DEAR DR. ROACH: I am an 85-year-old woman who is physically, mentally and socially active and in quite good health, except for osteoporosis issues. The only medications I take are Maxzide for blood pressure, rosuvastatin for cholesterol, and Prolia injections for osteoporosis. My most recent cholesterol readings were 119 mg/dL (total), 58 mg/dL (HDL), 33 mg/dL (LDL), and 170 mmol/L (triglycerides), which seem good.

However, two years ago, I had a CT cardiac calcium screening and received an Agatston score of 443, which shows that I’m at a “very high” risk. Could you explain the relationship between calcium and cholesterol? Why is my cholesterol good and my calcium score very high? I have no family history of cardiac problems. — M.L.

ANSWER: The best situation is not to have blockages in your heart arteries or calcium. However, if you do have blockages, then noncalcified blockages are (perhaps surprisingly) more dangerous than calcified plaque. Noncalcified plaque has a thin top layer, which can rupture easily and cause a heart attack. Calcified plaque is more stable and less likely to rupture and cause a heart attack.

I can’t be 100% sure that you have blockages. A high calcium score does not mean that there are blockages inside the blood vessels as calcium can only be in the outer layer of the blood vessels. However, with a calcium score over 400 and at age 85, it is likely that you do have blockages.

A CT angiogram could definitively answer this question, but I don’t think it’s necessary. Your doctor has prescribed a medication, rosuvastatin, which has been very effective at lowering the LDL cholesterol to a very desirable range, below 40 mg/dL. You are being treated as though you do have blockages, and this dose of a potent statin will reduce your likelihood of strokes and heart attacks.

Personally, I would also consider the use of aspirin in a person like you as long as you have no increased risk of bleeding. Just being 85 gives you a small risk of bleeding, but you haven’t told me about any additional risk, so you should discuss this with your doctor. Aspirin is no longer used routinely, only for people with known heart blockages or those at a very high risk.

DEAR DR. ROACH: I recently tried to donate blood but was denied because I take Propecia. They told me I needed to be off of it for one month. Knowing that things change frequently, I was hoping you could provide some information about this and when it might be lifted. — S.E.

ANSWER: Five-alpha reductase inhibitors, like dutasteride (Avodart) and finasteride (Proscar and Propecia), are dangerous to pregnant women as they can interfere with the development of a fetus, even at the microscopic doses that can be transferred during a blood transfusion. The Food and Drug Administration recommends being off these medicines for six months prior to donating blood. Dutasteride in particular can last for a very long time in the body.

I applaud you for wanting to help, but I am sure you would not want to be unknowingly responsible for a major developmental abnormality, should your blood be needed for a woman who might not even know that she is pregnant. This restriction has been in place for nearly 25 years and won’t be lifted.

Your letter is a good reminder for me and other prescribers who recommend this drug to tell our patients that they will not be able to donate blood while taking it.

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. (c) 2025 North America Syndicate Inc. All Rights Reserved