Dear doctor, is taking statin drugs effective for people over 75?

Dear Dr. ROACH: I’m a healthy 84-year-old who exercises regularly, eats meat and dairy sparingly, doesn’t smoke, and has a BMI of about 25. (I’m 6’2″ tall and weigh 185 pounds.) My annual health test was excellent except that my cholesterol and LDL levels were 250 mg/dL and 150 mg/dL, respectively. What is the risk-benefit ratio of statins for me? –BB

ANSWER: We don’t really know. There aren’t many studies about taking statins in people your age. However, I can tell you that an 84-year-old man is at high risk of heart disease at just 84 years old, even if his cholesterol and blood pressure levels are good. I entered your information into a risk calculator (most of which are only for age 79) without knowing your blood pressure numbers, and the calculator said that the chances of you having a heart attack or stroke in the next year are at about 20% is 10 years.

Many experts believe that statins are not as effective in people over 75; However, because age alone poses a risk for heart disease, statins may still provide significant benefit. My practice involves discussing options with my patients. In most cases, the benefits probably outweigh the risks, and some of my older patients choose to start the medication. I assume 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 the effectiveness of statins will have less to gain and more to lose from statin therapy. In general, I only recommend statin therapy for the healthiest of my older patients (over 75 years of age).

Dear Dr. ROACH: Should all healthy aging adults have A1C testing? My blood sugar is usually in the normal to high normal range, but I have never had an HbA1C test. — CL

ANSWER: The current recommendation for diabetes screening includes many adults. Consideration for testing should include people who are overweight or obese and have one or more of the following symptoms: family history of diabetes; a high-risk ethnic background (African American, Latino, Native American, Asian American, and Pacific Islander); high blood pressure or a known heart disease; low HDL cholesterol levels or high triglyceride levels; a history of polycystic ovary syndrome (PCOS); physical inactivity; and medications that could predispose patients to diabetes.

If I see high, random sugar levels in a person who is otherwise not at risk, I recommend a follow-up A1C test, which is much more sensitive in making a diagnosis. In rare cases, I will order a glucose tolerance test, the most sensitive test for diagnosing 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 (perhaps no increased risk at all) and stroke than oral hormone replacement therapy with an estrogen and a progestogen.

Dr. Roach regrets that he cannot answer individual letters, but will include them in the column if possible. Readers can email questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.