High Cholesterol and Statins: A Millennial's Guide to Heart Health
Written by Melissa Schenkman, MPH, MSJ
Dr. Garrett Ruth, a cardiologist in South Carolina, shares crucial insights about cholesterol, heart health, and statins for millennials navigating their healthcare journey.
Q: At what age should I start thinking about my cholesterol?
Most people typically get their first lipid panel in their 20s, with the preventative task force recommending a definitive screening in your 30s. However, certain red flags might prompt earlier investigation. Family history is crucial – particularly if you have a sibling who had a heart attack at a young age. Your ethnic background matters too, as some groups like South Asians and Hispanics tend to run higher LDL levels naturally.
Diet and weight are also significant contributors. A poor diet high in saturated fats and being overweight can substantially increase your cardiovascular risk. The key is to have an open discussion with your primary care physician, especially if you have characteristics that might warrant earlier screening.
Q: How does cholesterol change as we age?
Cholesterol is actually important for your body – it helps form cell membranes and produces hormones. However, as you age, significant changes occur. Your low-density lipoprotein (LDL or "bad" cholesterol) tends to increase, while your high-density lipoprotein (HDL or "good" cholesterol) decreases. This happens because the receptors in your body that process LDL become less efficient over time. As these receptors decline, more LDL circulates in your blood, which can lead to plaque deposition in your arteries. It's a gradual process that varies from person to person, but you'll typically start seeing these changes creep in during your 30s and 40s.
Q: Are there specific concerns for women regarding cholesterol?
Estrogen plays a critical protective role in lipid metabolism. As women approach menopause, estrogen levels drop, which directly impacts cholesterol levels. This hormonal change leads to higher LDL levels as you progress through life.
Notably, women who experience early menopause can face up to a two-fold increased risk of cardiovascular disease compared to the general population. While there's no primary treatment specifically targeting this hormonal change, standard recommendations remain consistent: focus on diet, exercise, and regular screenings to manage overall cardiovascular risk.
Q: What is a calcium score test, and when should I consider getting one?
A calcium score is essentially a "tiebreaker" test for patients in the moderate risk range. It's a very low-radiation CT scan that quickly scans your heart to show calcium buildup in coronary arteries. For someone around 40 with generally good health but borderline cholesterol levels, this test can provide crucial insights. If the score is zero, it suggests a lower risk. However, if calcium deposits are detected, it might indicate the need for more aggressive cholesterol management, even at a younger age. The test is quick, relatively inexpensive, and can help make more informed decisions about potential medical interventions.
Q: What are statins, and what misconceptions exist about them?
Statins are widely prescribed but often misunderstood. Common misconceptions include concerns about blood sugar increases, memory loss, and muscle pain. While statins can nominally increase blood sugar levels, they're typically not causing diabetes but might accelerate a diagnosis for someone already on that path.
The FDA's earlier concerns about memory loss have been largely addressed by more recent, higher-quality studies. Muscle pain affects about 10% of patients – typically feeling like you've worked out when you haven't. The key benefits include stabilizing arterial plaque and potentially reducing heart attack risks by making plaque more stable and composed.
Garrett Ruth, MD, FACC, FSCAI, is a cardiologist specializing in comprehensive interventional cardiology care, including treatment for coronary artery disease and acute coronary syndrome. Dr. Ruth earned his medical degree from the University of South Carolina School of Medicine in Columbia and is double board-certified in internal medicine and cardiovascular disease.
He completed his residency and fellowships in cardiology and interventional cardiology at University of Florida Shands Hospital in Gainesville, Florida. He currently practices in Columbia, South Carolina.
Q: When should I consider taking a statin?
The decision to start statin therapy is highly individualized. It's not about immediately prescribing medication but gathering comprehensive data. Doctors look at your overall risk using tools like the American College of Cardiology's risk assessment, which considers factors like age, hypertension, diabetes, smoking, and cholesterol levels. For younger patients, the goal is to avoid unnecessary lifelong medication while still protecting heart health. Additional tests like calcium scoring can help make more informed decisions, especially for those in the moderate risk range.
Q: What about statins and pregnancy?
For women planning families, the approach to statins is clear. They are generally stopped three months before attempting to conceive and throughout pregnancy and breastfeeding. This is due to potential risks of birth defects and cardiac malformations, though research is limited. For most patients, this temporary discontinuation won't significantly impact long-term heart health, as statins are designed for chronic, long-term protection.
Q: What questions should I ask my doctor during annual check-ups?
5 questions to discuss:
Detailed family history of heart disease
Your personal risk factors
Cholesterol levels and trends
Potential need for additional testing (like calcium scoring or ApoB)
Lifestyle modifications to support heart health
Key Takeaway: Your heart health is a journey. Stay informed, have open conversations with your healthcare provider, and focus on prevention through diet, exercise, and regular screenings.
Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult with a healthcare professional for personalized guidance.
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