Cholesterol Confusion

Q. Do I need to worry about cholesterol now that I am over 65?

A. I wish I had a simple answer to this one, but there isn't a definite yes or no. That’s because most studies on the effects of high cholesterol have been done on younger and middle-aged individuals. For these age groups, there’s no doubt that cholesterol reduction lowers the risk of both heart disease and stroke.

For those 65 and over, the benefits of lowering cholesterol are less certain. Many studies have shown that high cholesterol levels in older individuals increase the risk of heart attack, stroke and coronary heart disease. But other studies have shown no clear health benefit from treatment of high cholesterol with prescription medications.  Furthermore, elderly men who received medical treatment for high cholesterol showed a decreased risk of cardiovascular disease and stroke, though the same benefit was not shown for women. So what do we do?

1. Meet with your healthcare professional to determine your risk factors for heart disease and stroke.

If this information puts you in a higher risk category, then you will need to be concerned about your cholesterol levels. To get you on the road to better health, the beginning of any plan aimed at lowering cholesterol should start with your mouth. Yep, never underestimate the power of a healthy diet. Just look at the lower risk of heart disease and stroke in those individuals who follow the Mediterranean Diet or the Ornish plan. They have lower cholesterol levels, higher HDL levels and a definite decreased risk for heart disease and stroke. If you’re serious about improving your diet, meet with a registered dietician. They can devise a plan that’s right for you.

2. Combine a good diet with a healthy dose of exercise.

If you start moving more—even walking for 30 minutes a day, most days of the week—you can lower your risk of cardiovascular disease. If you are physically challenged, meet with a physical therapist. These highly trained professionals can devise an exercise plan tailored to your abilities.

3. Ask your doctor if you should be taking cholesterol-lowering medication.

Use of medication will depend on your risk of cardiovascular disease, as well as your LDL-cholesterol level. Fortunately, there are many different drug choices available, including the popular drugs known as statins. Your doctor can help determine which medication is best. If you’re over 65 and are taking multiple medications, it is especially important to choose your prescription carefully in order to decrease potential drug-to-drug interactions.

As our population gets older, more and more research is being done on high cholesterol in the elderly. Keep on top of this information by being your own health information specialist. Read, ask questions and take charge of your health. I always like it when a patient takes an active role in their own healthcare: it makes for a better team approach.

Risk Factors

For starters, let’s review some of the risk factors for cardiovascular disease and stroke. It’s important to know which you can control, and which you can't.

Factors you CAN control:

• High blood pressure
• High blood cholesterol and low HDL
• Smoking
• Obesity
• Physical inactivity
• Diabetes
• Excess alcohol
• Diet high in saturated fat, sodium and too many calories
• Too much stress

Factors you CANNOT control: 

• Males are at greater risk, but women catch up after passing through menopause
• Family history of early heart disease
• Age—the older a person is, the greater their risk
• People of African American descent have a higher risk for stroke

Find all articles by Dr. Rob.

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)