Heart Health: Ask Dr. Zipes

Article excerpt

A noted cardiologist answers your questions.

LOWER IS BETTER

Reader: There is a 1992 news release stating that very low cholesterol levels could be as harmful to your health as high cholesterol levels. Is there any validity to this article? My husband's cardiologist says that this is a "junk article." My husband's total cholesterol reading is 122; HDL is 42 and LDL is 61. He is taking Zocor. Should we be concerned or worried about such a low reading of 122?

Dr. Zipes: At one point, common medical thought was that very low cholesterol could be harmful by causing suicides (affecting brain function), cancers, and other problems. In fact, however, infants and some peoples isolated from modern influences have total cholesterol values of less than 100 mg/dl. More modern studies have disproved those early concepts, and the general thought now is "the lower, the better" for total and LDL cholesterol and the higher the better for HDL cholesterol. Your husband's values are acceptable.

AF AND VALVE PROBLEMS

Reader: I have longstanding atrial fibrillation. In August 2005, when my AF was paroxysmal, my echocardiogram showed some stenosis of the aortic valve and mild insufficiency of the mitral and tricuspid valves with an ejection fraction of 58 percent. My AF became chronic in February 2006. An echocardiogram in August 2006 again showed aortic stenosis as well as moderate mitral regurgitation, severe tricuspid regurgitation, and an ejection fraction of 27 percent. My cardiologist was of the opinion that the lower ejection fraction and worsened valve regurgitation are not due to my AF being chronic during the second test, but to other factors. Your opinion would be appreciated. I am 94 years old.

Dr. Zipes: In your case, it is difficult to know which is the cart or the horse. Atrial fibrillation can increase valvular regurgitation and reduce the ejection fraction, while worsening valve leakage can lead to atrial fibrillation and a reduced ejection fraction. Appropriate treatment can help both the atrial fibrillation and the valve problems.

Maximal medical management would be the first thing to do. If that fails to provide symptomatic improvement, invasive therapy such as valve replacement/repair or ablation of the atrial fibrillation to restore sinus rhythm would probably be next. (It is not likely that drugs would effectively do the latter.) Considering your age, however, I am not certain whether either would be indicated or appropriate. …