DEAR DR. ROACH: Can you please provide details on which cholesterol numbers to pay attention to? Half of my numbers are in the “good” range, and the other half are in the “bad” range. My total cholesterol is 248 mg/dL, triglycerides is 77, cholesterol/HDL ratio is 2.8, HDL is 88, LDL is 142, and non-HDL is 160. My total cholesterol has been over 200 for the past six years, but so far, my doctor has not prescribed any medication, since my ratio and good cholesterol numbers have been in the good range.

Though, my numbers have been steadily climbing (last year, my total cholesterol was 239, and my ratio was 2.4), and I am starting to get concerned.

I am a 60-year-old female in excellent health. The only medication I currently take is for hypothyroidism. I exercise daily (cycling, yoga, walking, weight-training). I eat decently, but of course, that can always be improved. My weight is in the normal range. — B.H.

ANSWER: If there is one number to look at when deciding whether to take cholesterol medicine, it’s your 10-year risk number. You can estimate this at tinyurl.com/ACC-risk-tool. This tool requires your cholesterol and blood pressure numbers and, together with your age and sex, can estimate your risk of having a heart attack or stroke. The very same cholesterol numbers have a very different interpretation in a 60-year-old woman compared to a 65-year-old man, for example.

The calculator does not consider some very important information, such as your diet and exercise patterns, but it gives a very good starting place to consider treatment. Most authorities recommend medication treatment at a 10-year risk of 7.5%, but some people would want to begin treatment at a lower risk percentage, while some would prefer waiting until their risk is higher.

DEAR DR. ROACH: Each night, I take 81 mg of aspirin for heart attack prevention and an Aleve for arthritis, along with other medications. My daughter said these two should not be taken together, as the effect of each one cancels out the other. — P.A.A.

ANSWER: I always recommend caution when taking an anti-inflammatory medicine like naproxen (Aleve and many others) along with aspirin, because they can predispose patients to stomach ulcers and bleeding in other parts of the body as well.

Recent studies have shown that unless a person’s risk for heart disease is very high, aspirin is more likely to cause problems than prevent them. Aspirin should be taken by nearly everyone who has had a heart attack or blockages in their arteries, as well as most people who have had a stroke, or by people whose doctors have gone over their individual risks and benefits and have recommended that the benefits of aspirin outweigh the risks. People taking aspirin who don’t fit into these groups should revisit its need when they visit their regular doctor or specialist who has been prescribing it.

In people who take aspirin, the use of anti-inflammatory drugs like naproxen, ibuprofen, and others can increase risk of bleeding. Thus, they should be taken only when they are worth the risk and may be best avoided by people at increased risk of bleeding.

Finally, naproxen and similar drugs have a small but real risk of heart attack and stroke, and their use should be minimized as much as possible, especially in people at increased risk for cardiovascular disease. Tylenol and topical anti-inflammatories work well for many people with arthritis symptoms and are generally safer choices.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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