Dear Dr. Roach: My 78-year-old mother has taken compounded estrogen since menopause. She swears that it has kept her from getting Alzheimer鈥檚 disease and other brain diseases.
I am 54 and have been in menopause for about a year. I鈥檝e tried hormone replacement therapy, but I鈥檝e had weight gain and other side-effects. Eventually, I decided that the hot flashes weren鈥檛 so bad after all, and went off the pills altogether.
So far, I鈥檓 managing my symptoms just fine. But my mom thinks I should go back on the estrogen because of the long-term brain benefits.
Are the long-term brain benefits of estrogen clear enough for me to give the pills another chance? And if so, does it matter if the estrogen is compounded?
M.S.
For many years, physicians recommended estrogen (plus progesterone for women who had not had a hysterectomy) because of benefits seen in reduced heart-disease risk, and some studies also showed reduced risk of developing Alzheimer鈥檚 disease. However, that changed when good studies were published showing that there was more harm than benefit overall, and now estrogen generally is used only for symptoms of menopause, especially the 鈥渉ot flashes鈥� caused by abnormal regulation of blood vessels.
Those same studies on heart disease also have provided some data on the risk of dementia in women taking estrogen compared with those who do not. Some studies showed a little benefit; others showed none, or even some harm. The largest, a subset of the Women鈥檚 Health Study, showed no benefit and a trend toward harm from estrogen.
I do not recommend estrogen to prevent Alzheimer鈥檚. The most effective interventions to reduce risk of dementia remain regular physical exercise; maintaining high levels of social contact and cognitive function (such as games, puzzles, etc.); and a Mediterranean-style diet high in fruits, vegetables, legumes, nuts, olive oil and whole grains. Future studies may show breakthroughs, but these interventions are considered safe and at least modestly effective.
Dear Dr. Roach: I heard a cardiologist say that she no longer prescribes statins because 鈥渢he calcium in statins clogged arteries, and instead of helping patients, we were killing them.鈥� I鈥檓 an 81-year-old man who had a very mild stroke, and was told by a doctor that he thought I had had two heart attacks and I should take atorvastatin calcium, 40 mg, daily. I like milk and consume at least two cups daily. I take a multivitamin with 200 mg calcium. Should I be concerned about taking the atorvastatin?
Anon.
More than 30 studies in the past 30 years have confirmed the effectiveness and safety of statin drugs in people with known coronary disease or who are at high risk. There still are those who doubt, but the evidence has long since been considered settled by the vast majority of experts.
It is not clear, however, whether calcium supplements increase the risk of heart attack or stroke. Some studies have said they do, and others have said they do not. If they do increase risk, it is only by a little bit. However, I would recommend against a calcium supplement, and would suggest that you stop your multivitamin completely (there is little evidence that they do any good in most people), or at least find a brand with no calcium.
Only about 1 mg of your atorvastatin tablet is calcium, so you need not worry about the calcium in it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
