September, the American Heart Association's National Cholesterol Education Month, is a great time to learn more about cholesterol and review the latest guidelines on its management to help prevent cardiovascular disease.
While clinical studies have clearly established that eating a low-fat, low-cholesterol diet is heart healthy - along with regular exercise and not smoking - many questions still remain regarding cholesterol management for seniors.
Types of cholesterol
You've likely heard of "good" and "bad" cholesterol, but these labels make more sense when you understand how the two types work.
Low-density lipoprotein (LDL, or "bad" cholesterol) is the most plentiful type in your body. Structurally, LDL is high in cholesterol and low in protein, and its job is to deliver cholesterol to cells throughout your body, including arterial cells. High-density lipoprotein (HDL, or "good" cholesterol) is low in cholesterol and high in protein. HDL carries excess LDL cholesterol to your liver, where it is broken down and ultimately removed from your bloodstream.
When you get a blood test for cholesterol levels, the results should be reviewed within the context of your entire health history. Some factors to consider include age, sex, family history, smoking status, and other health conditions - especially high blood pressure and diabetes.
Calculate your risk
You and your provider may want to calculate your risk for developing cardiovascular disease by using one of many tools available on the web. One such tool, ASCVD Risk Estimator Plus, was created by the American College of Cardiology for people with no prior history of heart disease.
If your provider thinks you are at risk for heart disease, and you need to bring your cholesterol numbers to healthier levels, the first steps are typically modifying your diet, increasing exercise, managing weight, and sometimes taking medication.
Review your history
Because there is limited research on cholesterol-lowering medicine for older adults, especially adults over age 80, it is important for seniors to review their entire medical history with a provider before deciding whether to take a medication. For instance, if you are at high risk due to diabetes or a prior stroke or heart attack, you will likely need to be more aggressive with the medicine.
To answer the question of whether cholesterol-lowering medicine, particularly statins, can prevent heart disease, disability, and dementia in seniors, the NIH is currently funding a research study called PREVENTABLE (PRagmatic EValuation of EvENTs And Benefits of Lipid-lowering in oldEr adults).
Results from this study, involving over 20,000 seniors, should provide greater insight into the effectiveness of statins in this age group, but for now, the best decision on these medications is made after a detailed conversation with your provider.
By sharing a complete picture of not only your medical history, but also your lifestyle choices and your hopes and plans for the future, you can arrive at the best decision together.