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I have many patients with HDL levels over 60. I have been practicing for over 40 years and my experience has shown that the “cardio protective” effect promotes longevity in these patients (including my 96 year old mother). Is a statin recommended in these patients?

  • 2 weeks 4 days
    People with naturally high HDL levels do in many cases come from families that enjoy longevity. But we also know that treating HDL does not seem to give the same sort of protection: not only are current treatments not all that effective for raising HDL but it may be that HDL is not always "the good guy". Right now I don't address HDL directly other than to point out how smoking cessation and exercise can definitely help. But these things of course are important independent of HDL level.

    Statins reduce risk, there is no question. Whether to treat with a statin can be framed with a risk calculator such as Framingham or ASCVD Estimator. If 10-year risk is high, most of us in Cardiology would treat regardless of HDL level. Shared decision making as to how much people prioritize "doing as much as possible to lower risk of MI and stroke" vs "avoiding more medications" is another way to frame the discussion.

    For someone in their 90s where there is a natural high HDL level and a clear family history of longevity, I'm still hard pressed to come up with a reason to not reduce risk, providing the statin dose chosen is tolerable. Freedom from stroke is in my experience the #1 "wish" most people that age would want when discussing cardiovascular risk.