Hello. Thank you for your question and welcome to HCM. I understand your concern. Cholesterol levels can vary from clinic to clinic and from country to country. In our clinic, for example, it is considered to be high 220 mg/dL. Anyway, with these figures, combined with the age of 63, I would also recommend starting on a hydroxy-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin, such as atorvastatin, rosuvastatin etc.). In your case, I would start her on atorvastatin 20 mg x 1 tb/d. There are no medications without side effects. This particular group of drugs tend to elevate the liver function enzymes (AST and ALT) in 8-10% of cases. Therefore, one month after she is on the drug, she should be tested for total cholesterol, LDL- and HDL-fraction, and AST and ALT. Also, rhabdomyolysis and myoglobinuria are reported with the use of statins. Although very rare conditions, they are serious complications of statins use. Nevertheless, there is a large number of studies about statin (you can find them for your own curiosity online) that provide sufficient evidence that this is a class of drugs with high benefits in preventing and treating the coronary artery disease and dislipidemia. In our clinic, it is used routinely in these cases. Also, never to forget, some diet and lifestyle changes should be undertaken. She should have a diet poor in salt, rich in fibre (green or dark green leafy vegetables and fruit), none or very little amounts of red or raw meat, more amounts of chicken, other poultry, fish, and alcohol up to a maximum of 30 g ethanol a day (i.e. two beers or a glass of wine). Also, a 60-minute physical activity, such as walking, brisk walking, light jogging, swimming etc., should be performed. In the end, my opinion is that she should also have a cardiac check-up: EKG, echocardiogram and cardiac stress test. Feel free to ask me again. I hope I was helpful with my answer. Best regards.