Dear Dr. Roach: I’m a female who is 63 years old. My blood pressure is 110 / 70 mm Hg. I’m 98 pounds, and my heart doctor believes that I might be one of those people who produces cholesterol. My total cholesterol is 241 mg/dL, my LDL is 168 mg/dL, and my HDL is 65 mg/dL. My doctor did a calcium score, and the result was 31. Should I take cholesterol meds?

— W.P.

Answer: There are several decision tools to help doctors and patients evaluate the potential benefits of cholesterol medication, and they start with estimating your risk of having a heart attack or stroke during the next 10 years. Since you have had a coronary calcium scan, the most appropriate tool to use is the MESA score (tinyurl.com/mesascore).

When I put in your information, it gave a 10-year risk of 3.5%. This is a level at which giving a medication like a statin would only have a miniscule benefit for you, and statins always have a small risk of causing side effects (such as muscle pain). It can also cause blood sugar levels to go up slightly. Experts do not recommend treatment for you at this level.

All humans make cholesterol. Statin drugs work by preventing our body from making as much cholesterol as we otherwise would by blocking an enzyme called HMG-CoA reductase. A drug in a different class called ezetimibe works by reducing the amount of cholesterol you can absorb from food. The two together are more effective at lowering cholesterol than either alone, but I do not recommend any medication for you.

Having a healthy, mostly plant diet (like a Mediterranean-style diet), along with regular exercise, would have a much bigger impact on keeping you healthier than a statin, since a good diet and exercise reduces many health risks, including cancer and heart disease.

Daer Dr. Roach: Since starting blood thinners, I’m unable to continue anti-inflammatories for ongoing arthritis pain. Is there a safe arthritis pain medication other than Tylenol? I am a 72-year-old male on meds for atrial fibrillation, Type 2 diabetes, cholesterol, and a hiatal hernia. Would the maximum daily amount of Tylenol to minimize the pain be too high over an extended period of time?

— L.M.

Answer: People taking anticoagulant drugs like warfarin, or one of the newer direct-acting oral anticoagulants (DOAC) like apixaban, are at a significantly increased risk of bleeding when they also take anti-inflammatory drugs like naproxen or ibuprofen. Most patients are recommended against using these drugs together. Sometimes after a careful discussion of the risks and benefits, a person on an anticoagulant will be prescribed an anti-inflammatory, but most of the time, they are avoided.

Acetaminophen (Tylenol) is much safer to use in combination with a DOAC. The maximum dose of Tylenol I recommend in older patients is 3,000 mg, or two extra-strength pills three times daily. I do not recommend this high a dose in some situations, such as an older person with liver disease who is very small in size (120 pounds or less) or who drinks moderate amounts of alcohol. However, adding Tylenol to warfarin (but not a DOAC) can cause the bleeding risk to go up when using a relatively high dose of Tylenol.

One option is an anti-inflammatory gel like diclofenac, which isn’t absorbed as well into the body, so they don’t put a person at risk. But it can penetrate superficial joints like the hands and knees.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.