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How young is too young to start taking a statin? My father had a middle cerebral artery (MCA) stroke from a clot from his carotid arteries and was a vegetable for eight years before he died. He had high cholesterol but was always told it was okay because his “good” cholesterol (HDL) was high and his “bad” (LDL) cholesterol was low. I’m in the same boat, and for obvious reasons, I don’t want history to repeat itself.
I asked my GP about starting a statin, and she said I’m too young (I’m 44). When is a reasonable time to start taking statins, and is there any harm in starting early/now?
—MK
It is true that in general, premenopausal women are relatively protected from developing cardiovascular disease. Women’s risk for heart disease and stroke begins to rise about 10 years after menopause and about 10 years later than men. We know the loss of estrogen plays a role in this process, but the existing data does not demonstrate a reduction in cardiovascular risk with hormone therapy.
It is also true that when estrogen levels drop in menopause, low-density lipoprotein (LDL) cholesterol levels rise. It is this LDL cholesterol that statins target. It is likely that statins do more than lower LDL cholesterol, but lowering LDL is the target that we focus on most in prescribing statins for many patients.
We typically avoid prescribing statins in premenopausal women. The reason for this is twofold. First, they are at low risk of developing heart disease, so they are not likely to benefit from taking the statin at that time, and statins can cause liver inflammation and muscle pain in a small number of patients. Second, statins are not safe in pregnancy because a fetus needs cholesterol to grow and develop normally. But there are exceptions to every rule.
Current guidelines recommend that people between the ages of 30 and 79 regardless of gender be treated with statins based on their risk of developing cardiovascular disease. If your risk of developing heart disease or stroke is greater than 10% over the next 10 years, you would benefit from a statin. Some factors, including a family history of early cardiovascular disease — defined as before age 55 in a man or before age 65 in a woman — lower the threshold for treatment to a 10-year risk of 7.5%.
We use evidence-based risk calculators like this one to determine your risk. The calculators take into account your age and gender, whether or not you smoke, how high your cholesterol is, and other risk factors, such as high blood pressure and diabetes. For a 44-year-old, otherwise healthy woman, cholesterol levels would need to be exceedingly high for statin therapy to be indicated.
The upshot: For most premenopausal women, the benefits of statin therapy to prevent cardiovascular disease do not outweigh the risks. Risk calculators can be used to assess individual risk based on age, gender, cholesterol levels, and other health factors.
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No mention of diet? A close relative was told to get cholesterol under control or need statins. She achieved the cholesterol drop through rigorous adherence to a new diet, having been advised by a doctor that vegan marathon runners almost never need statins. Many people can’t or won’t change diets. But I would think it should always be the first thing to try, no?
I know a vegan, long-distance cyclist who had a “widowmaker” heart attack at 35. Sometimes genetics are just genetics.
I highly recommend this person get their lipoprotein a levels checked and have a conversation with a cardiologist, not primary care. They assess cardiovascular disease risk quite differently.