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Ask Dr. Gott 8/27
Doctor cautious with heart patient
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    DEAR DR. GOTT: I am a 76-year-old male. I am 6 feet tall and weigh 175 pounds. My blood pressure ranges from 109 to 125/56 to 68, with a pulse between 44 and 53. I take an 81-miligram aspirin, a 10-milligram lisinopril and a multivitamin every day. I exercise daily by walking, biking or lifting weights.
    Because of an irregular heartbeat, I have had an angiogram, two echocardiograms, multiple EKGs and a stress test in the last five years. My cholesterol level is 171, LDL is 115, HDL is 36 and triglycerides are 102. My doctor wants my LDL below 100 and wants me to start Zocor. I don't agree with him, but I would like your opinion on the situation.
    DEAR READER: You sent a copy of your lab work, which I have reviewed. Everything appears to be within normal limits.
    In the cholesterol situation, I am going to side with you. Your total cholesterol is below 200, your LDL is 115 and should be below 130, the triglycerides are 102 and should be below 150 and your HDL is 36 and should be above 40. You may have some genetic predisposition to high LDL and low HDL cholesterol, but because you are otherwise healthy and exercise daily, this does not appear to be an issue.
    Your doctor is being especially cautious with you because you have an abnormal heart rate, which puts you at an increased risk of stroke. I can understand this position; however, you have expressed your wishes to not take any more medication.
    Because of your age, general well-being and normal labs, I believe you can safely continue as you have, although there is still some risk. I would recommend, if you have not already, making changes to your diet to reduce your intake of salt, fat and cholesterol. Continue to exercise, and try alternative therapies, such as niacin, flaxseed oil or omega-3 oil, to reduce your LDL and increase your HDL.
    Be sure to keep your physician in the loop so he or she can continue to monitor your levels and check your heart to ensure nothing has changed. Keep in mind that your doctor is only looking out for you and that you remain at an increased risk for heart attack and stroke as long as your heart rate is abnormal.
    You do not say whether your physician is a cardiologist. If not, I recommend you have a consultation with a cardiologist. Guidelines may have changed since your last checkup; however, you still have the right to refuse any medical treatment you believe is unnecessary as long as you have full knowledge of the risks you are taking.
    To give you related information, I am sending you a copy of my Health Report "Coronary Artery Disease."
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