Better sleep and less stress more effective than vitamins

Dear Dr. Roach: Do you prescribe vitamins or treatments to enhance the immune system?

C.N. I do not. In my opinion, a healthy diet makes a deficiency of a vitamin or mineral severe enough to weaken the immune system unlikely. Stress reduction and good sleep are more important than supplements. Many studies have shown that taking vitamins does not, in general, lead to improvements in prevention of disease, including heart disease, cancer or infections. So I would be more likely to recommend a better diet (especially fresh fruits and vegetables). Many adults have not gotten all the vaccines that are recommended, and these are a huge benefit to your immune system for those bacteria and viruses. Dear Dr. Roach: I am a 56year-old woman who weighs 112 pounds. I am a daily exerciser and nonsmoker, and I consume alcohol only socially. I do have mitral valve prolapse, which causes palpitations, but it has not required any treatment.

My total cholesterol without treatment is 230; my HDL is very good, at 121; my LDL is 106. My cardiologist ran a more comprehensive cholesterol test and found that my Lp(a) is 56, and that concerned him enough that he prescribed a statin. I was reluctant to begin statin treatment, knowing that it was likely to be a lifelong commitment, but I agreed to try 10 milligrams daily of atorvastatin. The medicine gave me heartburn and caused a lot of burping. He prescribed five mg of Crestor, which I just began.

How necessary is it to treat the lipoprotein(a) with a statin? How likely and significant are the side-effects over decades?

Anon. Lipoprotein(a) is a subtype of LDL cholesterol, and it appears to be more likely to cause blockages in the arteries of the heart. A 2009 study of 120,000 participants found the group with the highest levels (top third) of Lp(a) had a 13 per cent increase in risk, compared with the lowest third.

Most cardiologists do not check Lp(a) unless there are blockages or a strong family history of blockages without other cholesterol abnormalities, or in people not responding to standard treatments.

Statin drugs do not reduce Lp(a), but niacin does. However, no study has been able to show that reducing Lp(a) prevents heart attacks. Since data show people at high risk for heart disease benefit from statins, and recent data on niacin suggests it is not helpful in people being treated with statins, your cardiologist is acting reasonably by treating you with a statin. However, the benefit from a statin in you is likely to be low, due to your good overall health and habits.

If a statin is going to cause a problem, it’s usually within the first six to 12 months of treatment, and they are considered safe for long-term use.

Your preferences about taking medication are the most important. But I would not recommend continuing on the statin if it were causing side-effects.