No magic number to decide statin drug use
DEAR DR. ROACH: At the end of January, I had my yearly physical, and my doctor recommended that I start taking a statin drug. I am a female, 71 years old and take no prescription drugs now. At the end of the physical the doctor told me that I am “very healthy.”
My cholesterol is 212 with an HDL of 39. My blood pressure is 106/60. I chose to have a heart score screening done for my knowledge. Based on Mesa risk score, I am in the 64th percentile for age, gender and race with a total coronary calcium score of 55.
I really hate to start on a statin. I have never been on a diet, but the day I left her office I began the Mediterranean diet and plan to continue indefinitely. I am very active and get at least 30 minutes of exercise a day. I believe in doing all I can before taking any type of drug.
I would very much value your opinion on this matter. — M.J.G.
ANSWER: The calcium score is a test that uses a CT scan to provide information on a person’s likelihood of developing a heart attack.
It gives complementary prognostic value to the standard risks, such as your age and sex, cholesterol and blood pressure.
Statin drugs reduce risk for developing a heart attack, but should never be used indiscriminately.
The higher the risk of developing heart disease, the greater the value of a statin.
There is no single “magic number” that defines when people should get a statin drug.
A person’s own preferences, and the multiple other risk factors that aren’t considered by the calculators (especially family history, diet, exercise, stress and relationships) affect the decision.
However, the calculators are a place to start. The American Heart Association, American College of Cardiology and others recommend starting statin therapy at a level of 7.5%.
When I put all the information you gave me into the calculator at tinyurl.com/Mesa-risk, I get a 10-year risk of 5.3%. Given your strong desire to avoid medicine, your new diet and your good exercise, I would not recommend a statin drug for you.
DEAR DR. ROACH: I read your recent column on intertrigo (a red rash in moist areas where skin rubs together) and had a suggestion that may be helpful.
I was having radiation therapy for breast cancer and the area under my breast was very sore and inflamed. I bought coiled cotton at a beauty supply shop (plain, not reinforced). I would take a section and triple fold it and place it under the breast. It was such a relief. I still use it in warm weather. If the cotton gets damp or wet, it is simple to change it out.
ANSWER: I appreciate your writing. Keeping the inflamed area dry is an important part of the treatment. Cotton is very absorbent and will keep the skin folds from rubbing against each other. This might help people with intertrigo from many causes, not just in the inflammation related to radiation.
DEAR DR. ROACH: Some 20 years ago, as I was turning 50, a biopsy confirmed prostate cancer. I elected to deal with that through surgery, a radical perineal prostatectomy.
For the following 10 years, follow-up blood tests came back showing PSA at “less than 0.1,” which I interpreted to mean levels below the detectable limit.
About 10 years ago the lab announced that they had improved their methods and would henceforth report PSA in blood as low as 0.01.
Since then, my lab reports for PSA have been in the 0.02-0.04 range. Are there tissues that are not removed during a radical prostatectomy that could produce these low levels of PSA? Or are these some fugitive prostate cancer cells lurking somewhere? — D.A.S.
ANSWER: The term “prostate-specific antigen” isn't exactly correct, because there are other cells in the body that produce PSA at very low levels.
When a PSA level that was previously undetectable after treatment starts rising, it is usually due to recurrence of cancer. However, this doesn’t seem to be the case for you. I suspect the low levels you see now are either due to a small amount of normal prostate tissue left after surgery or other tissues making PSA. Levels below 0.1 ng/mL are of uncertain significance, and the fact that they have stayed low for 10 or more years is good evidence that there has been no recurrence of cancer.