Cholesterol Levels

with Kenneth Jensen, M.D., internal medicine specialist, Advanced Healthcare

Last Updated: July 1, 2003

Many seniors may have noticed that physicians are more concerned about cholesterol levels than in years past, and that the target levels for cholesterol have fallen. The reason for this is twofold. First, new data suggests that the lower the cholesterol level, the more healthy an individual is. Second, there are now highly effective drugs that make lowering cholesterol much simpler.

Kenneth Jensen, M.D., internal medicine specialist, Advanced Healthcare "There is no longer any time in a person's life when we stop paying attention to cholesterol."

These drugs, called statins, are particularly useful for seniors, who often have rising cholesterol levels as they age. "There is a 25 to 50 percent reduction in heart attack rates in seniors when cholesterol is lowered to targeted levels. Remarkably, even in those with normal levels, reductions result in increased survival rates," said Dr. Kenneth Jensen, an internal medicine specialist with Advanced Healthcare.

The falling guidelines
In the past a total cholesterol count of 200 or less was considered ideal. Now, physicians are more likely to look at the levels of HDL and LDL cholesterol. The HDL or high density lipoproteins are the "good" cholesterol, protecting the circulatory system. The LDLs, low density lipoproteins, are the "bad" cholesterol, causing narrowing of the arteries, increased blood pressure, heart attack and strokes. The goal today is to increase HDL levels and decrease the LDL ones.

"We used to be satisfied with an LDL level of 130 or less. Now we’ve learned that those under 100 are best so that has become our longterm goal. Similarly an HDL over 40 is good," Dr. Jensen said.

And these levels may fall even further. "In groups of aboriginals and societies where heart disease is rare, the levels are 60 to 70 for LDLs. This might become our ultimate target," he added.

The fountain of youth
In the past, physicians advised patients to follow a diet low in fat to decrease total cholesterol levels and to get more exercise to raise HDLs. While this is still beneficial for many reasons, it only has a moderate effect on cholesterol levels. There were drugs that could help lower cholesterol, but many of these had troubling side effects and were usually prescribed only for those with serious problems.

That changed with the advent of statin drugs. Now specific medications can target different cholesterol problems. The most common statins can lower LDL cholesterol with very little side effects. First touted for those in middle age, they are also remarkably well tolerated by most seniors. "There is no longer any time in a person’s life when we stop paying attention to cholesterol. It’s our closest product to a fountain of youth," Dr. Jensen said.

Statin drugs do have side effects: They may interfere with liver function and can cause muscle pain and weakness (myopathy). "Myopathy rates are about 1 in 200. Liver functions are interfered within about 1 of 50 patients. In all but rare circumstances, these problems go away when the drug is discontinued," Dr. Jensen said.

In addition, when statin drugs are discontinued there is no increased risk to the body. Instead, cholesterol rises to the level it had been at prior to treatment.

Treating high cholesterol in seniors
Physicians sometimes encounter seniors who are reluctant to take a drug for a problem that is causing no symptoms. "I tell my patients that we used to wait until the barn burned down before saying what should have been done. Today we are proactive and keep the fire from starting," Dr. Jensen said.

But statin drugs are not just preventive, they are also beneficial after heart problems develop. Open-heart surgery used to be considered a success if the arteries were still clear after five years. "Now we have people surviving up to 15 years with no problems," Dr. Jensen said.

"After age 40, two-thirds of deaths are due to vascular disease. As we age, almost everyone develops arteriosclerosis. Vascular disease has four to six times the frequency of breast cancers so there is no question that preventive treatment with statin drugs has tremendous benefits," he concluded.

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