Keith Roach, M.D., syndicated columnist

DEAR DR. ROACH: I am a 73-year-old man. I exercise regularly, eat a healthy diet and have not eaten beef or pork in over 40 years. In spite of all of this, I was diagnosed in January 2022 with a 90% blockage of the left anterior descending artery and had a stent put in. I have felt great ever since.

After the procedure, I was put on metoprolol, 20 mg of rosuvastatin and aspirin. My total cholesterol went from 196 to 118 mg/dL. My HDL stayed about the same, at 42 mg/dL, and my LDL went from 133 to 59 mg/dL.

During a recent visit to my cardiologist, he informed me that there has been a change of opinion, and the preferred LDL range is now below 55 mg/dL. He then started me on 10 mg of Zetia to lower my LDL level. I was apprehensive, as I do not like to take a lot of medications and feel as if I am a guinea pig.

After a few days of taking Zetia, I felt lethargic and had sinus headaches, muscle aches and an overall “blah” feeling. After 14 days, I stopped taking Zetia, and these symptoms went away quickly. I’m interested in your opinion on taking Zetia and this new guideline to keep LDL levels below 55 mg/dL. — S.E.

ANSWER: Caused by plaque in the arteries of the heart, coronary artery disease is the kind of heart disease that causes heart attacks and remains the leading cause of death in the industrial world. Treatment of this condition with statin drugs, like rosuvastatin, has been proven to reduce the risk of heart attack and death. Strong data supports a goal LDL cholesterol level of 70 mg/dL.

In people at the highest risk for heart attack and stroke (such as people with known blockages in their arteries and people with high blood pressure), there seems to be a small additional benefit in pushing LDL levels to even lower ranges.

The European Society of Cardiology has recommended a goal of 55 mg/dL in accordance with this group. It may be that even lower levels, below 40 mg/dL, may have additional benefit. I don’t think that the potentially increased length of life is worth the significant worsening of the quality of life you are experiencing with Zetia.

However, simply increasing your rosuvastatin to 40 mg may drop your LDL level without causing any side effects. As long as you aren’t getting significant side effects, I think the additional benefit, although small, is worthwhile.

DEAR DR. ROACH: What is the correct position a patient should assume when using a walker? I have been told to bend forward when using a walker, but the instruction sheet says that I should walk erect. — Anon.

ANSWER: You should walk erect. Trying to maintain a good posture is important in avoiding falls or injuries. There are some people with severe spinal issues who are unable to walk erect, but in general, the guideline is to keep as natural a posture as possible. People who lean forward tend to develop an abnormal gait, with shorter, quicker steps and overall slower walking progress.

DEAR DR. ROACH: I recently heard about a pill that helps with alcohol and tobacco cravings, but I don’t remember the name. — J.S.

ANSWER: I think you’re talking about naltrexone, which is indicated for alcohol use disorder by the U.S. Food and Drug Administration. Studies have also shown that it reduces cravings for smoking and improves quitting rates, although it is not one of the first-line medications for quitting smoking (nor does it have an FDA indication for this).

Naltrexone is not a medication to be prescribed lightly or without careful consideration of its risks. Some people have depression and even suicidal thoughts after using this medicine, and it should only be used by those familiar with treatment of these disorders.

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