For older people at risk, statins still make sense
DEAR DR. ROACH: I am a 79-year-old woman in good physical condition -- a gardener and lap swimmer. The only medication I take is vitamin D. My cholesterol readings for the past few years have shown a total cholesterol of about 200, with HDL 77 and LDL of 105. Is this normal for me? My ratio seems to be favorable. -- J.S.
ANSWER: Your major risk factor for developing symptomatic heart disease is your age. Being female and having a relatively high HDL level are protective; however, depending on your blood pressure reading, your risk of having a heart attack or stroke in the next 10 years is between 20% and 30%. Taking a statin-type medication would be expected to lower your risk to 15% to 24%.
The downsides of taking a statin are small. Most people have no side effects, and the medications are very inexpensive now. It is certainly worth a discussion with your doctor.
For many older people with multiple medical problems, some physicians are cautious about prescribing statins. The evidence of benefit in older patients is limited. However, you seem to be very healthy and are likely to get more benefit from a statin drug than most women your age. A large study is recruiting older patients now to see whether the expected benefits from taking a statin can be proven.
It is entirely your decision, but if I were having a discussion with a patient of my own similar to you, I would recommend a statin drug, such as atorvastatin or rosuvastatin, since the benefits greatly outweigh the risks.
DEAR DR. ROACH: My 35-year-old son died recently of a sepsis infection that quickly overtook his organs within days. While he was in the intensive care unit, tests showed he was born without a spleen, which ultimately resulted in his death. How often is someone born without a spleen? We wish we would have known. -- L.E.E.
ANSWER: I am very sorry to hear about your son.
Sepsis is a complication of serious infection. It's an abnormally exaggerated body response to infection, usually from bacteria. People can die from sepsis very quickly, especially if they have risk factors. Common risk factors include a depressed immune system due to cancer or treatment with medications that suppress the immune system, but not having a spleen is certainly a risk factor. In addition to its job in clearing out old red blood cells, the spleen acts as a kind of master lymph node, where the cells of the immune system interact with each other, improving the body's ability to fight off infection.
Most people without a spleen have had it surgically removed, whether as treatment for a blood disorder or due to trauma. People with sickle cell disease lose their spleen early in life because of progressive damage done by the abnormal blood cells and should be considered to have no functioning spleen.
Congenital asplenia (being born without a spleen) is extremely rare, with estimates of it happening less than one person per million. There is no way you could have known about this unless he had happened to have a scan for some other reason.