Age and Statins

Question: I am a 34-year-old female with high cholesterol. My only risk factor is genetics. Should I start taking a statin? What research is available on people younger than 50 starting on statins?

Answer:
There is no specific research that exactly addresses your excellent question. To help a 34-year-old female make the decision to start a statin for high cholesterol as her only risk factor, a doctor would want to know details about family history of coronary artery disease, waist size, the cholesterol breakdown, fasting blood sugar, and average blood pressure.

Two or more close relatives with early onset atherosclerosis (plaque buildup in the arteries) increases a person's risk five-fold of developing atherosclerosis, assuming no lifestyle and medical interventions.

Regarding the other measurements that I would request, with a strong family history and very low HDL cholesterol or very high LDL cholesterol, I would be inclined to recommend starting a statin. I also would want to know if the person has features of the metabolic syndrome:

• Waist size greater than 35 inches for women and greater than 40 inches for men;
• Fasting blood sugar greater than 110;
• Fasting triglycerides greater than 150;
• Blood pressure greater than 130/85;
• HDL cholesterol less than 50 in women and less than 40 in men.

Three or more of the above criteria define metabolic syndrome. Combined with a strong family history of coronary heart disease, I would recommend starting a statin at an early age for someone with metabolic syndrome. But weight loss with a healthy hypocaloric diet and vigorous exercise is probably more important.