Ask The Doctors: April 2015 Women's Edition
Q. My daughter is hooked on yoga and insists I try it. I’m in my late 60s and, like most women my age, am overweight and take a statin for high cholesterol. Frankly, I’m afraid to try yoga. Is it safe?
A. Yoga is a very old practice that has been shown to produce a number of health benefits. There are different types of yoga, and some may be better than others for a woman your age with some cardiovascular risk factors.
Last December, the European Journal of Preventive Cardiology published a review of clinical trials that assessed the benefits of asana-based yoga. Asanas are sitting and standing poses that are held while meditating.
When compared with people who did not participate in any physical activity, yoga participants reduced their LDL cholesterol by 12 mg/dL, increased their HDL by 3 mg/dL, lowered their systolic blood pressure by 5 mm Hg and lost five pounds. These reductions were comparable to what could have been achieved with a traditional cardiovascular exercise such as bicycling. However, asana-based yoga does not require preconditioning and can be comfortably practiced by people with medical conditions that would make a more aerobic form of exercise challenging or impossible.
Should you try yoga? I’d say yes, so long as you avoid bikram yoga, which is conducted in a hot, humid room. Easing into yoga by doing the poses that you can and holding them for as long as you find comfortable will increase flexibility and strength, both of which are vital as you age.
With the potential benefits of reducing your cardiovascular risk factors, yoga might be a wonderful way to improve your health, with a low risk of causing harm. Ideally, yoga can be among a variety of exercises done throughout the week.
Q. My local hospital advertises total-body computed tomography (CT) scans to evaluate the risk of heart attack and stroke. I have diabetes, so I know I’m at risk. Should I get a scan?
A. Several types of CT scans are used in the diagnosis of heart disease.
Coronary CT angiography (CTA) is being evaluated as a noninvasive alternative to coronary angiography. Its pictures clearly reveal the presence and extent of fatty plaques in the arteries with the potential to cause heart attack. At this time, CTA is primarily used to determine whether chest pain is being caused by a blockage in the coronary arteries. Exactly who it should be used on is still being worked out.
CTA can also be used to reveal the extent of calcium deposits in the coronary arteries. This feature, called coronary artery calcium scoring, is an excellent predictor of cardiovascular risk in certain populations.
Whole-body CT scans are another matter. The concept is to identify plaques containing calcium anywhere in the vascular tree. Most older people have such plaques and, unfortunately, there is no way to know whether they are dangerous. For this reason, a whole-body CT scan can produce a lot of useless information that often leads to unnecessary testing and worry.
CT is an excellent diagnostic tool when used appropriately. Each scan delivers a significant amount of radiation, so CT scans should be performed only when necessary.
If you are worried about your cardiovascular risk, talk to your doctor about what you can do to lower it. You will probably receive the same advice you would be given following a whole-body CT scan.
Q. My doctor says there are several cholesterol-lowering drugs, but wants to start me on a statin. Are statins effective in women?
A. Statins are the most powerful cholesterol-lower drug, and they work equally well in men and women. Studies have shown that for every 40 mg/dL reduction in LDL—an achievement that can generally be achieved only with the help of a statin—risk of heart attack, stroke, death from cardiovascular causes and the need for revascularization drop about 20 percent.
While it’s true that women have not been as well represented as men in most clinical trials of statins, a meta-analysis of 27 randomized clinical trials, published in The Lancet in January, found statins reduced the rate of major vascular events and all-cause mortality equally in women and men after one year of treatment.