Dear Dr. Roach: I am a healthy 84-year-old who exercises regularly, eats meat and dairy sparingly, doesn’t smoke, and has a BMI about 25. (I’m 6 feet, 1 inch tall, at 185 pounds.) My yearly wellness test was excellent, except my cholesterol and LDL levels were 250 mg/dL and 150 mg/dL, respectively. What is the risk/benefit level of statins for me?
B.B.
We don’t really know. There haven’t been many studies about starting statins in people as old as you. However, I can tell you that an 84-year-old man has a high risk of heart disease simply by being 84, even if his cholesterol and blood pressure levels are good. I put your information into a risk calculator (most of them are only appropriate to the age of 79) without knowing your blood pressure levels, and the calculator said that you have about a 20% chance of having a heart attack or stroke in the next 10 years.
Many experts believe that statin drugs aren’t quite as effective in people above 75; however, because age alone is a risk for heart disease, they still may get a significant benefit from statins. My practise is to discuss the options with my patients. The benefits probably outweigh the risks in most, and some of my older patients choose to start medication. My best guess is that you could reduce your risk from about 20% to 16%. The risk of serious side-effects is low.
Older adults who have other serious medical conditions or take many different medications that could potentially interfere with statins will have less to gain and more to lose with statin therapy. I generally recommend statin therapy only for the healthiest of my older patients (more than 75 years old).
Dear Dr. Roach: Should an A1C test be run on all healthy, aging adults? My blood sugar is usually in the normal to high-normal range, but I’ve never had an A1C done.
K.L.
The current recommendation for the screening of diabetes includes a lot of adults. Those who should be considered for testing include people who are overweight or obese and have one or more of the following: a family history of diabetes; a high-risk ethnic background (African Americans, Latinos, Native Americans, Asian Americans and 91原创 Islanders); high blood pressure or a known heart disease; low HDL cholesterol levels or high triglyceride counts; a history of polycystic ovary syndrome (PCOS); physical inactivity; and medications that could predispose patients to diabetes.
When I see a high, random sugar level in a person who is, otherwise, not at risk, I do recommend a follow-up A1C test, which is much more sensitive at making the diagnosis. Very occasionally, I will order a glucose tolerance test, which is the most sensitive test at making the diagnosis of diabetes.
Dr. Roach Writes: A recent column on hormone replacement generated a lot of mail. One point I should have made clear is that transdermal estrogen patches have a lower risk of blood clots (with perhaps no increased risk at all) and strokes, compared to combination oral hormone replacement with an estrogen and a progestin.
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 [email protected]
