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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Tekriwal for taking part in the program.

February: Cholesterol and Heart Disease

Question 1
I have been on coumadin since 1985 due to blood clots in the legs with multiple varicousities. It has been determined that I am Factor 5 positive. I have been on various statin medicines since then. I am currently taking coumadin maintaining an INR of 3.0

I also take Crestor 10mg 1/day and Zetia 10mg 1/day. The last lipid profile I got on 9/21/04 indicated chol 137, tri 160, hdl 36, ldl 69.

I started taking Zetia 8/04. My ldl came down from 116. The hdl has always been the same and the tri have been in the 130 range.

I have never had any heart trouble or high blood pressure. I am now 65 years old and wondering if
a. is my medicine giving me the right results
b. are there tests available to determine if I have potential heart problems.
c. any recommendations for medicine or tests that you can suggest.

a. The medicine is giving you the right results. Without knowing more details about your medical condition, it is difficult to say if you really need to have your cholesterol reduced to this level. Your doctor would be the best person to advise regarding that.

b. There is no single diagnostic test that will tell you about all the diseases that affect the heart. In absence of any symptoms, we usually do not suggest any diagnostic test to determine presence or absence of heart disease.

c. I think your physician would be the best person to suggest any further testing or medication.

Question 2
What is your take on the newly publicized concern over side effect of drugs like lipitor.I have heard that the biggest value is for middle aged men and that there is question as to it's value for women??? I get the feeling from a number of cadiologist that they have not heard enough to feel confident to change.

Cardiovascular disease (heart disease and stroke) is still the number one killer in women. Reducing cholesterol is as important in women as in men. I am not aware of any bad publicity regarding lipitor. Questions have been raised regarding Crestor (one FDA panel member raised on issue regarding Crestor)

Question 3
I would like to know how long stents last if you follow a low fat low cholestrol diet and watch your weight. Also, take your medication.

There are two kinds of stents, Bare Metal Stents and Drug Eluting Stents. A blockage may come back within six to 12 months with Bare Metal Stents in about 20 percent of cases. A blockage may develop with Drug Eluding Stents in less than five percent of cases. After some time, these stents just become a part of your heart.

Question 4
I have terrible numbness in my hands and fingers especially at night when I sleep. It is so bad I don't get any rest. Could heart disease or a blockage cause this problem?

It is unlikely that your problem is due to heart disease or blockage. I think you may have a nerve problem such as neuropathy. Please discuss with your physician.5. Other than prescriptions for cholesterol what over the counter supplements do you recommend for lowering cholesterol?

Proper diet, lots of grain cereal, fibers, non-fat milk, and exercise will reduce your cholesterol by 10-15 percent. Niacin, which is a natural substance, will reduce cholesterol but one needs to take large amounts of it. One small study suggested the cinnamon may also reduce cholesterol but this fact needs to be confirmed. Stopping smoking will increase good cholesterol. Exercise and alcohol in small amounts will increase good cholesterol.

Dr. Tekriwal's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.