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Dear Dr. Roach, I am an 82 year old man taking atorvastatin 10 mg a day. My HDL is 85 and my LDL is 46. I've read recently that people with low LDL cholesterol may have an increased risk of hemorrhagic stroke, such as a broken blood vessel. in the brain. Should I be concerned?
G. G.
A stroke is a brain injury that leads to the death of brain cells, with or without symptoms. It can be caused by thrombosis, which is the development of a blood clot in a cerebral blood vessel. by embolus, which is material, usually a clot, entering the brain from another place, especially the heart; or by bleeding from a broken blood vessel in the brain. About 13% of strokes are haemorrhagic.
It is true that people with naturally low cholesterol have a higher risk of hemorrhagic stroke. However, the preponderance of evidence shows that treatment with a statin, such as atorvastatin (Lipitor) that you are taking, does not significantly increase the risk of hemorrhagic stroke. . A review of 31 studies conducted in 2012 showed an increase in bleeding stroke rate of 8%, but the result could have been due to chance. In fact, statins reduced the overall risk of stroke by about 16% and the overall mortality rate by 8%: it was very unlikely that these results were due to chance.
People at high risk of heart attack are often treated with high doses of statin, often with a goal below 70. A very low LDL (less than 70) reduces the risk of future heart attacks in people with high blood pressure. a disease more than LDL levels that are less extreme (less than 100).
Even though the rate of hemorrhagic stroke increases slightly with the taking of a statin such as atorvastatin, reducing rates of stroke, heart attacks and deaths in general makes statins appropriate for people at high risk of heart disease.
I would be more hesitant to use a statin in someone with a history of hemorrhagic stroke, especially someone without risk factors for other types of stroke or heart disease. This decision should be individualized according to competing risks.
The age of 82, by itself, is not a reason for retaining statins, but it is certainly worthwhile to look at how older people are taking medications to determine which ones are still appropriate.
Dear Dr. Roach, My wife is a healthy little woman, 64 years old. She has been terrified by colonoscopy for years because of the preparation. Last July, our primary physician convinced her to do the Cologuard stool test at home. Unfortunately, the result was positive, described as "possible presence of colorectal cancer [CRC] or advanced adenoma [pre-cancer]. A colonoscopy was recommended. My wife tried to do this colonoscopy three times and failed. She is overwhelmed by the preparation in several variants and has trouble drinking a lot of fluids in general. One of the solutions made her nauseous. We will continue to try, but it is possible that she never completes this colonoscopy. What percentage of people who receive positive results from Cologuard have cancer? I have a broken heart!
P.S.
Of those with a positive Cologuard test, about 4% will have colon cancer; 20% will have advanced precancerous lesions (which can turn into cancer fairly quickly); 31% will have non-advanced adenomas (which may still turn into cancer, but not quickly); and 45% will have normal colonoscopies.
She should absolutely have a colonoscopy because her risk is well above that of an average person. There are options of preparation with much less fluid, and her doctor may also consider treatment to relieve nausea.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can e-mail their questions to [email protected]
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