DEAR DOCTOR K: My doctor never recommended statins to me, but he says there are new guidelines, and thinks that I should now start taking one. What do you think of the new statin guidelines?
DEAR READER: The new guidelines make a lot of sense, because we've learned that statins have more effects on the body than just lowering cholesterol.
DEAR DOCTOR K: At my last checkup, my doctor asked if I snore. When I told the doctor that my husband says I snore a lot, the doctor said snoring can be a sign of heart disease, particularly in postmenopausal women. What does snoring have to do with heart disease?
DEAR READER: Snoring is not a sign of heart disease, but it can be a sign of sleep apnea. And people with sleep apnea are at greater risk for heart disease.
DEAR DOCTOR K: I recently had an ECG in preparation for a surgical procedure. The doctor said it showed I'd had a silent heart attack. How could I have had a heart attack and not known about it?
DEAR READER: I know it sounds strange. After all, on television, heart attacks are portrayed in rather dramatic fashion. Typically, you see a person clutching their chest with agonizing pain. This mental image is embedded in our culture. But my colleague, Dr. Deepak Bhatt, a cardiologist at Harvard-affiliated Brigham and Women's Hospital, cites a recent study that is the latest to show that heart attacks often can be "silent."
DEAR DOCTOR K: I heard that fasting will no longer be required before a cholesterol test. Will the results still be as accurate?
DEAR READER: To answer your question, I need to first describe what a "cholesterol test" is. There are three types of cholesterol that typically are measured: LDL ("bad") cholesterol, HDL ("good") cholesterol and total cholesterol (basically, the sum of LDL and HDL). There is a fourth type of fat measured at the same time: triglycerides. Most doctors order all four tests as part of what's called a "lipid (fat) panel."
DEAR DOCTOR K: My doctor thinks my arthritis and heart disease are connected to my psoriasis. Is this possible? I thought psoriasis was a skin condition.
DEAR READER: Psoriasis (pronounced so-RYE-uh-sis) is named for an ancient Greek word meaning an itchy or scaly condition. It is classified as a skin disease, but psoriasis is the result of an immune system abnormality that can cause problems throughout the body.
DEAR DOCTOR K: I'm under a lot of stress in my life. Of course, I don't like that, but what really worries me is that it will affect my heart. Heart disease runs in my family. If stress can lead to heart disease, does reducing stress reduce heart disease risk?
DEAR READER: We often think of the heart and brain as separate from each other, yet these organs are intimately connected. And when your emotions adversely affect your brain, your heart is affected as well.
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.
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Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of the Harvard Health Letter. Learn more »
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