Dear Dr. Roach: I am a 66-year-old man diagnosed about 15 years ago with mild coronary artery disease, with some blockages in my peripheral arteries. I was taking the maximum recommended dosage of pravastatin to maintain a low cholesterol, but I experienced complete ruptures of both Achilles tendons. These incidences occurred five years apart, but after the second rupture, my doctor discontinued the pravastatin.
I then started Praluent injections twice a month to control my cholesterol, which has been incredibly effective — maybe even too effective — and is the purpose of my writing to you. With Praluent injections, my LDL level is about 26, and my HDL is 100. When my primary doctor’s assistant recently called to inform me of my bloodwork results, she said she has never seen anyone with such a low LDL level — and she sees a lot of bloodwork! My primary care doctor doesn’t like it that low, but two different cardiologists I have seen think that the lower it is, the better. What do you think?
J.W.
The first issue is whether statins increase the risk of an Achilles tendon rupture, and I can’t answer that with certainty, because there is some evidence it does. (Some studies have reported anywhere from an 80% relative risk increase to triple the risk, but the risk is still very, very low. Even if they triple the risk, the risk would be only three people per 10,000). The studies that have shown there is risk suggest that the risk is only in the first year of taking statins, but other studies have shown no risk at all from statins.
The second issue is your very low LDL level, and the data for LDL levels is firmly on the side of the cardiologists you spoke with. The lower the LDL, the lower the risk of heart disease, and levels under 30 are not at all unusual in a person taking alirocumab (Praluent) or the other drug in that class (called PCSK9 inhibitors), evolocumab (Repatha). Your doctor’s assistant will likely be seeing more people with LDL levels like yours. Do remember that a healthy, mostly plant-based diet and regular exercise still have benefits in people with LDL levels as low as yours — and not just in heart disease, but in reducing cancer risk, too.
Dear Dr. Roach: Can Dupuytren’s contracture be transmitted from one person to another via plasma donation? Is the theory a consensus in the medical field?
H.H.
Dupuytren’s contracture is a condition of fibrosis in the connective tissue of the hand, which leads to decreased hand flexibility and, ultimately (without treatment), to contractures, where fingers curl into the palm.
There is no known person-to-person transmissibility of Dupuytren’s contracture. It’s not an infectious disease. The risk factors include previous family history, being over 50, repetitive trauma, diabetes, smoking and alcohol. Some other related medical illnesses can also predispose a person to Dupuytren’s contracture. Potential treatments include surgery and enzyme injection.
The word “theory” means a well-thought-out explanation based on the scientific method that helps explain why certain observed phenomena occur. Your question about Dupuytren’s contracture being transmissible by plasma donation is a hypothesis for which I could find no support.
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 ToYourGoodHealth@med.cornell.edu
