The latest cholesterol levels of a 67-year-old white woman are total cholesterol 350 mg/dL, HDL 150 mg/dL, and LDL 186 mg/dL. In the past, her levels have been total cholesterol 229-290; HDL 120 and up, with one reading of 156; and LDL 106-190. My lab, which has checked and rechecked these values, tells me it has never seen HDLs this high. An older sister has similar cholesterol levels. My patient’s exam findings are within normal limits, including weight, x-ray, and ECG. How would you proceed in this case?
—Justin G. Krause, DO, Arvada, Colo.

Your patient’s HDL levels are in the “lifesaving” range, so why tinker with them? If you lower the LDL levels with statins, you’ll lower the HDL levels as well, perhaps doing more harm than good and exposing her to possible statin side effects. You could have her cut down on saturated fats in the diet, of course; that never hurts. Best bet: Find out what advice her older sister received, and then have the 67-year-old do the same!
—Peter F. Cohn, MD (104-11)

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