Dear Dr. Roach: Last year, I told my doctor that I no longer wanted to take a statin drug. I had read so much about statins and am on meds for cholesterol and high blood pressure. I will be 74 this July, and other than having arthritis in my knees, I am not having problems.
My doctor put me on fenofibrate. I am due for my yearly checkup in a few months and donít really know yet how this is working on my cholesterol. I was wondering what your feelings are about this drug.
Dear R.S.: Iíve written a lot about statins, which have been proven to save lives and reduce heart attacks in people with heart disease and also in some people at higher-than-average risk for heart disease. In contrast, although nonstatin medications reduce cholesterol, they have not been proven to do what they are really intended to do, which is to prevent heart disease and death.
I suspect that medications like fenofibrate do have a small benefit in protecting the heart; however, I would not use them unless the side effects of statins made it impossible to take one. Often, people intolerant of one statin do well on another.
For people at high risk, such as those with previous heart attack or known blockages, I would try a different class of medication. For people at lower risk, I would work on a diet proven to reduce heart disease risk, such as the Mediterranean diet, and encourage regular exercise and use medications such as fenofibrate sparingly or not at all.
Another medication, ezitimibe (Zetia or Ezetrol), also lowers cholesterol but without convincing proof that it lowers heart disease risk. It may be that the mechanism by which statins reduce heart risk is not just through lowering cholesterol.
Dear Dr. Roach: Does high blood pressure cause irregular or abnormal heart rhythms?
Dear P.K.S.: Not usually. In some people with very longstanding high blood pressure, the heart can become dilated ó blown up like a balloon to much more than its normal size. When the heart, particularly the atria (the top chambers), becomes dilated like that, it makes atrial fibrillation more likely.
High blood pressure is very common. Irregular heartbeats are universal ó we all have some every day. It is human nature to associate one problem with another; particularly in this case, since they are both related to the heart. However, itís more likely that the everyday irregularities you may have had without noticing take on new significance with a diagnosis of high blood pressure.
That being said, since it is possible they are related, itís certainly worth an EKG next time you see your internist or cardiologist to make sure you donít have a dangerous heart rhythm.
Sometimes doctors order 24-hour (or longer) EKGs for use at home, which can be correlated with any symptoms of heart irregularities.
Email questions to ToYourGoodHealth@med.cornell.edu.