Dr. Roach: It’s best to remain on a statin post-stroke
Dear Dr. Roach: I recently had a stroke, and the hospitalist started me on 40 milligrams atorvastatin per day the first day I was in the hospital. My cholesterol was only borderline high with a total of 210. I am 71 years old, no family history of stroke, never smoked, normal blood pressure and not too overweight (6 feet tall, weighing 190 pounds). Four weeks after starting the 40 mg per day, my total cholesterol was 130. Do I need to maintain 40 mg per day, or would it be reasonable to cut back to 10 or 20 mg as a maintenance dose? I am a believer in minimal effective dosing, especially with meds that can have serious untoward side effects, and extra especially when I’m the one taking them.
Fortunately, I recovered to maybe 90% of previous functioning level (balance and left side motor coordination) in a couple of weeks. My total daily medication regimen is the 40 mg atorvastatin and an 81-mg aspirin. I asked my family physician about this, and he kind of paused and said something along the lines of, “Well, your numbers look pretty good so if you’re not having any muscle issues why don’t you simply continue as is.” Not a resounding endorsement nor permission to try a lower dose. I’d like to know what you think.
Dear J.F.: A stroke is the death of brain cells. They can range in severity from asymptomatic to devastating. Strokes are typically the result of ischemia — literally, loss of blood flow. This can be caused by blockages of cholesterol and blood clot in the arteries; by embolus, usually a blood clot coming from somewhere else; or by hemorrhage, which is bleeding inside the brain. Hemorrhagic strokes are generally not treated with statin drugs such as atorvastatin or anti-platelet drugs like aspirin.
Multiple trials have proven that in people who have had an ischemic stroke, statin drugs reduce the risk of a second stroke. This is true even for people with cholesterol results in the normal range. Based on the trial results, high-dose statin drugs (40 mg atorvastatin) are preferred in people who are able to tolerate them. Since you haven’t reported any side effects, I would recommend you continue the high-dose atorvastatin. It is your best chance to prevent a future stroke.
DEAR DR. ROACH: Do you recommend microneedling for skin care?
Dear N.E.: Microneedling is used to help treat cosmetic issues of the skin, such as scarring, including scarring from acne, irregular pigmentation, stretch marks, fine lines and wrinkles, sun damage and other forms of damaged skin.
The damage caused by the needle sets up a healing response in the skin that causes regeneration of skin cells, similar to the mechanism of chemical peels. Approximately 80% to 85% of people are satisfied with the results of the procedure.
Four to six sessions spaced a week apart is the usual regimen, but there are many protocols for microneedling. A session typically takes 20 or so minutes and is not covered by insurance. Risks include temporary pain and redness, but permanent scarring is unlikely. Some people (18% in one study) will get darker skin after the procedure — called post-inflammatory hyperpigmentation — which tends to lighten over time.
I am cautious about cosmetic procedures, and feel it isn’t my place to recommend them. For microneedling, I would say that the risks seem to be low and that most people are satisfied with the results.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.