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01 Jul 2005

Female, 54 yrs, non-smoker, moderate drinker (red wine), 1.65m, 59 kg, family history of cholestrol, healthy diet (red meat 2-3 x per month). Fasting cholestrol 6.3 LDL 3.8 HDL 1.84. Doctor suggests taking medication which I'm reluctant to do. Is it really necessary? I don't want to jeopordise my health, but would also not like to take drugs if not absolutely necessary. Am on HRT (more than 10 years, which I would also like to stop - Estrofem 2mg per day). No other medication, moderate exercise.
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01 Jan 0001

Dear Jacomina,

Your biggest risk factor is your family history of cholesterol problems. Your total is raised, and whilst your HDL is very good, you are postmenopausal, and now want to stop your HRT. Your weight is admirable, and you are a non-smoker, you exercise and eat sensibly. You can do nothing about your family history, but you can minimise the chances of it causing problems by tackling the one thing you know is not quite right, and that is your cholesterol. If your cholesterol is raised despite the fact that you are eating correctly, then this is your genetics at play – no matter how little cholesterol and fat you consume, you are programmed to make more cholesterol than other people. What I am saying is that diet alone clearly has not brought your cholesterol down to normal limits. Even if your total:HDL ratio is normal or only moderately raised, for you this is still a high risk because of your family history. So it therefore makes sense to me to take some form of cholesterol-lowering agent to control the one factor you can control.

There are many good medications available, with minimal side effects. I do not wish to endorse any particular product, but I can say that there have been excellent results with a substance called ezetimibe.(Marketed as Ezetrol) This will soon be available in combination with a statin, and promises to be the best yet.

On balance, I would advise that you strongly consider a cholesterol-lowering agent, and keep up the good lifestyle habits you are already following. Good luck.

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