Recent heart cath "totally clean". Have had bad cholesteral values for 25 years. Allergic reactions to all cholesteral meds. With a clean cath and an ef of 70% from and echo, should I even worry about a medication to lower cholesteral?

A . A presumably normal angiogram significantly lowers your risk particularly if you are not having cardiac symptoms. However, some risk remains because the angiogram takes a picture of the inside of the artery. The angiogram does not "see" the wall of the artery where arteriosclerosis takes place but can only identify whether that buidup in the wall is causing obstruction in the arterial tube. In other words, you could be building some plaque in the wall the angiogram does not see. You can see into the wall with certain tests such as special ct calcium scoring but that involves some radiation and only sees hard calcified plaque, not soft plaque. Family history is very important in these situations as well as your age. If your family history is benign and you are old enough to have developed plaque in presence of risk factors, this is a very good sign. You should look at your total cardiac risk including a detailed lipid profile and weigh that risk against the medications. If in doubt, consult the web and consult with a member of the national lipid association for an expert opinion on lipid management.
For . For elevated cholesterol consider optimizing diet, weight, exercise and stress reduction. Avoid saturated fats mostly found in animal product foods. Consider adopting a high fiber vegetarian diet including 2 to 3 grams daily of plant sterols and stanols, found in some fruits, vegetables, nuts and fortified margarines. To assess 10 year risk of a cardiac event, you may consult ncep national cholesterol education program 10 year risk calculator, some limits apply on effectiveness. Consider consulting an internist or allergy and lipid specialists if vascular disease risk is elevated.