Dr. Keith Roach

DEAR DR. ROACH: I have been using “lite salt,” which has 50% less sodium than regular table salt. Do you agree that this is OK? — C.D.
ANSWER: Lower-sodium salt substitutes are generally made from potassium salts; sometimes they’re all potassium, and sometimes they’re a mixture of sodium and potassium salts. The evidence is pretty strong that increasing potassium and decreasing sodium in your diet reduces heart disease risk, and controlled studies have proven that potassium salt substitutes lower blood pressure.
For most people, potassium-based salts are safe. However, there are a few people who need to be cautious. Those with chronic kidney disease of any kind should talk to their doctor first. Many medications can increase blood potassium levels through their effect on the kidney, including ACE inhibitors, angiotensin receptor blockers and spironolactone. People taking these should also discuss potassium-based salt substitutes with their doctor before using them.
Even most people who take these medications can probably handle the recommended daily dose (typically 1/4 teaspoon), but I still recommend discussing this with your doctor if you have ever been told you have high potassium, if you take one of the medications above, or if you have any kind of kidney disease.
DEAR DR. ROACH: After a successful ablation to correct atrial flutter, I was told I have mild atherosclerosis of both the aortic arch and the descending aorta. I asked my doctor about this, and he feels that this is not unusual for a very active 75-year-old male. I power walk for two hours five days a week, and I golf. I’ve never had a problem. What do you think of my findings? — D.B.
ANSWER: There are two concerns about finding atherosclerosis, which are blockages in the arteries due to plaque, made largely from cholesterol and calcium. One concern is that plaque can break off in small pieces, which can float downstream in the blood supply and get lodged, sometimes in a critical organ. Cholesterol emboli can cause small strokes, damage to the eyes, kidney problems and more. Of course, mild disease is much less likely to do this than severe disease.
The second concern is that it’s extremely common for people who have atherosclerosis in the aortic arch and the aorta to have atherosclerosis in the coronary arteries as well. The decision of how aggressively to treat your findings is a judgement call, but I take these very seriously.
Most of my patients benefit from significant changes to their lifestyle. It sounds like you are doing well with exercise, but it may be that your diet can benefit from some changes. Careful control of blood pressure and blood sugar, if appropriate, is critical. I almost always recommend medication treatment, such as a statin and aspirin, to reduce the risk of a heart attack.
People who have already had a stroke or transient ischemic attack (TIA, which is very similar to a stroke, but without permanent loss of function) should consider additional medications to prevent another stroke.
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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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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