Greetings, Dr. Roach I am a healthy 84-year-old with a BMI of approximately 25, who exercises frequently, consumes dairy and meat in moderation, and does not smoke. (I weigh 185 pounds and am 6 feet 1 inch tall.) Except for my cholesterol and LDL values, which were 250 mg/dL and 150 mg/dL, respectively, my annual wellness test was outstanding. How risky and beneficial are statins for me? — B.B.
ANSWER: We’re not entirely sure. Few studies have been conducted on the use of statins in individuals your age. Even though his blood pressure and cholesterol are within normal limits, I can tell you that an 84-year-old man has a high risk of heart disease just by virtue of his age. Without knowing your blood pressure, I entered your information into a risk calculator, which indicated that you have a 20% probability of experiencing a heart attack or stroke within the next ten years. Most risk calculators are only suitable for people aged 79 and up.
Although many specialists think that persons over 75 aren’t as effective with statin medications, they may still benefit much from them because heart disease risk increases with age. I usually talk to my patients about their options. Some of my elderly patients decide to start taking medicine since the advantages most likely exceed the hazards. I would estimate that you could lower your risk from roughly 20% to 16%. There is little chance of severe adverse consequences.
Older persons who take numerous drugs that may conflict with statins or who have other major medical issues will have more to lose and less to gain from statin therapy. Only the healthiest of my elderly patients (those over 75) usually receive my recommendation for statin medication.
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Greetings, Dr. Roach Should all healthy older persons have their A1C levels checked? I’ve never had an A1C, but my blood sugar is typically in the normal to high-normal range. — K.L.
ANSWER: Many adults are covered by the current diabetes screening recommendation. Overweight or obese individuals with one or more of the following conditions should be evaluated for testing: a history of polycystic ovarian syndrome (PCOS); a high-risk ethnic background (African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders); high blood pressure or a known heart disease; low HDL cholesterol levels or high triglyceride counts; physical inactivity; and medications that may predispose patients to diabetes.
I do suggest a follow-up A1C test, which is far more sensitive in diagnosing the condition, when I notice a high, random blood sugar level in someone who is otherwise not at risk. The most sensitive test for diagnosing diabetes is a glucose tolerance test, which I will very rarely order.
DR. ROACH WRITES: There was a lot of correspondence about a recent column about hormone replacement. One thing I should have clarified is that, in comparison to combination oral hormone replacement with an estrogen and a progestin, transdermal estrogen patches had a lower risk of blood clots (perhaps no additional risk at all) and strokes.
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