DEAR DR. ROACH: I am a 68-year-old female with a more-than-40-year history of extremely high cholesterol (350-411 total). I have not been able to tolerate any kind of statin drug, even if I take CoQ10 with it. Welchol and Zetia had side effects that I couldn’t tolerate either. I am not diabetic, and my blood pressure is generally around 120/80. My total cholesterol is 354, with HDL at 60, triglycerides at 133 and LDL at 269.
Carotid ultrasound, echocardiogram and, finally, a CT scan of my heart were negative for any significant atherosclerosis. My calcium score was 0. My diet is fish, chicken and legumes. How can I have such high cholesterol for over 40 years and have a calcium score of 0? My doctor still insists I take a statin. Why should I take statins for a condition that doesn’t appear to exist? I went to a cardiologist who could not explain how I could have had these numbers for years and not have issues. He agrees that I should take a statin for prevention purposes. Can you shed some light on this? I don’t want to suffer with constant muscle aches and weakness if there is no need to. — Anon.
ANSWER: A cholesterol number of 354 with an LDL of 269 is a clear indication for a statin drug. The odds for not developing heart disease are better with a statin, but some people, even without any medication, will never get heart blockages; some people with cholesterol numbers like yours will never get heart disease. It appears from the many studies you have had that you are one of those who are destined not to, or at least not for quite a few years from now.
The guidelines clearly state that most people like you should be taking a statin, but not everybody fits the guidelines. While it is possible that you still have blockages (blockages with a calcium score of 0 are unlikely, but not impossible), in my opinion, the small possible benefit isn’t worth the side effects you have had. I can say that only because of the three tests you took being negative.
DEAR DR. ROACH: I was hoping that you could answer a quick question. I am a 46-year-old female and have hemochromatosis. I can’t get very good medical care where I live. It’s a small town where I can’t switch doctors, and mine is subpar. Anyway, I just had a blood test, and my ferritin is 39 and my saturation is 0.76. I don’t know if I need a phlebotomy. The doc likes to have me do it when my ferritin is in the 50-75 range. He has NEVER mentioned saturation before. Can you shed some light on this? — A.R.
ANSWER: Hemochromatosis is iron overload caused by the body being unable to reduce iron absorption even when it doesn’t need iron. The high iron saturation is a good test for diagnosing hemochromatosis. However, it’s the ferritin that best approximates total body iron stores.
A large proportion of the body’s iron is located in the red blood cells, so by removing these through phlebotomy (literally, “bloodletting” — usually the blood is donated), iron is taken out of the body. Most experts remove iron through phlebotomy until ferritin levels are below 50. Someone with a ferritin of 39 probably doesn’t need treatment, since the total body iron is nearly normal.
Women who are still menstruating have some degree of protection against iron overload, although it certainly still is possible to develop problems if the iron intake is greater than iron output, in which case phlebotomy is necessary.
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 request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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