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Ask the doctors.

I've seen reports about possible memory loss and depression that might be caused by statins. Perhaps people who are more susceptible to depression because of a genetic predisposition, or a previous history of depression, might be more sensitive to medication than others. Any comment?

Questions have lingered about the possible effects of statins on memory and cognition (perceiving, learning, reasoning). As more and more physicians prescribe statins to lower cholesterol aggressively, these concerns have resurfaced. But be reassured: Among the tens of thousands of patients who have been studied over several years, there is no good evidence that statins affect brain function negatively.

In fact, statins appear to reduce the risk of certain types of stroke. And stroke can lead to memory loss or depression. So statins may protect mental abilities and emotional health, not harm them.

Nonetheless, in an individual patient, it's conceivable that any drug might produce an unanticipated side effect. Despite the clean record for statins so far, studies are continuing to examine specifically whether the drugs have any adverse--or beneficial--effect on cognitive function.

I was surprised when my neighbor told me I could buy a device for about $1,500 to shock my heart back to life if it stopped. He said I didn't even need a prescription. If this is true, what risks are there in getting one for my home?

You're right. It's now possible to purchase small, portable defibrillators, like the ones you see more and more frequently in airports and sports arenas, without a prescription. These devices can shock a heart out of ventricular fibrillation, a fast, chaotic heart rate that leads to cardiac arrest. Untreated fibrillation uniformly causes death; defibrillation can save lives. In general, defibrillators are used by medical professionals with at least some training in basic cardiopulmonary resuscitation (CPR) techniques. Assuming that you follow the instructions correctly, you could put a home device to work in an emergency while someone else calls 911.

The major limitation for most people is the cost, and it's a good idea to talk over the purchase with your physician. If you are concerned about being prepared for a cardiac arrest at home, a great first step is to encourage everyone in your household to take a course to learn CPR basics.

My mother in her 90s has had heart disease and received a couple of stents two years ago. Now her legs are very swollen, she's weak, can no longer walk and needs full time nursing care. Her doctor says she has heart failure, but I'm glad to say she's not at all short of breath or particularly uncomfortable. What should we do to help her now?

It sounds as though your mother has probably developed end-stage heart failure. It's possible that another round of stenting, or even bypass surgery, might improve her situation. But it may be best just to continue to treat her with medications to ensure that her breathing remains comfortable and her lungs don't fill up with fluid, a possible complication of heart failure.

Depending on her prognosis, it may also be reasonable to start thinking of end-of-life issues and care. In particular, hospice programs for the terminally ill can be quite helpful to patients with end-stage heart failure, as well as for their families. Hospice care can be delivered at home, and with appropriate nursing support, can ensure that a patient's final days are spent as comfortably as possible.

Heart Advisor Editor-in-Chief Gary S. Francis, M.D., is Head, Section of Clinical Cardiology at The Cleveland Clinic.

Deepak L. Bhatt, M.D., is Associate Director, Cleveland Clinic Cardiovascular Coordinating Center.
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Title Annotation:statins can cause memory loss and depression
Author:Francis, Gary S.; Bhatt, Deepak, L.
Publication:Heart Advisor
Article Type:Brief article
Geographic Code:1USA
Date:Jun 1, 2006
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