DEAR DR. ROACH: In 2010, at age 59, I had a heart attack. An angiogram was clear, and an echocardiogram showed no damage to the heart. I had some high blood pressure the previous year and was on one medication. At the time of the heart attack, I had been under extreme stress from dealing with a family crisis. The stress was mentioned as a possible cause. The heart specialist prescribed Zocor, 30 mg once a day for cholesterol. I questioned the cholesterol medication, as I did not have high cholesterol. I was told that there was information indicating it might help heart-attack patients. My cholesterol has never been above 145. My EKG was normal. I recently saw two specialists on TV discussing women and cholesterol medication. They both said it could cause diabetes and cancer. What is your opinion on the use of cholesterol meds? — L.D.

ANSWER: You bring up two important points. The first is whether it’s possible to have a heart attack with no blockages on an angiogram. The second is whether medications for cholesterol are effective in women.

The answer to the first question is yes, it is possible to have a heart attack without blockages visible on angiogram. There is a condition sometimes called cardiac syndrome X (which is confusing, since another disease of insulin resistance and abdominal obesity was called syndrome X in the past), or microvascular angina. This is an uncommon disorder, and heart attack is uncommon even in people with this condition. In microvascular angina, it’s not the big blood vessels that are blocked with cholesterol, as is the case for the vast majority of heart attacks, but the small vessels that are abnormal. Fortunately, this condition has a good prognosis in most people. It is far more common in women.

The second question is about statin drugs in women. The scientific studies are not as strong in women as they are in men, but the data strongly suggest that statins are of benefit in women who have blockages in their arteries, even if the proof isn’t iron-clad. In my opinion, women with proven coronary artery disease should be on statin drugs. For women without known disease and who are contemplating taking medication to prevent heart attacks, it depends on the degree of risk. If there is a risk for diabetes and cancer with statins, it appears to be very small.

Finally, stress can have a powerful effect on the heart. There is a condition called takotsubo cardiomyopathy, which does not cause a heart attack but can cause similar symptoms, usually around times of intense emotional stress. I wonder if that is what your cardiologist was considering, but it should have been seen on the echocardiogram.

DEAR DR. ROACH: I am a 75-year-old male with a nearly spotless medical history. I have been diagnosed with a benign 10-cm lipoma located on my neck. The surgeon acknowledges that an excision would be difficult, taking perhaps two to three hours and not without risks to nerves and blood vessels. Are there any other treatments available? — T.K.

ANSWER: A lipoma is a benign tumor of fat cells. These are treated if they are cosmetically important, cause pain or if their diagnosis is unclear. Liposuction is another alternative. It sounds like your surgeon is trying to give you a warning that you should heed.

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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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