Question 1

Hi Dr John, like most of my family, I have a history of high cholesterol but none of my family has ever had  any sort of coronary disease. Should I still take precautions?

Accepted Answer

Yes.
Having high cholesterol levels is one of the risk factors for heart disease but it’s not the only one.  For a start, we need to differentiate between the two types of cholesterol - LDL ("bad" cholesterol) which contributes to plaque buildup in arteries and increases heart disease risk and HDL(so-called "good" cholesterol) which helps remove excess cholesterol, lowering risk.

Then there are other risk factors including having high triglyceride levels, high blood pressure, diabetes, smoking and obesity.  Genetics also plays a part but a family history absent of heart disease won’t provide you with absolute insurance.

Ageing itself is a risk factor as it causes  blood vessels to stiffen, and the heart may become less efficient, increasing the likelihood of conditions like hypertension, atherosclerosis, and heart failure.

High cholesterol is considered to be a warning sign, rather than a death sentence and you need to consider your overall heart health rather than just one indicator.

The good thing is that the lifestyle changes you should make, particularly introducing regular exercise and following a healthy diet will improve your overall health as well as lower your risk. Keep in mind that 6 out of 10 people get heart disease and 3 or 4 out of 10 die from it making it Australia’s second biggest killer after dementia.

Question 2

Dear Dr John, I know that women, in particular, suffer from bone density loss after we reach the menopause. Is there anything I can do to make sure it doesn’t result in osteoporosis?

Accepted Answer

You are correct. Menopause does significantly increase the risk of osteoporosis because of the accompanying drop-off in estrogen levels.  Estrogen has a crucial role in maintaining bone density and its depletion causes bones to lose mass and become prone to fractures, particularly in the hip, spine or wrist.

Women can lose up to 10% of their bone density in the first five years after menopause and 1 in 2 postmenopausal women will develop osteoporosis.
You can take measures, however, to lower the risk, for instance hormone therapy is obviously intended to replace estrogen.

Apart from that, there are three things you can do that will make a significant difference.

Firstly, Calcium & Vitamin D are essential for maintaining strong bones and these can be boosted by supplementation, which should always be under the direction of your GP after taking your overall health state into consideration.

Secondly, weight-bearing exercise such as jogging, and resistance training with weights and/or bands helps to strengthen bones. Don’t feel that its too late or that  you are too intimidated to join a gym. You can always buy some basic free weights and train in the privacy of your home.

Thirdly make sure you’re supporting these initiatives by including plenty of leafy greens, dairy, and fortified foods in your diet.

And, of course, ask your doctor about bone density screening. The precursor to osteoporosis is osteopenia and bone density tests can let you know if its time to take precautionary measures.

Question 3

Hi Dr John, over the last 12 months I’ve been finding that I have to get up during the night to urinate more and more often. I’m in my early 60s so is that normal or should I be talking to my doctor about a prostate examination?  (I shudder thinking about what that means.)

Accepted Answer

If your sleep is being interrupted frequently every night, that’s reason enough to consult with your doctor. Constant sleep interruption can affect your health in many ways. You’re correct in guessing that it may have something to do with your prostate but that’s not necessarily the only possible source of the problem.

Men over 60 should discuss the value of a Prostate Specific Antigen (PSA) test with their doctor as a matter of course as yes, prostate problems become more likely with age.

But don’t worry too much on two counts.

Firstly, and I’m second-guessing your reluctance, we don’t rely on digital prostate examinations any more. Its just a blood test so don’t be a sook.

Secondly, and keep this in mind if your doctor does advise you to have a PSA test, a high PSA reading does not necessarily mean you have prostate cancer. The reading could indicate that you have a benign prostate enlargement which becomes more common for men as they get older.  This would also explain, on its own, your urinary urges at night as an enlarged prostate increases pressure on the bladder.

I don’t want to get too many steps ahead but keep in mind that, although prostate cancer is the most commonly diagnosed cancer in older men, it is also a comparatively slow progressing condition and you are far more likely to die of another cause before this one threatens your mortality.

Believe it or not, this is all good news.

Q & As

Ask Dr John