DEAR READERS: You've sent me lots of correspondence about the new statin guidelines. Most have come from people whose doctors put them on statins because of the new guidelines. In October 2015, I discussed the new guidelines in two columns and said I'd keep you up-to-date about any important new information.
DEAR DOCTOR K: My right calf starts aching when I exercise. My doctor said she wants to do a test that is like taking my blood pressure in my leg instead of my arm. Does that make any sense?
DEAR READER: I can understand why that seems confusing, but your doctor is right. She is probably worried that the arteries to your right leg have blockages from plaques of atherosclerosis. When you exercise, your leg muscles need more blood; it provides the nutrition they need to work. When blockages prevent your leg muscles from getting the blood they need, they scream in pain.
DEAR DOCTOR K: Despite taking statins, my cholesterol hasn't dropped as low as my doctor would like. I figured he'd put me on the new PCSK9 inhibitors. Instead, he suggested that I stay on my statin, but also take another drug called ezetimibe. What can you tell me about this combination?
DEAR READER: From what you say, I assume your doctor has used the highest dose of the most potent statins before giving up on those drugs. There are very few people whose cholesterol does not drop substantially on statins alone.
DEAR DOCTOR K: I'm at an increased risk for heart attack and stroke. Will the new dietary guidelines help keep my heart healthy?
DEAR READER: In late 2015, the U.S. government issued a new edition of the Dietary Guidelines for Americans. This report helps Americans make healthy food choices. But if you're concerned about having a heart attack or stroke, the advice in the latest update doesn't entirely agree with what many nutrition experts -- as well as the American Heart Association (AHA) -- recommend.
DEAR DOCTOR K: I survived cancer, only to be told that the treatments that saved my life may have increased my risk for cardiovascular disease. What are the risks? And can I minimize them?
DEAR READER: As more people are living longer after a cancer diagnosis, more people are coping with the long-term effects of cancer treatment. Many cancer-suppressing treatments can have undesirable effects, for example, on the heart and blood vessels.
DEAR DOCTOR K: I often experience heart palpitations -- almost every time I'm excited, angry or scared. Is this dangerous to my health?
DEAR READER: The word "palpitations" is used differently by different people. To me, palpitations are simply an awareness of your heart beating. People aren't usually aware of their heart beating. But when it beats unusually forcefully, irregularly or rapidly, you notice the heartbeat.
DEAR DOCTOR K: I'm in my third year of menopause, and my doctor won't prescribe hormone therapy. He says it increases the risk of heart disease. I think I recall that you told another reader that this is not true. Is my doctor right, or are you?
DEAR READER: You won't be surprised to learn that I think I'm right. But in the previous column you refer to, I didn't say exactly what you remember. I said that the effect of hormone therapy (HT) on heart disease depends on a woman's age and how recently she entered menopause. In younger women, in their first six to 10 years after menopause, HT protects against heart disease. In contrast, in older women, HT increases the risk of heart disease. It's called the "age effect."
DEAR DOCTOR K: I have high cholesterol and high blood pressure, so I know I'm at increased risk for heart disease. Should I see a cardiologist?
DEAR READER: For many people, a primary care physician (PCP) can effectively manage standard risk factors for heart disease. Your PCP also will know when you need to see a cardiologist, and can refer you to a particular one.
DEAR DOCTOR K: A test showed a 50 percent blockage in one of my coronary arteries. That sounds pretty bad to me. But the cardiologist said I didn't need an angioplasty and stent. Why?
DEAR READER: Coronary arteries send needed blood to the heart muscle. That blood flow can be blocked by cholesterol-rich plaques of atherosclerosis. When the blockage seriously reduces blood flow, it increases your risk of a heart attack. An angioplasty and stents can be helpful for restoring blood flow, but the procedure is not risk-free.
DEAR DOCTOR K: You've written that fatty fish like salmon are a good source of omega-3 fats. Does it matter whether the salmon is farmed or wild?
DEAR READER: Salmon and other fatty fish certainly are an excellent dietary source of omega-3 fatty acids, which lower the risk of heart disease. Many supermarkets offer both farmed and wild-caught salmon. The two types have noticeably different tastes and textures. Wild-caught also tends to be more expensive.