decision.
|
Leaning toward taking medicine |
Leaning toward NOT taking medicine |
Return to the topic High Cholesterol.
References
Citations
Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
Foster C, et al. (2004). Primary prevention. Clinical Evidence (11): 163–195.
Pignone M, et al. (2004). Secondary prevention of ischaemic cardiac events. Clinical Evidence (12): 193–235.
Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
Credits
| Author | Ralph Poore |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman |
| Associate Editor | Terrina Vail |
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
| Specialist Medical Reviewer | Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology |
| Last Updated | July 20, 2006 |
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