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Dear Dr. Roach: In a recent column, you wrote about reducing cholesterol with the help of statins along with a PCSK9i, such as Repatha or Praluent. My question is: Are these PCSK9is at all beneficial if one cannot take statins? -- D.C.S.
Answer: Yes, PCSK9 inhibitors are very effective at lowering cholesterol and reducing the risk of heart attack in high-risk people. Because these drugs are given by injection and are quite expensive, they are not usually the first-line treatments. We have decades of experience using statins, so they remain the first choice for most.
However, if a person cannot take a statin, or one of the alternatives such as bempedoic acid, then PCSK9i drugs are a very reasonable choice. In people with familial high cholesterol and extraordinarily high levels of cholesterol, combination therapy with two or three drugs (a statin, a PCSK9i and sometimes ezetimibe) is frequently used.
Dear Dr. Roach: My wife had COVID and has lost most of her smell and taste. This has lasted for two years. She is in her late 70s. Strong flavors like barbecue sauce and onions can be detected. Is there any hope that her condition will improve? -- P.M.
Answer: Most people recover their loss of smell after COVID. Having had this for two years is a bad sign; however, the fact that she does have some sense of smell is a good sign.
The most effective treatment for the loss of smell after a viral infection is olfactory training. The same scents that were used in clinical trials can be purchased online. Recent evidence has shown that a supplement combination, ultramicronized palmitoylethanolamide and luteolin, along with olfactory training, led to greater improvement. The dose used in studies was 770 mg.
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.