People’s Pharmacy: The ongoing controversy over lowering cholesterol

Q. As a nurse for decades, I have seen numerous episodes of negative statin experiences. Most often, the prescribing physician refuses to entertain the possibility of statins as the cause, though when given a doctor-approved “statin holiday,” many patients become pain-free and resume normal activity.

One patient with a total cholesterol level of 98 read your article on the danger of extremely low cholesterol. The physician’s response was: “The lower, the better.” A short time later, the patient died of a hemorrhagic stroke, as your article had warned.

Reactions to statins can ruin lives, even if some doctors refuse to believe the reactions are serious.

A. You have raised one of the most controversial topics in cardiovascular medicine. Most experts are in agreement that lowering LDL cholesterol reduces the risk of ischemic strokes (those caused by blood clots in the brain). But they don’t agree about how using statins to lower LDL cholesterol affects the risk of hemorrhagic strokes (those caused by bleeding in the brain).

The most recent meta-analysis reviewed 33 statin trials (Journal of the American Heart Association, Feb. 20, 2024). The authors reported a small increased relative risk (17%) for bleeding strokes among people taking statins to lower their LDL cholesterol. An accompanying editorial emphasizes that “… the fear of HS (hemorrhagic stroke) risk should not preclude statin use if clinically indicated.”

You can learn more about the pros and cons of statins and other ways of managing cardiovascular risk in our “eGuide to Cholesterol Control & Heart Health.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I’ve had trouble at times with irritation under the breast and in the groin area. Thanks to your website, I found a great remedy – topical milk of magnesia.

I use it as a deodorant, and I think it works better than name-brand deodorants. I just use the hair dryer after applying it, so it doesn’t run. I do the same for the area under my breasts daily. No more irritation!

A. Under-breast rash has a fancy medical name: inframammary intertrigo. It is usually associated with skin folds where sweat can accumulate and encourage the overgrowth of yeast.

Magnesium hydroxide (milk of magnesia) does not stop sweating as antiperspirants do. However, it does control odor if used in the armpits. We suspect that it may alter the balance of microbes on the skin. That might discourage the fungus that causes irritation.

Q. Reading your article about medicines that are risky in hot weather helped me make sense of my experience. I often feel too hot and have trouble with sweating.

Because I have fibromyalgia, chronic pain syndrome and arthritis, I have been taking gabapentin and amitriptyline as well as some other meds. Even in the depths of winter, I can be found with few bedclothes on because I feel too hot! It drives my partner mad as he feels the cold intensely. What do I need to know about these drugs in the summer?

A. Antidepressants like amitriptyline are especially troublesome in hot weather because their anticholinergic activity reduces sweating. That is the primary way the body stays cooler, especially when it is hot and humid. Reducing perspiration makes hot weather riskier.

Please do NOT stop any of your medications suddenly. That could precipitate unpleasant withdrawal symptoms. Your best strategy would be to stay out of the sun and try to keep as cool as possible.

Email Joe and Teresa Graedon via their website: www.PeoplesPharmacy.com.