Is 'good' cholesterol all that good?
DEAR DR. DONOHUE: I have a yearly checkup with a number of blood tests. All has been well for a number of years, except for my HDL cholesterol. I am a 62-year-old woman, and my HDL has hovered around 39. I watch my diet carefully, exercise daily and have taken and am still taking niacin, but the HDL refuses to budge. My total cholesterol and LDL cholesterol are fine. What should I do? -- L.Y.
ANSWER: HDL cholesterol is the so-called good cholesterol. It's believed to remove cholesterol from the walls of arteries and take it to the liver for disposal. For women, HDL cholesterol ought to be 50 mg/dL (1.3 mmol/L) or higher. For men, the target is 40 (1.04) or higher.
British researchers have punctured the HDL balloon. They say that HDL cholesterol doesn't protect the heart and that its benefits have been greatly overblown.
HDL is a complicated substance, composed of a variety of components, each having different and often opposing effects. The full extent of how it figures into artery-hardening and heart disease hasn't been completely explained.
If you were my patient, I'd tell you to forget your HDL cholesterol. You've done everything you can to raise it, but it hasn't budged. More importantly, your total cholesterol and bad cholesterol, LDL cholesterol, are at favorable levels. The main attention should be directed to these cholesterol components. If your doctor hasn't said you need to be strict about HDL cholesterol, don't pay so much attention to it.
The booklet on cholesterol details its effect on the body and the heart. It does not contain this information on HDL cholesterol, however. To order a copy, write: Dr. Donohue -- No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: In regard to the person who had a cough for a long period of time, I also had a cough for months. When I saw my doctor, he said it was due to my medicine. He took me off lisinopril, and the coughing stopped. -- S.K.
ANSWER: Lisinopril (Zestril) is an ACE (angiotensin-converting enzyme) inhibitor. Medicines of this family are popular and effective blood-pressure-lowering drugs. All of them can cause a cough that starts within a week of beginning the ACE inhibitor. It resolves fairly quickly on stopping the medicine. I took an ACE inhibitor as part of a study. I developed a cough that kept me awake at night. I had to quit that study.
Other ACE inhibitors are Lotensin (benazepril), Capoten (captopril), Vasotec (enalapril), Monopril (fosinopril), Aceon (perindopril), Univasc (moexipril), Accupril (quinapril), Altace (ramipril) and Mavik (trandolapril).
DEAR DR. DONOHUE: I had a persistent cough. My primary-care physician thought I was allergic to Old Spice aftershave lotion, so my husband stopped using it, to no avail. Then she thought it might be acid reflux, and put me on medicine that did nothing.
She sent me to a specialist, who took chest X-rays and all that good stuff. He gave me a cough medicine with a tiny bit of codeine in it. He said my cough would stop shortly. It didn't. He sent me to an ear, nose and throat doctor. The first question he asked was what the humidity of our house was. It runs around 40 percent to 45 percent. He told me to get it up to 50 percent to 75 percent. We did, and my cough left in four days. It took three years and four doctors before I learned what was really wrong. I hope you can pass this along to the person with a chronic cough. -- R.G.
ANSWER: A dry environment is not often thought of as a cause of cough. I'm happy the ENT doctor gave you and me the tip. The three major causes of a persistent cough are asthma, postnasal drip and gastroesophageal reflux disease (heartburn). These readers have alerted us to think of other possibilities.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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