I'm 40 and my cholesterol is 250. My doctor wants to put me on a cholesterol-lowering medication, but I'd rather try and lower my cholesterol through diet and exercise. How long should I try this? And could I harm myself by not taking the medication right away?
Most primary care doctors discuss these same questions with at least one patient every day. Doctors measure cholesterol, blood pressure, and other "numbers" because they help predict heart disease, which is the number one cause of death. But these numbers only estimate your risk for heart disease. After all, you can have a good cholesterol number and still have a heart attack. Or you can have high cholesterol and live to a ripe old age.
When it comes to your health, though, playing the odds makes sense. To understand your odds and answer your question, I need to know more. A total cholesterol of 250 is labeled "high," and is enough to recommend lifestyle changes—frankly, almost everyone could eat better, exercise more, and shed a few pounds. However, doctors almost always use LDL ("bad") cholesterol to decide when and whom to treat with medications.
In addition to LDL cholesterol, doctors also look at risk factors. I know your age, but it's also important to know your gender, family history, blood pressure, tobacco use, and if you have certain conditions like diabetes. If you have risk factors, I'd determine your LDL cholesterol goal by calculating your 10-year chance of having a heart attack. In people with certain conditions, like a past heart attack, doctors don't calculate 10-year risk, as an aggressive goal is set based on medical history alone. In people with no risk factors, the 10-year risk is so low that only the LDL is used. So LDL, risk factors, and 10-year heart attack risks can all be important in making treatment decisions.
If you've had a heart attack, angioplasty, or bypass surgery, you definitely shouldn't wait to use medications. (You should still change your lifestyle.) On the other hand, if your doctor is trying to prevent the first signs of heart disease and you don't have diabetes or other major risks, it may be useful to try lifestyle changes before medication.
In theory, LDL can be lowered by up to 30 percent, but usually doctors only see small reductions. However, a number isn't the only reason to change habits. Losing weight improves how your body handles sugar, insulin, and other factors that may play a role in clogging arteries, even if you don't have diabetes. You might ask your doctor if it is reasonable to see if your lab results and weight improve after three months of a healthy lifestyle. Every doctor would love to see you succeed.
To calculate your 10-year risk, please visit ATP III, a cholesterol-lowering project from the National Institutes of Health. The Centers for Disease Control and Prevention has good cholesterol resources as well.
