Women's Heart Advisor October 2012 Issue

Ask The Doctors: October 2012 Women's Edition

Q. I’ve been taking statins to manage my high cholesterol. While my “bad” cholesterol level is improving, I feel really tired most of the time. Is this normal when taking statins?

A. Severe fatigue is not a common side effect of taking statins. However, a recent study from the Archives of Internal Medicine (June 2012) shows that the drug may lead to decreased energy levels.

In a randomized clinical trial, researchers at the University of California at San Diego evaluated 1,016 patients who received either a low-dose statin or placebo. The patients initially reported their energy level and fatigue on exertion at baseline. Six months after the patients started taking statins, the researchers asked if there had been any changes from baseline, rating their changes on a 5-point scale ranging from “much less” to “much more.” The results reported that statins were associated with both decreased energy level and increased fatigue with exertion.

In the study, women in particular had decreased energy when starting statins. These symptoms can improve with time, but it’s important to talk to your doctor if you experience fatigue when taking statins. 

Q. My husband was recently diagnosed with high blood pressure. His doctor says I need to help him change his diet, but he really doesn’t want to give up the foods he loves, like steaks and hamburgers. How important is it that I reduce the amount of red meat in his diet?

A. It is crucial that you help your husband change his diet. Although he may be taking a medication for his high blood pressure, medications are only supplements, not substitutes for a good diet and lifestyle.

There was an interesting study recently in the Archives of Internal Medicine (April 2012) that looked at the diets of 120,000 medical professionals. The research reports findings from observations over 22 years of 37,698 men enrolled in the Health Professionals Follow-up Study and over 28 years of 83,644 women enrolled in the Nurses’ Health Study.

They divided the study into five groups: those who ate read meat 0.22 servings a day and compared those to patients that ate 0.62, 1.01, 1.47 and 2.36 servings of red meat per day. The researchers showed a 1-serving-per-day increase in unprocessed and processed red meat was linked to increased death rate, and increased heart attack, stroke, and cancer death. As expected the death rate increased proportionally to the amount of red meat that was consumed. Those who ate over two servings of red meat per day had a 33 percent increased risk of dying.

Red meat increases cholesterol and because of the way it is prepared increases blood pressure, with both increasing the risk of dying from heart attack and stroke. Also, it increases cancer risk.

There are good ways to find red meat substitutes that are tasty, with many ideas online. Cleveland Clinic’s web site publications, such as the Be Well eNews (http://bit.ly/TyeAJ3) are a good source of information, but there are plenty of other sources out there as well. I think a good way to think about red meat is to use it as an accent, like a spice or condiment, to your meal and not as the main focus of your meal.

Q. I am a 50-year-old woman who just started menopause. Is it true that my risk for heart disease automatically increases while going through menopause, and even more so as I age?

A. The biggest risk factors for heart disease are smoking, family history, diabetes, high blood pressure, and high cholesterol.

The only one risk factor that menopause has an impact on is cholesterol and at times, blood pressure. With menopause, a woman’s bad cholesterol (LDL) levels go up and their good (HDL) cholesterol go down. Women should be thinking about their risk factor for heart disease, not just at menopause and afterwards, but as early as their twenties.

Q. How do you manage female patients with congestive heart failure? I’ve read that natural supplements, such as vitamin E and selenium can be very helpful for this condition—is this true?

A. First of all, vitamin E has never been proven to have beneficial effect on patients with heart disease. In fact, there have been studies that show 400 IU of vitamin E a day can increase your risk of heart failure and death. Because of this, we do not recommend taking vitamin E. As for selenium, most American do not have a selenium deficiency thus taking additional selenium is not helpful for heart failure.