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DEAR DR. ROACH: I’m a 70-year-old female who had a stress test, echocardiogram and carotid study. I passed all tests. My cholesterol is 173, with my HDL 56, LDL 95.6 and triglycerides 108. My blood pressure is 110/64. The cardiologist put me on 5 mg of Crestor. He feels this will help my numbers. He also has me taking CoQ10 and vitamin D3 in case my legs start aching from the Crestor. I’ve been taking everything now for two weeks, and my legs are starting to ache. Is it really necessary to stay on Crestor? – J.S.
ANSWER: I put all your numbers into the standard risk calculator at www.cvriskcalculator.com, and your risk for heart disease or stroke in the next 10 years is 6.8%. That is in a range where medication therapy is not usually recommended.
Of course, I can’t tell you to stop taking the medication your doctor has recommended. He may know something about you that I don’t. It’s possible you have a less-common risk factor your cardiologist may not have told you about.
Some people with very good cholesterol and blood pressure numbers have high levels of C-reactive protein, for example, which confers an increased risk for heart disease. That’s true even in people with desirable cholesterol levels, and people in that situation would clearly benefit from taking Crestor or a similar medicine. All of these medicines have the risk of muscle aches, although the risk of serious muscle damage is very small.
Nearly everyone can reduce their heart disease risk by having a diet with very little meat but high in vegetables, legumes and nuts, along with whole grains and fruits. Regular moderate exercise is as important as diet. Keeping stress levels low, having good close relationships and sleeping 7-8 hours daily are underappreciated beneficial factors to reduce heart risk as well.
DEAR DR. ROACH: I am 76, female, healthy, do not take any meds and am scheduled for a total knee replacement. During the testing, they made an incidental discovery on the CT scan of “a possible right sided right Hutch diverticulum of the bladder” and “two prominent right external iliac lymph nodes, measuring up to 15 and 13 mm in short axis.”
My surgical team did not respond, and my internist says “do not worry,” with no explanation. I would greatly appreciate your opinion. – L.M.
ANSWER: A Hutch diverticulum is a congenital condition, a small pouch in the wall of the bladder. They are seldom diagnosed in adults. They can be associated with infection and stones, but if you have had no problem with either of those conditions, I would certainly advise against doing anything about it.
The external iliac lymph nodes are structures in the hip, and like all lymph nodes, may enlarge in the presence of infection or inflammation. Yours are definitely enlarged, with less than 8-10 mm considered normal. Although we worry about enlarged lymph nodes as a symptom or sign of cancer, it’s thought to be cancer only about 1% of the time. After you recover from surgery, it may be worth taking another look to see if they have shrunk. If they are persistently enlarged, especially if they are growing, some physicians would recommend a biopsy to be sure it is nothing to worry about.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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