Relating to beginning a statin, it’s not all within the numbers

Relating to beginning a statin, it’s not all within the numbers

Q: I’ve a query in your column. What’s the variety of LDL ldl cholesterol that

Q: I’ve a query in your column. What’s the variety of LDL ldl cholesterol that might necessitate taking statins? I’m an energetic 51-year-old feminine and weigh 126 kilos at 5 ft, 2 inches tall. I eat a nutritious diet and keep away from trans fats. My complete ldl cholesterol is 260, LDL is 173 and HDL is 67. I’ve had excessive LDL since I used to be an adolescent. My blood stress is 123/77. My common practitioner prescribed a low-dose statin (Crestor 5 mg). My heart specialist mentioned that statins will decrease my ldl cholesterol however that it doesn’t guarantee I will likely be protected against a coronary heart assault or stroke.

I don’t need to take the statin. I’ve two shut family members who took statins. One suffered from Parkinson’s with out a household historical past of the illness. One other developed diabetes and had a coronary heart assault at 66.

I’m on no different remedy, and my blood stress is nice. Do you agree with my physician? How dangerous is it if I don’t take the statin?

M.I.C.

A: Statin medication like rosuvastatin (Crestor) definitely do decrease ldl cholesterol, and so they do scale back the danger of a coronary heart assault or stroke. Most specialists imagine that statins exert profit each via discount of LDL ldl cholesterol and thru different pathways, not but exactly recognized. Nonetheless, like all medicines, they’ve a threat of unwanted effects.

Diabetes has been proven to develop extra shortly in an individual taking a statin drug if they’re predisposed to getting diabetes. Nonetheless, there is no such thing as a clear affiliation between Parkinson’s illness and statin use — in truth, some research have proven a decreased threat of creating Parkinson’s illness amongst statin customers.

The advantage of a statin is dependent upon how excessive the underlying threat is for the individual. Though your LDL and complete ldl cholesterol numbers are excessive, you’re a 51-year-old girl, with an excellent blood stress and a excessive HDL, so your threat of a coronary heart assault, stroke or demise from heart problems is only one.4 % within the subsequent 10 years. I believe your physician noticed your excessive LDL quantity and acquired nervous. However given your entire image, the good thing about a statin at the moment for you is negligible. So even a small threat of unwanted effects isn’t value it.

There isn’t a single LDL quantity that makes a statin mandatory. However very excessive LDL numbers require a unique dialog. The choice is dependent upon how a lot an individual desires to keep away from a coronary heart assault and the way a lot they need to keep away from taking medicines. Whereas there is no such thing as a magic quantity for 10-year threat that claims when an individual ought to take a statin, a 10-year threat of seven.5 % is a degree that many physicians use to suggest a statin drug for his or her sufferers in danger. When threat over 10 %, the advice ought to be sturdy.

Most significantly of all, almost everybody can decrease their threat of getting coronary heart illness by enhancing their life-style. Having a wholesome physique weight and avoiding dietary trans-saturated fats is an efficient begin, however there are various dietary habits that scale back coronary heart illness threat (and plenty of different dangers as effectively). Common train is as essential as a nutritious diet.

Q: My blood stress crept up on me, and I went on remedy. I had been consuming what I believed was a nutritious diet to maintain my blood stress in verify. My nutritionist recommended to me I again off my handful of almonds day by day and verify my consumption of different meals excessive in oxalates. Two weeks later, my blood stress was regular. I ended taking blood stress remedy, and after 4 years, my stress has stayed low-to-normal.

D.

A: Oxalate is a plant-derived chemical current in lots of meals — corresponding to almonds, but in addition darkish leafy greens corresponding to chard and spinach. A low oxalate eating regimen is usually really useful in folks with a historical past of calcium oxalate stones. I couldn’t discover definitive proof that oxalates improve blood stress in folks with no historical past of kidney stones.

A big trial oxalate consumption in folks with persistent kidney illness confirmed that these with great amount of oxalate consumption had a higher threat of progressing to worse kidney illness, however there was no distinction in blood stress among the many completely different teams. Particular person trials confirmed that some excessive oxalate meals, corresponding to beetroot juice and inexperienced tea, lowered blood stress in wholesome volunteers.

The DASH eating regimen — which is excessive in fruits, greens, legumes and nuts, reasonable in low-fat dairy merchandise, and low in animal proteins, refined grains and sweets — has been proven to scale back blood stress. This isn’t a low oxalate eating regimen however was in contrast in opposition to a low oxalate eating regimen in folks with a historical past of kidney stones. Within the research, those that adopted the DASH eating regimen diminished their threat of kidney stones to a higher extent than those that consumed a low oxalate eating regimen, suggesting the dietary impact of oxalate is small.

I’m glad your eating regimen helped you, however since many meals excessive in oxalate are wholesome for different causes, I wouldn’t suggest a low oxalate eating regimen with out a good motive (like stones) or different proof of profit, which I don’t discover.

Q: At my yearly bodily examination, my creatinine was 1.11 (regular vary 0.6-0.88). What do I have to do? Is it secure to make use of Tylenol?

C.C.

A: The upper the creatinine quantity, the more severe the kidney perform. Nonetheless, in case you hadn’t eaten or drunk any fluids for a very long time earlier than your lab take a look at, that would have made the creatinine go up too. The general sample of your creatinine over time must be thought of. A quick improve is far more regarding than a secure or slowly rising degree.

Most frequently, in folks with a modest elevation in creatinine, nothing must be carried out past ensuring you aren’t hurting your kidneys. Anti-inflammatories like ibuprofen and naproxen are far more harmful to your kidneys than Tylenol, which is secure if taken often. Nonetheless, even Tylenol taken at excessive doses over a few years can itself trigger kidney harm. A kidney specialist is the professional who ought to be consulted in case your creatinine retains going up.

Q: Please advise: Do our our bodies “reject” sure meals as we grow old? I’m a wholesome, slender 70-year-old girl on no medicines. For a number of years now, I can’t eat something fabricated from corn or oats (to call a pair). I get an irritation in my throat and mucus buildup, which drives me loopy! This isn’t an allergy. I’ve no different issues. I’ve all the time been in a position to eat something, however there’s lots that I can’t get pleasure from anymore. How does this occur? It’s me, or is it the meals?

J.B.

A: I wouldn’t dismiss the potential for meals allergy symptoms so shortly. Meals allergy symptoms have extremely variable signs, relying on the individual and the meals they’re allergic to. It’s potential to have a meals allergy with higher airway signs, corresponding to throat irritation or nostril and sinus signs, like nasal mucus with out different meals allergy signs, corresponding to wheezing, pores and skin rash, swelling across the mouth and face, or probably the most harmful of all, anaphylaxis. Nonetheless, it’s not widespread in any respect to have simply the signs you describe.

Corn and oats are additionally not typical meals allergens, however they definitely are reported. Having a response such as you describe to a meals you have got consumed all of your life can be unusual. A session with an allergist can be very cheap.

Dr. Roach writes: A current column on RhD incompatibility and hemolytic illness of the new child contained an embarrassing typo: It’s when the mom is RhD detrimental and the daddy is RhD constructive that the hazard lies, and I wrote it backward. Most individuals have been comparatively good about stating this error.

Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column every time potential. Readers might e mail inquiries to [email protected] or ship mail to 628 Virginia Drive, Orlando, FL 32803.