DEAR DR. ROACH: I am an organ transplant recipient who has received both COVID vaccinations and both boosters. I did this because numerous medical professionals recommended them for immunosuppressed patients, but I am wondering if I did the right thing.
I take immunosuppressants to keep my body from producing antibodies that would attack my donor kidney. Unfortunately, immunosuppressants effect my entire immune system, making me highly vulnerable to viruses, bacteria, etc. I am afraid that by stimulating my body to produce an antibody to the COVID virus, it will boost my immune system to produce antibodies that might attack my new kidney. Am I in a Catch-22 situation? — G.K.
ANSWER: I understand why you are concerned, but the COVID vaccine stimulates your immune system to make only the antibodies directed against the COVID spike protein. These antibodies are precise and do not react to the donor kidney or your own body. Many people in your situation have gotten the vaccines and have not had any rejection. You did the right thing.
People with autoimmune disease also ask a similar question: Will the increase in immune system activity cause my autoimmune disease to flare? This has proven to be more of a theoretical concern than a real one, with no more flares after vaccination reported than would be expected without one, in people with multiple sclerosis and other autoimmune diseases.
Because of the immunosuppressive medicines necessary to prevent rejection of a transplanted organ (your kidney), organ recipients are indeed at higher risk of infection, so the COVID vaccine (as well as vaccines against other infections) are particularly important.
Some people who are unable to make antibodies because of an immune system disease or medication that suppresses this ability are at high risk. Those patients may want to consider tixagevimab and cilgavimab (Evusheld). This provides approximately six months of protection against COVID infection, reducing symptomatic infection rates by almost 80%. Many people who would benefit from this don’t know about it. If you do get COVID despite preventive medication, you should get treatment.
DEAR DR. ROACH: I’ve heard that women could raise another consideration about statins: that studies on their efficacy were done on men only, and that nothing has been established on the way they do or do not work on women. Is that true? — C.D.C.
ANSWER: Many of the initial studies were indeed done on men only, and even in those done on men and women, the number of women in the individual studies was not enough to prove a benefit. Since then, studies have confirmed that women with coronary disease benefit from statin drugs. In women without known blockages in the arteries, combining the results from many trials has shown that women achieve about the same benefit as men do.
However, since women have a lower risk for heart disease when compared to men of the same age, there is less of an absolute benefit for women. To complicate matters further, women who could benefit from a statin are treated with statins less often than men are, and are consequently at a higher risk than they should be.
Women may be at higher risk for muscle aches than men, and statins must not be taken by pregnant women. As always, lifestyle changes, especially with diet and exercise, are the first line in preventing heart disease.
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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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