Last month I started taking statins because I have furred arteries. My cholesterol level is now 2.5, having fallen from between 4.1 and 4.3 since I started the statins.
I’ve read that people with Alzheimer’s have very low cholesterol, and that people with the highest cholesterol live the longest. Is this correct? I am 81.
David Whittern, Knowle, Bristol.
You have touched on a controversial subject. Yes, there are some people who have high cholesterol levels in old age and remain perfectly healthy. But they are an unusual minority.
For the vast majority of those with high cholesterol, the safest option is to manage this with statins.
Many studies have shown these drugs can reduce the plaque that furs up the arteries and prevent further build-up.
More recently, there is also evidence that they may help reduce inflammation, another factor in heart disease.
Yes, there are some people who have high cholesterol levels in old age and remain perfectly healthy. But they are an unusual minority
It’s true that our bodies need some cholesterol — it plays a role in creating hormones such as testosterone, for instance.
But the conventional view is that, in otherwise healthy people, levels are best kept below a total (i.e. good HDL and bad LDL, as well as other blood fats) of 5 mmol/l (millimoles per litre), with the LDL level below 3 mmol/l.
If a patient has coronary artery disease or has experienced a stroke or heart attack, then the lower the better.
To address your concern about Alzheimer’s, contrary to popular belief, the brain does not require cholesterol for healthy function, and there’s no evidence that a low cholesterol level (whether natural or because of medication) contributes to dementia of any type.
The known risk factors for dementia are high blood pressure, obesity, hearing loss, depression, type 2 diabetes, physical inactivity, smoking, social isolation and low educational achievement.
The latter may be related to the effect on the brain reserve — the brain’s ability to make up for changes caused by disease.
These factors in combination contribute to a third of all cases of dementia. They are largely linked to lifestyle and can be changed.
The known risk factors for dementia are high blood pressure, obesity, hearing loss, depression, type 2 diabetes, physical inactivity, smoking, social isolation and low educational achievement
The biggest risk factor is ageing. Genetics can also play a significant part in two common forms of the disease, Alzheimer’s and frontotemporal lobe dementia. The former affects memory and the latter our judgment in social situations.
The second most common type of the disease — vascular dementia — can be caused by furring of the arteries in the brain. It may lead to memory loss symptoms similar to those experienced in Alzheimer’s.
High cholesterol levels are a major cause of this form of the disease. Lowering cholesterol with effective treatments, such as statins, is critical to minimising the risk and progression of the disease.
I hope that these comments are useful and, combined with confirmation from your GP, will clarify that a higher cholesterol level will not lead to a better outcome.
I’VE suffered with a globus muscle for two years. Medical checks have revealed nothing untoward, but it is so annoying. I have a continuous cough but no reflux or difficulty eating. I would be delighted if you can help.
Mrs Irene Bell, Hawick.
What you describe is a common but poorly understood disorder known as globus sensation, where you feel like you have a lump or tightness in the throat.
The problem accounts for around 4 per cent of referrals to ear, nose and throat clinics.
In most cases, including your own, investigations confirm there is no underlying condition such as gastro-oesophageal reflux disease, where the stomach acid rises back up into the throat and mouth. There are many theories about the cause of globus sensation, ranging from the brain misunderstanding feelings in the oesophagus, through to abnormal functioning of the oesophageal muscle.
Anxiety and other psychological problems can also contribute.
The uncomfortable sensation is invariably worse when swallowing only saliva, but less noticeable with food or drink. Luckily, it is not painful.
When it comes to treatment, low doses of tricyclic antidepressants are helpful in some patients with anxiety, for instance.
However, I think this is unwise at your age (you are 80), as there is an increased risk of side-effects such as lightheadedness, urinary retention, dry mouth, constipation and blurred vision.
Similarly, the anticonvulsant gabapentin was found to be effective in a study involving a small group of patients with this disorder, but the same warning about side-effects applies, as well as a risk of nausea.
Older patients are more prone to experiencing side-effects than younger age groups.
Generally, I tend to avoid prescribing complex medications for a condition which, although annoying, is not dangerous.
Your longer letter mentions that you have also experienced long-term nasal blockage, post-nasal drip (where mucus accumulates at the back of the nose and throat) and a cough.
This suggests to me that you have an inflammatory condition affecting the nasal airway and sinuses. These are typically caused by allergies.
Nasal sprays containing steroids are usually prescribed to treat these. I suggest you discuss this with your GP. I do not believe those symptoms to be the cause of the globus sensation.
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Replies should be taken in a general context and always consult your own GP with any health worries.
In my view… It’s time we stopped circumcising babies
I was shocked by a recent report from Australia of a toddler who died following circumcision.
It’s a story that should act as a warning about the perils of unnecessary surgery. In recent years I have seen more than one patient suffer near fatal pulmonary embolism (a blood clot on the lung) following trivial cosmetic surgery.
Many consider neonatal circumcision a form of genital mutilation, and at the very least it must be regarded as non-essential cosmetic surgery.
There are those who say the procedure lowers the risk of cancer of the penis, yet there’s no suggestion that pre-emptive surgery for male breast cancer in babies is a good idea.
Circumcision was used in pre-history as a way of marking and identifying captured warriors who were then enslaved. It later evolved into a religious or cultural ritual.
The view in modern medicine is that the fundamental right of a child to ‘bodily integrity’ outweighs the parents’ rights, yet the practice continues.
All doctors should champion abandonment of this unnecessary and potentially risky surgery on behalf of boys, just as was achieved for female circumcision.