San Antonio Express-News (Sunday)
Statins good for seniors fighting cholesterol
Dear Dr Roach: You seem to promote statins. How about statins for older people? A recent study from 2017 that appeared to be peer reviewed and well done found “no benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.”
Is this a significant result?
R.B.R. A: I do recommend statin drugs for people at a higher risk for heart disease and stroke but only after a comprehensive look at all of their risk factors. Often, the risk can be lowered by changing lifestyle, especially diet and exercise. Sometimes the risk can be lowered enough that statins are no longer necessary.
Older people had not been the subject of much study until fairly recently. On the one hand, we don't want to treat people without a good reason to expect that the benefits outweigh the risks. On the other hand, older people have a higher risk of developing vascular disease and its complications.
The 2017 study you quote has been upended by more-recent studies. A 2019 review of all available trials showed that older adults with known cardiovascular disease (blockages in arteries) had a large benefit in reduction of heart attack, stroke and need for procedures such as bypass surgery. A 2020 study on veterans with an average age of 81 who did not have heart blockages showed that starting a statin in this older group reduced overall death rates by about 25 percent.
Looking at it another way, about 23 people per thousand per year died from cardiovascular causes on a statin, while 26 people per thousand per year died from cardiovascular causes if they did not take a statin. This study was not a clinical trial. It just looked at whether a person's doctor put them on a statin at an older age.
The higher a person's risk of heart disease, the more value there is to taking a statin. Recent evidence confirms that this remains true even for people over 75.
However, the costs of taking a statin — including the financial cost (much lower than it used to be now many drugs are available as generics), side effects and potential drug interactions — need to be considered.
Dear Dr. Roach: I have some questions about my lab results. My doctor’s office called to say all results were good and everything is fine. However, when I received the printout from the lab, I read several readings that alarmed me, including a hemoglobin A1C of 5.9 percent ( flagged as high) and glucose 114 (again flagged as high). Should my doctor have given me any suggestions to get these results under control through change of diet, etc.? What suggestions do you have?
Anonymous A: These results show you have prediabetes, which means you are at risk for developing diabetes. Prediabetes itself carries additional risk for developing heart disease. The standard of care now is to treat prediabetes, both to reduce cardiovascular risk as well as to prevent progression to overt diabetes. Unfortunately, I think your doctor missed an opportunity to make an intervention that could help your overall health.
As you suggest, diet is a major component of treatment. A visit with a dietitian nutritionist and a diabetes health educator would be the ideal way of giving you personalized recommendations about diet. I can only scratch the surface by saying that you will want to consume very small amounts of simple sugars, such as fruit juices, sugar-sweetened soft drinks, sweet baked goods and candies.
You also want to have no more than modest consumption of processed starches, such as bread, pasta and white rice. When you do consume them, it should be as part of a mixed meal with protein and fat, which slows absorption of the starches that would otherwise be converted rapidly to sugar by the body.
Exercise is just as important as diet. Regular, moderate-intensity exercise helps the body use dietary carbohydrates better, reducing the risk of progression to diabetes. Your exercise goal should be to eventually reach 20-30 minutes a day of moderate exercise. Some people are already way above that, while others may take weeks to safely get to that level of intensity.
Neither exercise nor a proper diet are guarantees against developing diabetes, but the two together are powerful.
Dear Dr. Roach: This is a general question about vaccine reactions. My husband and I both recently had influenza vaccines and shingles second vaccine. Neither of us had a reaction other than a red spot where the injections were done. Does this mean that they weren’t effective? We’re both over 75 and wonder how strong our immune systems are. Should there have been some reaction? J.D.
A: Both the flu vaccine and the shingles vaccine are effective at reducing risk of developing their respective diseases, although neither of them is perfect. Last year, the flu vaccine was about 45 percent effective overall, while Shingrix (the new two-shot vaccine) has greater than 90 percent effectiveness in protecting against shingles, even in people in their 70s.
A vaccine reaction within the first 24 hours often relates to the body's response to the preservatives and stabilizers in the vaccine. A lack of reaction to the vaccine does not mean that your body isn't responding to the key portion of the vaccine, the part that gives immunity to the virus. You should still be protected.
Dear Dr. Roach: We are often instructed to wash our hands with soap. What kind of soap? Does it need to be antibacterial? What about soaps that are sodium lauryl sulfate-free? L.B.
A: I do not recommend antibacterial soaps. The evidence shows they are no better than any other soap. They may also increase resistance, not only to the antibacterial agent in the soap, but to other antibiotics as well.
Hence, the Food and Drug Administration removed the most commonly used antibacterial agents from most soaps and body washes in 2016.
Regular soap is very effective at removing bacteria and viruses from the hands through a mixture of washing them away and the action of the soap on the germs themselves. Some germs, such as the spores of C. diff, are highly resistant to soap, so it's the washing away part that is critical, and that needs time and running water — at least 20-30 seconds.
Sodium lauryl sulfate is a common ingredient in soaps, and is very effective. However, it can be irritating to some people. Fortunately, SLS-free soaps are also effective at removing most germs from the hands.
When handwashing is not practical, alcohol-based antiseptic gel is an alternative in most cases, but not for the C. diff, as mentioned above.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med .cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.