Q: I’ve a query to your column. What’s the variety of LDL ldl cholesterol that might necessitate taking statins? I’m an lively 51-year-old feminine and weigh 126 kilos at 5 toes, 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 a teen. My blood strain is 123/77. My basic 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 wish to take the statin. I’ve two shut relations who took statins. One suffered from Parkinson’s and not using a household historical past of the illness. One other developed diabetes and had a coronary heart assault at 66.
I’m on no different treatment, and my blood strain is nice. Do you agree with my physician? How dangerous is it if I don’t take the statin?
M.I.C.
A: Statin medicine like rosuvastatin (Crestor) actually do decrease ldl cholesterol, they usually do cut back the danger of a coronary heart assault or stroke. Most consultants imagine that statins exert profit each by discount of LDL ldl cholesterol and thru different pathways, not but exactly recognized. Nevertheless, like all medicines, they’ve a danger 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. Nevertheless, there isn’t any clear affiliation between Parkinson’s illness and statin use — the truth is, some research have proven a decreased danger of growing Parkinson’s illness amongst statin customers.
The good thing about a statin will depend on how excessive the underlying danger is for the particular person. Though your LDL and complete ldl cholesterol numbers are excessive, you’re a 51-year-old girl, with a superb blood strain and a excessive HDL, so your danger of a coronary heart assault, stroke or demise from heart problems is only one.4 % within the subsequent 10 years. I think your physician noticed your excessive LDL quantity and received nervous. However given your entire image, the advantage of a statin at the moment for you is negligible. So even a small danger of unwanted effects isn’t value it.
There isn’t a single LDL quantity that makes a statin essential. However very excessive LDL numbers require a special dialog. The choice will depend on how a lot an individual desires to keep away from a coronary heart assault and the way a lot they wish to keep away from taking medicines. Whereas there isn’t any magic quantity for 10-year danger that claims when an individual ought to take a statin, a 10-year danger of seven.5 % is a stage that many physicians use to suggest a statin drug for his or her sufferers in danger. When danger over 10 %, the advice needs to be sturdy.
Most significantly of all, practically everybody can decrease their danger of getting coronary heart illness by bettering their life-style. Having a wholesome physique weight and avoiding dietary trans-saturated fats is an efficient begin, however there are lots of dietary habits that cut back coronary heart illness danger (and plenty of different dangers as nicely). Common train is as necessary as a nutritious diet.
Q: My blood strain crept up on me, and I went on treatment. I had been consuming what I assumed was a nutritious diet to maintain my blood strain in examine. My nutritionist steered to me I again off my handful of almonds day by day and examine my consumption of different meals excessive in oxalates. Two weeks later, my blood strain was regular. I finished taking blood strain treatment, and after 4 years, my strain has stayed low-to-normal.
D.
A: Oxalate is a plant-derived chemical current in lots of meals — comparable to almonds, but in addition darkish leafy greens comparable to chard and spinach. A low oxalate weight loss program is usually advisable in individuals with a historical past of calcium oxalate stones. I couldn’t discover definitive proof that oxalates enhance blood strain in individuals with no historical past of kidney stones.
A big trial oxalate consumption in individuals with continual kidney illness confirmed that these with great amount of oxalate consumption had a better danger of progressing to worse kidney illness, however there was no distinction in blood strain among the many totally different teams. Particular person trials confirmed that some excessive oxalate meals, comparable to beetroot juice and inexperienced tea, lowered blood strain in wholesome volunteers.
The DASH weight loss program — 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 cut back blood strain. This isn’t a low oxalate weight loss program however was in contrast towards a low oxalate weight loss program in individuals with a historical past of kidney stones. Within the examine, those that adopted the DASH weight loss program diminished their danger of kidney stones to a better extent than those that consumed a low oxalate weight loss program, suggesting the dietary impact of oxalate is small.
I’m glad your weight loss program helped you, however since many meals excessive in oxalate are wholesome for different causes, I wouldn’t suggest a low oxalate weight loss program and not using a good purpose (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 must do? Is it secure to make use of Tylenol?
C.C.
A: The upper the creatinine quantity, the more serious the kidney perform. Nevertheless, when you hadn’t eaten or drunk any fluids for a very long time earlier than your lab take a look at, that might have made the creatinine go up too. The general sample of your creatinine over time must be thought-about. A quick enhance is far more regarding than a steady or slowly rising stage.
Most frequently, in individuals with a modest elevation in creatinine, nothing must be accomplished 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 sometimes. Nevertheless, even Tylenol taken at excessive doses over a few years can itself trigger kidney injury. A kidney specialist is the skilled who needs 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 made 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 at all times been capable of eat something, however there’s quite a bit that I can’t take pleasure in anymore. How does this occur? It’s me, or is it the meals?
J.B.
A: I wouldn’t dismiss the potential of meals allergy symptoms so shortly. Meals allergy symptoms have extremely variable signs, relying on the particular person and the meals they’re allergic to. It’s doable to have a meals allergy with higher airway signs, comparable to throat irritation or nostril and sinus signs, like nasal mucus with out different meals allergy signs, comparable to wheezing, pores and skin rash, swelling across the mouth and face, or essentially the most harmful of all, anaphylaxis. Nevertheless, it isn’t widespread in any respect to have simply the signs you describe.
Corn and oats are additionally not typical meals allergens, however they actually are reported. Having a response such as you describe to a meals you may have consumed all of your life can also be unusual. A session with an allergist could be very affordable.
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 unfavorable and the daddy is RhD constructive that the hazard lies, and I wrote it backward. Most individuals had been comparatively good about declaring this error.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column at any time when doable. Readers could e-mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Drive, Orlando, FL 32803.
