Your Cholesterol Questions—Answered!

Confused about cholesterol? An expert decodes the new guidelines.

Health Monitor Staff
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Cholesterol Questions, Statin
Robert Greenfield, MD

You may have seen some of the headlines yourself last fall: “New Cholesterol Guidelines!” “Do You Need Statins?” “U.S. Doctors Urge Wider Use of Cholesterol Drugs.” And if you read any of the articles, you may be confused about what the new guidelines from the American Heart Association and American College of Cardiology mean to you.

We asked Robert Greenfield, MD, medical director of noninvasive cardiology and cardiac rehabilitation at Orange Coast Memorial Medical Center in Fountain Valley, CA, to answer some common questions.

Q: Do I need a statin?
A: If you fit into one of the following four groups, you may. The guidelines note that the benefits of statins—drugs that lower cholesterol as well as the risk of heart attack and stroke—outweigh the risks for people in these categories:

  • Group 1: People with cardiovascular disease (CVD; that includes peripheral artery disease, or hardening of the arteries in the legs) or anyone who has had a heart attack, stroke, bypass surgery or other heart disease.
  • Group 2: People whose levels of LDL (bad) cholesterol are 190 milligrams per deciliter (mg/dL) or higher.
  • Group 3: People with diabetes between 40 and 75 years old.
  • Group 4: People who have an estimated 10-year risk of cardiovascular disease of 7.5% or higher, based on the “CV Risk Calculator” (available at the American Heart Association site,

This new tool gives a score based on nine risk factors: gender; age; race; total and HDL cholesterol levels; systolic blood pressure; and whether you take blood pressure meds, smoke or have diabetes).

Q: I don’t get it. Why do I need a statin just because I have diabetes? My cholesterol is fine!
A: While the previous cholesterol guidelines were based on achieving certain numbers, the new guidelines take into account a person’s risk for heart attack and stroke. The higher your risk, the more likely you’ll benefit from a statin. Because diabetes—especially when it’s uncontrolled—damages the arteries (as well as raises risk for high blood pressure and stroke), a statin can be very protective.

Q: I don’t have diabetes. In fact, I’m pretty healthy, and my cholesterol is normal! So why is my doctor recommending a statin?
A: It’s likely you’ve fallen into Group 4, according to the new risk calculator. The risk calculator is the most controversial part of the new guidelines—researchers say it seems to be giving higher scores than it should. It sounds as if you feel that way about yourself.

Here’s what I do: If I see a patient who’s reasonably healthy, yet the calculator claims their 10-year risk of CVD is a little over 7.5%, I don’t put them on a statin right away. I tell them to lose five pounds, start exercising and make some healthy diet changes. Six months later, I test them again and then we make a decision about statins. You could suggest a similar strategy with your physician.

March 2014