Roach: Genetic high cholesterol may not need statin
Dear Dr. Roach: I need a second opinion. I was diagnosed with familial hypercholesterolemia about 30 years ago and have gone through about six doctors (ranging from internist to surgeon to general practitioner) during that time. My new doctor, having never treated this condition, is now asking me, “How aggressive do you want to be?” I took niacin for many years in the past, but I discontinued it due to recent findings about its lack of efficacy and potential harm.
I am a female in good health approaching 73; I watch my diet and am a faithful exerciser (five days a week, which currently includes biking 10 miles or walking three miles).
He placed me on a 20-milligram trial dose of Crestor daily. I take no other medications but vitamins (fish oil, calcium plus). I am alarmed by this approach and am confused and uncertain about what to do. The rub is that he showed up wearing blue jeans and sandals.
Dear M.T.: Familial hypercholesterolemia is a genetic condition of high LDL cholesterol, which is present from birth. The disorder can be diagnosed by a genetic test of an abnormal LDL receptor, but it is considered probable in people with high or very high LDL levels and evidence of cholesterol deposits on tendons, called xanthomata, or cholesterol plaques near the eyes, called xanthelasma. Premature coronary artery disease is very likely in true FH. I’m not sure if your diagnosis of FH is correct without knowing whether you have these physical exam findings, which by themselves are not necessarily indicative of a genetic condition.
I put the personal information you provided in your letter into an online calculator and found your risk of a heart attack in the next 10 years is about 3 percent. Readers can do the same at cvdrisk.nhlbi.nih.gov. Based on that number, taking a medication like Crestor or other statin generally would not be recommended.
Other concerns, such as a significant family history, might push me to recommend treatment. If you don’t have a very bad family history for heart disease, and considering your concerns about taking medication, most experts would not recommend medication treatment for you. Ask your doctor how much benefit you could expect from taking the Crestor. His wearing sandals and blue jeans is less important to me than his ability to explain why you should take a medication that appears to me, based only on the information you’ve provided, to have very little benefit.
Dear Dr. Roach: Can drinking tart cherry juice really help my joints feel better?
Dear C.H.: Cherry juice is a traditional remedy for arthritis, and it contains compounds that improve pain and reduce inflammation. A well-done study in 2013 could not prove improvement in symptoms of arthritis compared with a placebo.
Email questions to ToYourGoodHealth@med.cornell.edu.