DEAR DR. ROACH: I’m a wholesome 84-year-old who workouts recurrently, eats meat and dairy sparingly, doesn’t smoke, and has a BMI about 25. (I’m 6 ft, 1 inch tall, at 185 kilos.) My yearly wellness check was wonderful, besides my ldl cholesterol and LDL ranges had been 250 mg/dL and 150 mg/dL, respectively. What is the chance/profit stage of statins for me? — B.B.
ANSWER: We don’t actually know. There haven’t been many research about beginning statins in individuals as previous as you. However, I can let you know that an 84-year-old man has a excessive threat of coronary heart illness just by being 84, even when his ldl cholesterol and blood stress ranges are good. I put your data right into a threat calculator (most of them are solely applicable to the age of 79) with out understanding your blood stress ranges, and the calculator mentioned that you’ve a couple of 20% likelihood of getting a coronary heart assault or stroke within the subsequent 10 years.
Many consultants imagine that statin medicine aren’t fairly as efficient in individuals above 75; nevertheless, as a result of age alone is a threat for coronary heart illness, they nonetheless could get a big profit from statins. My follow is to debate the choices with my sufferers. The advantages in all probability outweigh the dangers in most, and a few of my older sufferers select to begin remedy. My finest guess is that you could possibly scale back your threat from about 20% to 16%. The threat of great uncomfortable side effects is low.
Older adults who produce other severe medical circumstances or take many alternative drugs that might doubtlessly intrude with statins could have much less to realize and extra to lose with statin remedy. I typically suggest statin remedy just for the healthiest of my older sufferers (greater than 75 years previous).
DEAR DR. ROACH: Should an A1C check be run on all wholesome, growing older adults? My blood sugar is often within the regular to high-normal vary, however I’ve by no means had an A1C completed. — Okay.L.
ANSWER: The present advice for the screening of diabetes contains a whole lot of adults. Those who ought to be thought of for testing embrace people who find themselves chubby or overweight and have a number of of the next: a household historical past of diabetes; a high-risk ethnic background (African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders); hypertension or a identified coronary heart illness; low HDL levels of cholesterol or excessive triglyceride counts; a historical past of polycystic ovary syndrome (PCOS); bodily inactivity; and drugs that might predispose sufferers to diabetes.
When I see a excessive, random sugar stage in an individual who’s, in any other case, not in danger, I do suggest a follow-up A1C check, which is way more delicate at making the analysis. Very sometimes, I’ll order a glucose tolerance check, which is essentially the most delicate check at making the analysis of diabetes.
DR. ROACH WRITES: A current column on hormone substitute generated a whole lot of mail. One level I ought to have made clear is that transdermal estrogen patches have a decrease threat of blood clots (with maybe no elevated threat in any respect) and strokes, in comparison with mixture oral hormone substitute with an estrogen and a progestin.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time doable. Readers could e-mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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