Q. I take simvastatin, and I am concerned that my cholesterol may be too low (143, HDL 46, LDL 75). My mother died at age 64 from a massive stroke. Somewhere I read that very low cholesterol increases the risk of the bleeding type of stroke. How low is low?

A. Do you know if your mother died of a hemorrhagic (bleeding) or a thrombotic (clotting) stroke? The difference is very important.

Controlling cholesterol levels and keeping blood from forming clots are important strategies in preventing a thrombotic stroke, which is like a heart attack in the brain. But a bleeding stroke, which is less common, is associated with low cholesterol and high blood pressure.

A study presented at the American Heart Association Conference on Stroke demonstrated that men with cholesterol below 180 were at twice the risk of hemorrhagic stroke compared with those at 230 or above.

A Honolulu study many years ago showed that middle-age men with cholesterol below 150 had four times the risk of such a stroke.

There are some physicians who believe that you cannot have too low a golf score or too low a cholesterol level. We beg to disagree. Cholesterol is essential for life. Without it, you would die. It forms the building blocks for crucial hormones like testosterone and estrogen. It is also key to the integrity of cell membranes.

We go into far greater detail about the dangers of too low cholesterol levels in our book, Best Choices From The People’s Pharmacy. In addition, we discuss a great many other ways to reduce the risk of heart disease. They include dozens of non-drug strategies. You can learn more about Best Choices by clicking here.

Do not stop taking simvastatin, but please discuss this issue with your physician. Aiming for a total cholesterol between 180 and 200 may be more desirable than getting it as low as you can.

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  1. Torrence

    I guess I am lucky. I can get generic drugs from a Giant Eagle store in my area at $4.00 for 30 days supply and $10.00 for a 90 day supply. I have to get my wife’s generic meds for her problem at Medco at $20.00 for a 90 day supply. I think that anyone can find a drug store that also sells generic drugs at the same cost as the store I go to. Make sure you look around and see for yourself. GOOD LUCK

  2. peter g.

    I have been using SIMVASTATIN. The cost went from 7.71(30 day supply)to
    41.79. The pharmacy is CVS. I have cancelled my plan B insurance because
    they never paid for any of my prescriptions but collected $45.00 every
    month. I talked to my doctor about this price increase and she suggested
    CRESTOR. When I went to pick up my medication I found out the price was
    My question is: is there a reasonably priced medication to lower cholesterol. My recent blood test showed that my cholesterol is normal but my doctor doesn’t think I should stop the medication.
    sincerely peter g.

  3. Buck

    My cholesterol has been around 100 for a few years now. My Dr says that’s fine. should I worry? HDL 35 LDL 43 Triglycerides 53. I am also type 2 diabetic with an A1C of 6.5. Dr says he has patients that would kill for my lipids. What’s up?

  4. Paul43

    How can anybody come up with a baseline for Cholesterol when everybody is different?

  5. DS

    I worry about a lot of my friends. The Low Fat patrol is hard at work making people fat and unhealthy, and the Low Cholesterol folks are right behind them. When my mother was gravely ill with cirrhosis, the visiting nurse was concerned that she was drinking whole milk instead of low fat! Mother lived another seven years eating butter and using half and half on her cereal. My father never fell ill until taking the “low fat” advice of doctors.

  6. Torrence

    After reading this question and answer I will be asking my doctor what is going on. My cholesterol was just checked and it was 128. And I was told that was excellent. Now, I’m not so sure, but will BE SURE. Thanks for the question and answer.
    The question to ask is what is the optimal range for total cholesterol. We have a full discussion of this very topic in our book, Best Choices From The People’s Pharmacy. In addition, this is what Walter Willett, MD, Dr.P.H., M.P.H. (Chair, Department of Nutrition, Harvard School of Public Health) has said on this topic several years ago during an interview on The People’s Pharmacy:
    “Can you drive the cholesterol too low? That’s been an interesting question around for a long time because a number of studies have shown that at very low cholesterol levels there are increased risks of hemorrhagic stroke, both within this country and also if you go to Japan, where cholesterol levels have been very low.
    “And a lot of people have said AHAH, that’s what we should be aiming for. Their heart disease rates are low. But we forget that in Japan hemorrhagic stroke rates have been extremely high so that total cardiovascular mortality has not been very much different between the United States and Japan. So whether it’s really the low cholesterol that’s the issue has been a big question. But I think there is indeed some basis for real concern even though it’s not been absolutely proven that cholesterol levels can be driven down too low.
    “One hypothesis has been that very low sat fat intake or very low cholesterol intake could be a problem, or very low animal protein intake could be a problem, and indeed within the Nurses Health Study if you look at extreme low sat fat intake or extreme low animal protein intake we did see some risks of hemorrhagic stroke. So it does seem like there is some extreme that may not be so good for us, and particularly if that’s combined with hypertension that very low animal protein very low cholesterol seem to be a potential risk factor.”

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