Dear Dr. Roach: In your recent column on sleep aids, I noticed that you said nothing about nondrug preparations. Some people find that chamomile helps, as do other herbs.

I have mild Parkinson’s disease with resting tremor in one arm, which makes it harder to fall and stay asleep. My neurologist recommended melatonin as a naturally occurring hormone. At what she calls a low dose (3 mg nightly), it definitely makes a difference, with no side effects that I can see.

B.J.

Dear B.J.: There are many herbal products marketed as treatment for insomnia, but little good evidence that they are useful, and they are not regulated by the Food and Drug Administration. However, most of them are very likely to be safe (the one exception is valerian root, which was shown to have more adverse effects than benefits, and can cause liver damage in some people). A cup of chamomile tea at bedtime has helped many people, anecdotally at least, and certainly is safe. Melatonin is safe, but it helps only a minority of people, in my experience.

However, it still may be worthwhile to try these, as they are safer and less expensive than most prescription drugs, and they may work.

Dear Dr. Roach: I am a male, age 73. I weigh 160 pounds and am 5 feet 10 inches tall. My total cholesterol is 202, triglycerides 44, HDL 69 and LDL 124. I exercise six days a week, jog five miles every day, then lift weights for one hour every day, alternating upper body and lower body. My blood pressure is 128/65 on no medications. My doctor wants to put me on drugs to lower my LDL. I do not want to be on statins. I do not smoke or use any alcohol, and have no history of family heart problems. What should I do?

K.F.

Dear K.F.: There are many risks for heart disease, and looking at your information, readers might guess your risk of heart disease to be low, since your health characteristics are outstanding. However, being a 73-year-old male is itself a significant risk factor. I went to an online risk calculator (I used tools.acc.org/ASCVD-Risk-Estimator/) and found that your risk of a heart attack in the next 10 years is 19.6 percent. The calculator does not take into account your excellent exercise habits, which I believe significantly reduce your heart disease risk; however, 19.6 percent is a fairly high risk. Treatment with a statin would be expected to reduce your risk by 3 to 4 percent, meaning that you have about a 1 in 25 chance of NOT having a heart attack because of taking statins, which do have the risk of side effects.

You should talk through the decision with your doctor, who will want to know why you are averse to taking a statin. Your doctor knows that although your individual benefit from a statin is modest, if doctors can get 25 patients like you to take a statin, one heart attack will be prevented. Remember that people at highest risk for heart disease benefit from statins even if their blood cholesterol is nearly normal.

Ultimately, the decision is yours. You need to feel comfortable with it, whether that means taking the statin or not.

Email questions to ToYourGoodHealth@med.cornell.edu.

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