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Statins Are Best Method To Reduce Heart Risk

Dear Dr. Roach: My husband is 68, and about seven years ago, during a cardiac catheter, doctors found a very small vessel more than half blocked, but it was too small even for a stent. The rest of his vessels looked pretty good. The doctor put him on Zocor and Toprol. His total cholesterol is only about 160, and his LDL and HDL are normal. He is starting to have some slight short-term memory loss, and I have read that statins are noted for this. I would like him to get off that and try more natural things, but his doctor is adamant that he not quit.

Most of the studies that I have read recently are saying that cholesterol is not the cause of heart disease, and that if it is too low, it does cause cognitive problems. What can we do, short of finding another doctor who is more reasonable to listen to our concerns? — L.S.

Answer: You raise three very important points.

First, does someone with fairly minimal blockages in the heart and not very elevated cholesterol benefit from Zocor or other statins? That answer is, clearly, yes. No matter what the cholesterol, if it’s high enough to cause blockages in arteries, it’s too high.

Second, can statins cause memory problems? Also, the answer is absolutely yes, if you look at what people who are taking the medicines say. However, a large study showed no significant memory loss, but subtle loss may not have shown up in that study. Also, different statins may have different effects, and pravastatin, the one in the study, may be least likely to cause memory problems.

Third, is cholesterol the cause of coronary disease? It’s probably only one cause among many, but then, statins have multiple effects, and not just on cholesterol. The take-home point is that statins save lives in people with blockages in their arteries. You should have a very good reason to stop taking them.

I believe strongly that patients (and families) should be able to make their own decisions, even if the doctor thinks it’s not the best choice. There certainly are more natural options, some of which may work, such as red yeast rice and fish oil. However, the best evidence we have is that statins, along with proper diet and exercise, are the best treatment we have to reduce the risk of heart attack and death from heart disease.

Dear Dr. Roach: Can you write about Addison’s disease? — D.L.

Answer: Addison’s disease is an autoimmune condition where the body destroys the cells in the adrenal gland, which is responsible for making cortisone. Cortisone is important for many of the body’s functions. Early on, the symptoms of cortisone deficiency are subtle — fatigue, lightheadedness, low blood pressure. Too-low levels of cortisone can cause what is called an Addisonian crisis during times of stress. Very low blood pressure, vomiting and diarrhea, fever and confusion are common signs. This is an emergency and needs to be treated with cortisone right away. There are few treatments in medicine as effective as giving cortisone to someone with an Addisonian crisis — it’s like watching someone come back to life.

Fortunately, Addison’s disease is rare. It is most commonly diagnosed with a blood test, or by stimulating the adrenal gland with a hormone (ACTH) to see if cortisol levels in the blood go up. People with Addison’s disease need replacement cortisone every day to prevent problems.

Dear Dr. Roach: My friend has been unable to say a word for four weeks. He went to a doctor and is on antibiotics, but they don’t seem to be doing anything. Have you any idea what might be causing it, and the cure? — E.B.

Answer: We are all aware of acute laryngitis, where you can lose your voice, usually for a few days, around the time of a viral respiratory infection. This is caused by swelling in and around the vocal cords, and it’s treated by resting the voice. Chronic laryngitis causes the same symptoms but may last for weeks or even months. Causes of this can include severe acid reflux, infection and voice overuse. However, in my experience, these are far more likely to cause a hoarse voice than complete voice loss.

For voice loss lasting this long, it’s time to find out what’s really going on. A direct look at the vocal cords is a good first step. The best person to see is an ear, nose and throat specialist (ENT). If your friend was a smoker in the past, this information is very important; smoking increases the risk of tumors that can paralyze the vocal cord.