Dear Dr. Roach: I had a CT calcium scan, and my score was 530. My doctor said that this was high, so he put me on a statin (Lipitor). But it debilitated me with so much muscle pain that I had to stop. I am wondering if there is something other than a statin to help lower cholesterol. My doctor told me to go on the Mediterranean-style diet, then check my numbers again. Last time, my blood pressure was 160/90 mm Hg. I also have a family history of heart disease.
C.S.
I entered your information into a calculator (the MESA score, available at tinyurl.com/MESAscore) and found that you have an approximately 13% risk of having a heart attack, needing a bypass, or dying from heart disease in the next 10 years. This is high enough that treatment to reduce risk is clearly recommended. A statin like Lipitor is usually the first-line treatment, since we have decades of research showing that it reduces heart attack in people at a high risk. Treatment with a statin is expected to reduce your risk to about 10.5%. A Mediterranean-style diet is expected to reduce your risk by another 1% or 2%.
When a person can’t tolerate Lipitor, I usually stop the drug for at least a month, then restart them on a different statin, preferably one with a lower risk of muscle pain. If a person really can’t tolerate any statin, then another option is the new treatment bempedoic acid, which works similarly to a statin but does not affect muscles. Unfortunately, it’s very expensive. Some other options are a PCSK-9 inhibitor, which is also very expensive, or ezetimibe, which isn’t quite as effective, but is better than no treatment at all.
Getting your blood pressure down (ideally below 130 mm Hg) either through lifestyle changes or medication can also reduce your heart disease risk.
Dear Dr. Roach: Your knowledge of medicine seems wide and deep, and your column is certainly helpful. Do you use AI when answering your readers’ questions?
R.L.M.
Thank you. I do a fair amount of research for every question, as medicine is constantly changing. Sometimes what I was taught has been proven to be inaccurate, so it’s a constant challenge to stay on top of the medical literature. I haven’t always been perfect and occasionally print follow-ups to my answers.
The time will come when AI will be very helpful to physicians and patients, but we aren’t quite there yet. I have seen some very strange responses by some of the AI programs that can be potentially misleading. (I am being kind. Recent examples of AI-generated information about putting glue on pizza and the safety of puffball mushrooms are highly problematic.)
This is analogous to the long-standing problem of people using internet searches to find information; not all sources are reliable, and some of my own patients and readers of this column have occasionally relied on incorrect or outdated information.
The computer scientists who are creating these models work hard to ensure that the information used to train the models is correct, but I caution against relying on even the best AI-generated advice until it is confirmed by a trained human being.
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 [email protected]
