DEAR DR. ROACH: I am a 69 year old woman. Recently I had some blood work done and my doctor decided to put me on Lipitor based on my LDL results. After reading the side effects, I am hesitant to take this medication. My LDL level is 128 mg/dL, my HDL is 49 mg/dL, and my total cholesterol is 192 mg/dL. Over the years my numbers go up and down. I think if I controlled my diet better, I could lower my LDL levels without medication. Is this possible? -Annon.

ANSWER: Since all medications can be harmful, it is always good to take a clear-eyed look at the risks and benefits of a medication, especially a medication like Lipitor which is designed to prevent future problems (a heart attack or stroke) rather than treating current symptoms.

The critical endpoint is not cholesterol; that’s your risk of a “cardiovascular event,” which specifically means death, heart attack, or stroke in this case. Cholesterol and blood pressure are among the biggest risk factors, but your diet, physical activity, family history, smoking, and even non-traditional risk factors (like stress, sleep, and close relationships with your family and friends) also impact your risk of heart disease. .

Improving your diet is always a good idea, regardless of your cholesterol levels, because a healthy diet has independent beneficial effects on the heart and many other conditions, as does regular exercise.

When considering starting a medication like atorvastatin (Lipitor), I start with your baseline risk of a cardiovascular event. I use the PREVENT calculator (tinyurl.com/preventcalc) from the American Heart Association, which uses the most recent data to provide your 10-year risk based on your risk factors.

Assuming your blood pressure, kidney function, and BMI are normal, the model predicts that you have an 8.8% chance of experiencing a cardiovascular event in 10 years. These are very good odds, a probability greater than 91% that your heart will be fine at age 79. Your cholesterol level is not bad and most of your risk is simply because you are 69 years old. major risk factor for heart disease.

With treatment with a drug like Lipitor, your risk would drop to about 7%, or a 93% chance that everything will be fine. You should ask yourself, “Is this worth it for me?” » Many readers will say “no”, while some will say “yes”. You are at a level where there is no right answer for everyone, which is why I like to give a person as much information as possible to help them make their decision.

You should also consider the possible harm of taking Lipitor or another statin. You’ve probably read that some people will notice muscle pain, which is true. However, in studies in which people don’t know whether they’re taking a statin, people were just as likely to say they had muscle pain while taking an inactive placebo pill.

However, in clinical practice, where people expect muscle pain, up to 15% of people notice it. Many of these symptoms are due to expectations rather than a side effect of the medication. Actual muscle damage caused by statins is fortunately rare: fewer than one in 10,000 people take the drug for a year.

The vast majority of people who start taking statins to reduce the risk of heart disease tolerate the medication very well. If your doctor treats 50 people like you, on average, these medications will prevent one cardiovascular event. Maybe it’s you.