At what level should high cholesterol be medicated?

[nmh722]

My husband is an active, trim 34 year-old with a family history of high cholesterol. We had it tested a few years ago as part of a routine physical and I remember that it was high. We just got new results, and his cholesterol is now 241, HDL 61, and LDL 158. We eat lots of fruits, vegetables, nuts, beans, fish, etc. and only have red meat maybe once a week. Should he be on medication? I know one of the side effects of statins is liver damage and, despite his overall healthy diet, he has been a daily drinker for years (average of 3 drinks a night). Is this a concern?

[CCFHeartMD 15]

Hello. It is difficult to give you a complete recommendation without all the information available, but in general a patient like your husband should not be started on medications (e.g. statins) as his good cholesterol is high (HDL) and the bad cholesterol (LDL) is <190. Additional factors that may be important in his case would be history of cigarette smoking, high blood pressure (≥140/90), or family history of premature heart attack (in male first degree relatives <55 years, in female first degree relative <65 years). The diet recommendations will probably depend on the presence of these other risk factors. In terms of the alcohol use, it is always reasonable to decrease the dose as much as possible but not only because of the cholesterol but also because of risk of long term liver damage. So in summary, keep trying to control the bad cholesterol intake (red meat, fried food, junk food, cheess, eggs, butter, bacon, etc) and favor white meats (especially fish), nuts, olive oil, salad, fruits and avocado. Control a lipid panel at most yearly.
Good luck.

[eleaders]

You have described me when I was about the same age.  I am 52 now and have not yet been prescribed any medicine.  My doc continues to tell me I need to increae exercise and watch what I eat.  Last year she told me she may subscribe it this year if there is no change. I have avoided ALL medications to date because often the potential side effects seem a greater risk than the condition they are ment to treat.  One of the side effects I guess I fear most is bleeding (internal and external).  I know both seem to take some time to develop but why start now when it can be put off?  Of course... I am the kind of person who believes I have lead a good life and whenever God says I'm ready who am I to argue.  Good luck