When it comes to statins, it’s not all in the numbers
Q: I have a question for your column. What is the number of LDL cholesterol that would necessitate taking statins? I am an active 51year-old female and weigh 126 pounds at 5 feet, 2 inches tall. I eat a healthy diet and avoid trans fat. My total cholesterol is 260, LDL is 173 and HDL is 67. I have had high LDL since I was a teenager. My blood pressure is 123/77. My general practitioner prescribed a low-dose statin (Crestor 5 mg). My cardiologist said that statins will lower my cholesterol but that it does not ensure I will be protected from a heart attack or stroke.
I do not want to take the statin. I have two close relatives who took statins. One suffered from Parkinson’s without a family history of the disease. Another developed diabetes and had a heart attack at 66.
I am on no other medication, and my blood pressure is good. Do you agree with my doctor? How risky is it if I don’t take the statin?
M.I.C.
A: Statin drugs like rosuvastatin (Crestor) certainly do lower cholesterol, and they do reduce the risk of a heart attack or stroke. Most experts believe that statins exert benefit both through reduction of LDL cholesterol and through other pathways, not yet precisely identified. However, like all medications, they have a risk of side effects.
Diabetes has been shown to develop more quickly in a person taking a statin drug if they are predisposed to getting diabetes. However, there is no clear association between Parkinson’s disease and statin use — in fact, some studies have shown a decreased risk of developing Parkinson’s disease among statin users.
The benefit of a statin depends on how high the underlying risk is for the person. Although your LDL and total cholesterol numbers are high, you are a 51-year-old woman, with a good blood pressure and a high HDL, so your risk of a heart attack, stroke or death from cardiovascular disease is only 1.4 percent in the next 10 years. I suspect your doctor saw
your high LDL number and got nervous. But given your whole picture, the benefit of a statin at this time for you is negligible. So even a small risk of side effects isn’t worth it.
There isn’t a single LDL number that makes a statin necessary. But very high LDL numbers require a different conversation. The decision depends on how much a person wants to avoid a heart attack and how much they want to avoid taking medications. While there is no magic number for 10-year risk that says when a person should take a statin, a 10-year risk of 7.5 percent is a level that many physicians use to recommend a statin drug for their patients at risk. When risk over 10 percent, the recommendation should be strong.
Most importantly of all, nearly everyone can lower their risk of getting heart disease by improving their lifestyle. Having a healthy body weight and avoiding dietary trans-saturated fat is a good start, but there are many dietary habits that reduce heart disease risk (and many other risks as well). Regular exercise is as important as a healthy diet.
Q: My blood pressure crept up on me, and I went on medication. I had been eating what I thought was a healthy diet to keep my blood pressure in check. My nutritionist suggested to me I back off my handful of almonds daily and check my intake of other foods high in oxalates. Two weeks later, my blood pressure was normal. I stopped taking blood pressure medication, and after four years, my pressure has stayed low-to-normal.
D.
A: Oxalate is a plant-derived chemical present in many foods — such as almonds, but also dark leafy greens such as chard and spinach. A low oxalate diet is often recommended in people with a history of calcium oxalate stones. I could not find definitive proof that oxalates increase blood pressure in people with no history of kidney stones.
A large trial looking at oxalate intake in people with chronic kidney disease showed that those with large amount of oxalate intake had a greater risk of progressing to worse kidney disease, but there was no difference in blood pressure among the different groups. Individual trials showed that some high oxalate foods, such as beetroot juice and green tea, lowered blood pressure in healthy volunteers.
The DASH diet — which is high in fruits, vegetables, legumes and nuts, moderate in low-fat dairy products, and low in animal proteins, refined grains and sweets — has been shown to reduce blood pressure. This is not a low oxalate diet but was compared against a low oxalate diet in people with a history of kidney stones. In the study, those who followed the DASH diet reduced their risk of kidney stones to a greater extent than those who consumed a low oxalate diet, suggesting the dietary effect of oxalate is small.
I’m glad your diet helped you, but since many foods high in oxalate are healthy for other reasons, I wouldn’t recommend a low oxalate diet without a good reason (like stones) or other evidence of benefit, which I don’t find.
Q: At my yearly physical exam, my creatinine was 1.11 (normal range 0.6-0.88). What do I need to do? Is it safe to use Tylenol?
C.C.
A: The higher the creatinine number, the worse the kidney function. However, if you hadn’t eaten or drunk any fluids for a long time before your lab test, that could have made the creatinine go up too. The overall pattern of your creatinine over time needs to be considered. A fast increase is much more concerning than a stable or slowly increasing level.
Most often, in people with a modest elevation in creatinine, nothing needs to be done beyond making sure you aren’t hurting your kidneys. Antiinflammatories
like ibuprofen and naproxen are much more dangerous to your kidneys than Tylenol, which is safe if taken occasionally. However, even Tylenol taken at high doses over many years can itself cause kidney damage. A kidney specialist is the expert who should be consulted if your creatinine keeps going up.
Q: Please advise: Do our bodies “reject” certain foods as we get older? I am a healthy, slender 70-year-old woman on no medications. For several years now, I can’t eat anything made of corn or oats (to name a couple). I get an irritation in my throat and mucus buildup, which drives me crazy! This is not an allergy. I have no other problems. I’ve always been able to eat anything, but there’s a lot that I can’t enjoy anymore. How does this happen? It is me, or is it the food? J.B.
A: I wouldn’t dismiss the possibility of food allergies so quickly. Food allergies have highly variable symptoms, depending on the person and the food they are allergic to. It is possible to have a food allergy with upper airway symptoms, such as throat irritation or nose and sinus symptoms, like nasal mucus without other food allergy symptoms, such as wheezing, skin rash, swelling around the mouth and face, or the most dangerous of all, anaphylaxis. However, it is not common at all to have just the symptoms you describe.
Corn and oats are also not typical food allergens, but they certainly are reported. Having a reaction like you describe to a food you have consumed all your life is also uncommon. A consultation with an allergist would be very reasonable.
Dr. Roach writes: A recent column on RhD incompatibility and hemolytic disease of the newborn contained an embarrassing typo: It’s when the mother is RhD negative and the father is RhD positive that the danger lies, and I wrote it backward. Most people were relatively nice about pointing out this error.
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 Drive, Orlando, FL 32803.