QUESTION

My doctor wants me to take a statin drug, but I’m concerned about side effects. I’m 63. How can I tell if it’s the right thing to do?

ANSWER

I certainly understand feeling hesitant about taking a pill for the rest of your life. If you’re on the fence about taking a statin, I recommend having a CT scan of your heart to look for calcium buildup in your coronary arteries. The scan will give your coronary artery calcium (CAC) score, an indication of the amount of hardening of the heart arteries (atherosclerosis) you have.

 

When artery-clogging plaque builds up, the body deposits calcium in it. On the CT scan, that calcium shows up very clearly as bright white areas. Your CAC score tells you how much plaque you have in your arteries. More important, the higher your CAC score, the higher your risk of having a heart attack or stroke.

 

Before getting a CAC score, talk to your doctor and discuss how it may affect the decision you make. If the test result isn’t going to change your mind, don’t take the test. For example, some people have a genetic tendency to have super-high cholesterol levels and an independent high risk for heart attacks which, taken together, may make them statin candidates in any case. But if the CAC score might make a difference, get it. Many people who are statin candidates based on their statistical cardiovascular risk would find out that they won’t get the expected benefit from a statin—if they took a CAC test.

 

Many adults will have a CAC score of zero, for example, meaning no evidence of calcium at all. In many cases, someone with a CAC score of zero won’t benefit as much as expected from a statin. On the other hand, I feel that any CAC score above 100 is a strong marker of risk and means that you should consider taking a statin. (A CAC score can go to 400 or higher.)

 

What about a score between 1 and 100? That indicates some calcium—and thus some plaque and cardiovascular risk. The closer you climb toward 100, the greater your risk. It’s not linear, though—a score of 10 means nearly twice the cardiovascular risk of a score of zero.

 

Here’s where age comes in. If you’re 45 years old, a CAC score of even 1 is an indicator that you’re already on a trajectory toward developing plaque in your arteries. Aggressive intervention now, by starting on a statin and making lifestyle changes, could prevent a heart attack or stroke later in life.

 

On the other hand, if you’re in your 70s and have a CAC score of 1, you have below-average risk for your age.

 

If you’re on the fence about whether to take a statin, that might affect your decision.

 

I wouldn’t dissuade a patient from taking a statin—in my opinion the risks are low—but I fully respect patients weighing in on their own care.

 

So ask your doctor to order a coronary CT scan and discuss the results. If your CAC is zero, at your age of 63, you can likely hold off on a statin. Focus on lifestyle changes instead and check for calcium again in four or five years.

 

Getting a heart CT scan is very quick and easy. It’s noninvasive and takes just few minutes. As of now, however, health insurers don’t usually cover the cost. In most large cities, you can have the scan done for about $100 to $200.