Dr. Roach: Lifestyle changes can benefit heart health of almost everyone
Dear Dr. Roach: I’m a 70-year-old female who had a stress test, echocardiogram and carotid study. I passed all tests. My cholesterol is 173, with my HDL 56, LDL 95.6 and triglycerides 108. My blood pressure is 110/64. The cardiologist put me on 5 mg of Crestor. He feels this will help my numbers. He also has me taking CoQ10 and vitamin D3 in case my legs start aching from the Crestor. I’ve been taking everything now for two weeks, and my legs are starting to ache. Is it really necessary to stay on Crestor?
Dear J.S.: I put all your numbers into the standard risk calculator at www.cvriskcalculator.com, and your risk for heart disease or stroke in the next 10 years is 6.8%. That is in a range where medication therapy is not usually recommended.
Of course, I can’t tell you to stop taking the medication your doctor has recommended. He may know something about you that I don’t. It’s possible you have a less-common risk factor your cardiologist may not have told you about.
Some people with very good cholesterol and blood pressure numbers have high levels of C-reactive protein, for example, which confers an increased risk for heart disease. That’s true even in people with desirable cholesterol levels, and people in that situation would clearly benefit from taking Crestor or a similar medicine. All of these medicines have the risk of muscle aches, although the risk of serious muscle damage is very small.
Nearly everyone can reduce their heart disease risk by having a diet with very little meat but high in vegetables, legumes and nuts, along with whole grains and fruits. Regular moderate exercise is as important as diet. Keeping stress levels low, having good close relationships and sleeping 7-8 hours daily are underappreciated beneficial factors to reduce heart risk as well.
Dear Dr. Roach: When is the best time of day to take things like fish oil, vitamin D3 and calcium supplements?
Dear M.W.R.: There is moderately strong evidence that fish, or fish oils, may reduce the risk of cardiovascular disease. One or two servings a week of oily fish provides about as much benefit as more. For people who don’t want to eat fish but want the benefit, a fish oil supplement daily (of about 1 gram) provides some of the benefit. I recommend taking it with meals to minimize the side effect of “fish burp” and to maximize absorption.
Vitamin D, given to people at risk for deficiency or with proven deficiency, also should be given with meals to improve absorption. Vitamin D is also needed for some people with inability to absorb vitamins properly. I recommend once-daily dosing with the largest meal of the day.
I seldom prescribe calcium supplements anymore. Recent data suggest that vitamin D and calcium together actually increased stroke risk. While vitamin D is important for bone health and is very difficult to get through food, calcium should be consumed as food, not as supplements. In addition to dairy products, many seeds, legumes, almonds and sardines are excellent calcium sources.
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