A physically active 47-year-old woman who has no true risk factors for coronary artery disease (CAD) has a total cholesterol of 235 mg/dL, LDL 160 mg/dL, and HDL 53 mg/dL. She has done most of what she can with diet and exercise. While I would start a statin in a man, the literature is confusing in a premenopausal woman. Are statins indicated here?
—Robert Goldstone, MD, Foothill Ranch, Calif.

This is not an uncommon situation, and the literature offers no black or white solutions. We see many premenopausal women with LDLs in the 150-175 range, usually with higher HDLs than this patient. The lower the HDL and the higher the LDL, the more I lean toward low-dose statin therapy. In this case, I would not treat at this time, but I would follow the patient’s lipids at six-month intervals.
—Peter F. Cohn, MD