The only number that is high is your LDL, it should be under 130 plus you have a high HDL which off sets some of the high LDL. It is reasonable to try some lifestyle changes first, ask your doctor what your options are. I would certainly try that before starting statins, but if I could not make any effective change within 6 months I would not hesitate with statins.
I would differ a bit in my analysis of your results.
I would say that both your total cholesterol and LDL are both significantly high compared to what is ideal.
BTW, your TC is high even compared to "normal".
Additionally you must remember that what is "normal" or average in the USA is what leads to heart disease being the #1 killer.
So to aspire to "normal' is to fall into the category that puts you at significant risk.
You should indeed make significant changes in your diet. See what that gets you, then re-evaluate. At that point you might crank down further on your dietary changes or accept getting a statin.
Minor changes in diet will only make minor improvements.
If you take a gradual approach to large changes, then over time,, they won't be that difficult.
Just don't fall into the trap of thinking that a TC of 200 is "protective"
Half the people in the emergency room with heart attacks have "normal" cholesterol. And right now, you are above normal.
The fact that you have low blood pressure, low heart rate, and exercise, does not mean you aren't undergoing buildup in your coronary arteries.
I have a resting heart rate equal to yours. I have blood pressure lower than yours, I have been super active with cardio exercise, and I have a cholesterol lower than yours.... a lot lower. Yet by age 62 I was diagnosed with a blockage.
You have a long way to go to get your cholesterol down to a safe number, yet you can do it quickly if you apply significant changes.
Just stop falling for the trap that fitness and exercise will give you huge protection. I rode my bike over 100 miles a week and still developed a blockage.
Now my diet is radically changed and I also take a statin.... and continue to exercise.
You might read a book that offers you a range of options. From more moderate changes to the more extreme.
By Dean Ornish, called The Spectrum. Lays out the range of changes you might make. He certainly advocates the more extreme, but lays out the steps short of that which also provide protection. You can take your choice or gradually change over time.
Bottom line, I wouldn't feel safe with a TC of 219 over the next 20 years.
His TC/HDL ratio is 4.06 compared to a goal of under 5.0 and his HDL/LDL ratio is .386 compared to a goal of greater than .30, both are considered as good. These being in line makes me think there is time to make some lifestyle changes before jumping on a statin.
Ratios are the true indicators.
Oh, I also certainly think there is no rush to a statin. He could transform his diet over a couple of years to see what happens as he makes more and more changes. I'm a great believer in gradual change as the individual's tastes adjust.
Having said that, the TC/HDL goal of 5.0 is surely not something to take comfort in. My gosh, if your HDL was 55 that means you could have a TC of 275. That would be horrible for many people over 20 years into the future..
Though I don't have the exact statistic right at my fingertips, I believe that half of all heart attacks occur in people with a TC of 200 or less.
By contrast, a TC of 270 seems a very poor goal for a man with a 54 HDL.
The ideal is under 3.5 which would mean him getting to a TC of 189 or less while having a HDL of 54
Everyone is different, but aiming for 189 or less is very possible for many men with dietary change...even without a statin.
I might add, I've always had a TC/HDL ratio of 3.5 or under, without a statin... but I still developed a blockage.
Now my ratio is much lower due to the drug.
We're on the same page, my only point is his HDL is high and offsets much of his high LDL. My personal goals are an LDL under 70 and a TC under 150, so far so good.