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Dr. Keith Roach

DEAR DR. ROACH: I am a 66 year old male diagnosed about 15 years ago with mild coronary artery disease, with some blockages in my peripheral arteries. I was taking the maximum recommended dose of pravastatin to maintain low cholesterol, but suffered complete ruptures of both Achilles tendons. These incidents happened five years apart, but after the second rupture, my doctor stopped the pravastatin. I then started Praluent injections twice a month to control my cholesterol, which was incredibly effective – maybe even too effective – and that is the point of my letter. With Praluent injections, my LDL is around 26 and my HDL is around 100. When my primary physician’s assistant called me recently to tell me about my blood work results, she said says she’s never seen anyone with such low LDL – and she sees a lot of blood work! My GP doesn’t like it being that low, but two different cardiologists I’ve seen think the lower the better. What do you think? —JW

ANSWER: The first question is whether statins increase the risk of Achilles tendon rupture, and I cannot answer for sure, as there is some evidence that this is the case. (Some studies have reported between an 80% increase in relative risk and three times the risk, but the risk is still very, very low. Even if they triple the risk, the risk would only be three in 10,000 people) . Studies that have shown there is a risk suggest that the risk only exists within the first year of taking statins, but other studies have shown no risk with statins.

The second issue is your very low LDL level, and the data on LDL levels is firmly on the side of the cardiologists you’ve spoken with. The lower the LDL, the lower the risk of heart disease, and levels below 30 are not at all unusual in someone taking alirocumab (Praluent) or the other drug in this class (called inhibitors of PCSK9), evolocumab (Repatha). Your doctor’s assistant will likely see more people with LDL levels like yours. Remember that a healthy, mostly plant-based diet and regular physical activity still have benefits for people with LDL levels as low as yours – and not just for heart disease, but also for reducing the risk of cancer.

DEAR DR. ROACH: Can Dupuytren’s disease be transmitted from person to person through plasma donation? Is the theory consensus in the medical field? — H.H.

ANSWER: Dupuytren’s contracture is a condition of fibrosis in the connective tissue of the hand, which results in decreased hand flexibility and ultimately (without treatment) contractures, where the fingers curl into the palm.

There is no known human-to-human transmissibility of Dupuytren’s disease. It is not an infectious disease. Risk factors include family history, being over 50, repetitive trauma, diabetes, smoking, and alcohol. Certain other related medical conditions can also predispose a person to Dupuytren’s disease. Potential treatments include surgery and injection of enzymes.

Word “the theory” means a thoughtful explanation based on the scientific method that helps explain why certain observed phenomena occur. Your question on the transmissibility of Dupuytren’s disease by plasma donation is a hypothesis for which I found no support.

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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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