I recently met with a new primary care physician. At the close of the appointment, the doctor ordered a lipid panel to check cholesterol levels. After the results were posted, his nurse called to report that the doctor had prescribed a statin (cholesterol-lowering) drug that he would like me to start right away.
There was no discussion and no further testing.
Total cholesterol: | 285 mg/dL (< 200 mg/dL) |
Triglycerides: | 69 mg/dL (< 150 mg/dL) |
High-density lipoprotein (HDL): | 77 mg/dL (> 40 mg/dL) |
Low-density lipoprotein (LDL): | 194 mg/dL (< 99 mg/dL) |
Cholesterol to HDL ratio: | 3.7 (3.5—5.0) |
I sheepishly admit that I gave the poor nurse an earful. I first inquired as to what other risk factors indicated heart disease risk—and got no response. I then questioned the wisdom of being concerned about heart disease in a patient who received a stage 4 cancer diagnosis in his mid-30s. That’s when the stuttering on the other end of the line began.
The nurse hadn’t read my chart and had zero context for the prescribing of the drug to an actual person with a medical history, instead relaying a doctor’s reaction to a small set of lab numbers. (For the record, I showed the results to my oncologist, who was unconcerned and didn’t encourage taking a statin.)
If my now-fired doctor (or his nurse) had bothered to ask about my medical history, I would have told them that my cholesterol has been elevated my entire adult life. A previous physician deemed it genetic (familial hypercholesterolemia) and not clinically relevant for treatment, provided I had no other signs of or risk factors for heart disease.
A more comprehensive evaluation of heart disease risk could include measuring homocysteine, calcium score, high-sensitivity C-reactive protein, and blood sugar markers, while factoring in other risk factors such as blood pressure, weight, and smoking history. Moreover, the notion of “bad” LDL is heavily nuanced—more on that in a moment.
Together, these numbers are a better predictor of heart disease risk than overall LDL.