Concerns About Discontinuing Cholesterol Medication in Family Medicine

Concerns Regarding Medications for Hyperlipidemia

Hello, doctor.
I would like to consult about my father.
He visits a family medicine clinic near our home every month, and every three months he receives medication for his three high conditions (hypertension, hyperlipidemia).
However, during his recent visit on March 27, he only received medication for hypertension and not for hyperlipidemia.
The doctor's reasoning was that the lab results from March 27 showed total cholesterol: 150 mg/dL and triglycerides: 132 mg/dL (the report did not include LDL and HDL), which were considered normal, so no medication could be prescribed.
However, I looked at my father's lab results from three months ago on January 2, which showed total cholesterol: 290 mg/dL and triglycerides: 158 mg/dL, both of which were elevated.
Additionally, my father has a history of atherosclerosis and other cardiovascular diseases.
His liver function tests are normal.
I would like to ask if it is reasonable to not prescribe medication simply because the values are normal now, especially considering that they could spike again in three months.

Mr. Hong, 20~29 year old female. Ask Date: 2024/04/04

Dr. Ye Qianyu reply Family Medicine

Hello! The target levels for hyperlipidemia medication are determined based on individual risk factors.
There are also relevant regulations for health insurance coverage.
Typically, if dietary and exercise modifications do not achieve target levels after 3-6 months, medication treatment may be initiated.
For any medication-related concerns, it is best to discuss directly with the prescribing physician.
I will try to interpret this: it may be that your father's initial cholesterol levels were too high, so the doctor started medication to bring it down to a safe level.
After that, dietary and exercise management will be implemented along with monitoring.
Please discuss shared medical decision-making further with the attending physician.

Reply Date: 2024/04/04

More Info

When it comes to managing cholesterol levels, particularly in patients with a history of cardiovascular disease, the decision to discontinue medication should be approached with caution. Your father's situation raises several important considerations regarding the management of cholesterol and the potential risks associated with discontinuing medication.

Firstly, it is essential to understand that cholesterol levels can fluctuate due to various factors, including diet, physical activity, weight changes, and even stress. The fact that your father's total cholesterol was significantly elevated at 290 mg/dL three months ago and then dropped to 150 mg/dL in the latest test is noteworthy. However, it is crucial to consider the context of these numbers. The absence of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels in the recent report is a significant gap, as these values provide a more comprehensive picture of cardiovascular risk. LDL is often referred to as "bad" cholesterol, and high levels can lead to plaque buildup in arteries, increasing the risk of heart disease and stroke. Conversely, HDL is considered "good" cholesterol, as it helps remove LDL from the bloodstream.

Given your father's history of atherosclerosis and cardiovascular disease, the decision to stop cholesterol-lowering medication solely based on a single set of cholesterol values may not be prudent. It is essential to have a complete lipid profile, including LDL and HDL levels, to assess the overall risk accurately. Additionally, the physician should consider other risk factors, such as family history, lifestyle, and any other underlying health conditions.

Furthermore, the management of cholesterol is not solely reliant on medication. Lifestyle modifications play a crucial role in maintaining healthy cholesterol levels. Encouraging your father to adopt a heart-healthy diet, engage in regular physical activity, maintain a healthy weight, and avoid smoking can significantly impact his cholesterol levels and overall cardiovascular health.

If your father’s cholesterol levels were previously high and he has a history of cardiovascular issues, it may be beneficial to discuss the following points with his healthcare provider:
1. Request a Comprehensive Lipid Panel: Ask for a complete lipid profile that includes LDL and HDL levels. This will provide a clearer picture of his cholesterol status.

2. Evaluate Risk Factors: Discuss other cardiovascular risk factors that may warrant the continuation of cholesterol medication, even if current levels appear normal.

3. Consider Medication Alternatives: If there are concerns about the long-term use of current medications, inquire about alternative treatments or lifestyle interventions that could help manage cholesterol levels effectively.

4. Regular Monitoring: Emphasize the importance of regular follow-ups and monitoring of cholesterol levels, especially given the history of atherosclerosis.

5. Patient Education: Ensure that your father understands the importance of adhering to prescribed medications and the potential consequences of discontinuing them without proper medical guidance.

In conclusion, while the physician's decision to withhold cholesterol medication based on a single set of normal cholesterol values may seem reasonable at first glance, it is essential to consider the broader context of your father's health. Engaging in a thorough discussion with his healthcare provider about the implications of discontinuing medication, the need for a complete lipid profile, and the importance of lifestyle modifications will help ensure that your father receives the best possible care for his cardiovascular health.

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