Ask the doctor: Should I be taking a statin?
Q. I had a heart attack three years ago at age 78. My doctor started me on lisinopril, carvedilol, and aspirin. My total cholesterol is 190, and my LDL is 128. Should I be taking a statin?
A. Almost everyone who has had a heart attack should be on a statin for life. There are some exceptions, of course, such as individuals whose heart attacks stemmed from unusual causes, like an infection, and those who have had an exceptionally severe problem from taking a statin, like severe skeletal muscle breakdown (called rhabdomyolysis). I recommend that you ask your doctor why you aren't taking a statin; if he or she doesn't know, then you should see a cardiologist.
Even if you fall into one of the no-statin categories, your harmful low-density lipoprotein (LDL) cholesterol is too high. National guidelines recommend that someone like you aim for an LDL under 100. If you can't take a statin to get your LDL down that far, non-statin medications such as niacin and colesevelam (WelChol) can help. You can also try dietary measures, such as using margarine enriched with plant sterols and eating oats and other foods rich in soluble fiber.