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Q I had a mild stroke two years ago, but recovered completely and am now healthy and active. After my stroke, my doctor prescribed a statin medication, even though I don't have heart disease. The medication gives me indigestion. Can I stop it without any problems?

A Statins are used to lower levels of LDL "bad" cholesterol, but they also may help mitigate inflammatory responses and prevent the formation of blood clots. Stroke patients, even those who have no signs of cardiac disease, can benefit from taking statins, which significantly lower the risk of another stroke. A 2007 study of 631 survivors of ischemic stroke, none of whom had heart disease, found that among the 38.9 percent of patients who stopped taking their statins, the risk of dying from a stroke or other cause within a year was double the risk of people who continued their medication. Do not discontinue your medication without speaking with your doctor. If side effects from your statin are a problem, perhaps your doctor can prescribe a lower dose or a different medication for you.

Q Can air pollution cause heart disease? If so, how can I reduce my risk?

A Yes, air pollution contributes to the risk of heart disease. Just as smoking was found to be a strong risk factor for heart disease, and then secondhand smoke was also determined to cause heart problems, now air pollution has been established as a contributor to a wide array of cardiovascular risks, including heart attack and stroke. This is true even for healthy people, though the risks are more substantial in patients who already have some degree of cardiovascular disease. Abnormal heart rhythms are more likely to be triggered when air pollution levels are high. Some studies have found that higher levels increase the risk of blood clots forming in arteries as well as inflammation within arteries. Also, people with chronic lung diseases often have greater difficulty breathing when levels of air pollution are elevated. In many areas, air pollution levels are monitored and reported daily. On days of heavy air pollution, avoid strenuous outdoor physical exercise if possible and exercise indoors instead.

Q I've been diagnosed with gout and told that the elevated level of uric acid that brought it about may also increase my risk of heart attack. Is this true?

A For many years, both gout and elevated levels of uric acid have been prime suspects as risk factors for heart attack. This was confirmed in a large study of approximately 13,000 men that examined the impact of gout and blood uric acid on heart attacks. Alone, each risk factor was associated with only a small increase of the likelihood of a heart attack. Blood uric acid raised heart attack risk by 11 percent and gout by 26 percent, but together they can increase your risk of heart attack. Inflammation is an important contributor to atherosclerotic plaques that lead to heart attacks, and it appears that chronic joint inflammation in people with gout accelerates the development of atherosclerosis. Although decreasing your levels of uric acid has not been proven to reduce the risk of heart attack, it will help avoid attacks of gout. Uric acid levels can be reduced by not overindulging in meats and seafood, which contain purines, substances known to raise uric acid levels, and by limiting alcohol intake.

Q I've just been diagnosed with "muscular rheumatism." Is this a form of arthritis?

A "Muscular theumatism" is not an accepted term in rheumatology, but muscular aches and pains often occur as part of an arthritic condition. In supporting joints that may be inflamed, muscles attempt to "splint" the joint and can get sore. There are diseases, such as polymyositis, that directly attack the muscles, causing muscle inflammation and elevation of enzymes in the blood. This condition is usually treated with prednisone as primary therapy, often in combination with an immunosuppressive agent such as methotrexate or azathioprine (Imuran).
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Publication:Duke Medicine Health News
Date:May 1, 2009
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