DEAR DR. GOTT: I have had two angioplasties because of coronary artery disease, take medication for angina and have a cholesterol level of 250. My present goals are to maintain the quality of my life, exercise regularly and improve my diet. In the past, you have mentioned low-fat programs, such as the Ornish diet. Can you elaborate and guide me?

DEAR READER: Several studies have confirmed that by drastically -- and I mean drastically -- altering one's diet and reducing saturated fat, many cardiac patients can significantly retard arteriosclerotic build-up in coronary arteries and thereby lessen the risk of subsequent heart attacks. However, such diets are incredibly strict and, for most patients, difficult to follow for extended periods. If you believe that this option is right for you, address the subject with your doctor, who is more familiar than am I with your heart condition and lifestyle. He or she will probably enlist the aid of a registered dietician or refer you to a medical center for intense dietary therapy. My concern about this choice is that it contradicts your first goal (to maintain quality of life). People on the Ornish diet, for instance, tell me that after six months or so, they would kill for some good, old-fashioned, greasy fast-food.

I'd like to offer an alternative, providing you do not need to lose weight (in which case, dieting is appropriate). Ask your doctor to prescribe a "statin" drug, such as Lipitor, Zocor, Pravachol, Mevacor and others (Baychol has recently been withdrawn from the market because of dangerous side effects). By using such cholesterol-lowering therapy, you should easily be able to reduce your level of 250 down to 200 or less. My cardiology consultants tell me they prefer levels of 150 or less in patients with coronary disease. To achieve such a profound effect with diet alone is virtually impossible. Consider medication; one or two pills at bedtime should do the trick.

Having endorsed this therapy -- which, in my experience, is effective and safe in the vast majority of patients -- I must add a word of caution. "Statin" drugs have two major side effects.

On occasion, they may cause liver inflammation. Therefore, when treated patients have cholesterol blood tests (at periodic intervals), they should have simultaneous liver tests, such as the measurement of the hepatic enzyme ASAT. If the enzyme level is above the normal range, the situation should be monitored at the discretion of the primary care physician. Discontinuation of the medicine may have to be considered.

The second, more serious but more unusual, side effect is rhabdomyolysis, a strange disorder marked by muscle stiffness and soreness, caused by drug-induced destruction of muscle cells. As the cells disintegrate, they release protein into the bloodstream. This protein is carried to the kidneys and may result in serious kidney disease or renal failure. This is the reason that doctors (and, on TV, the voice-overs) urge patients on statin drugs to check with their physicians for any unexplained muscle soreness or pain. Rhabdomyolysis can be diagnosed with blood tests.

In summary, you have significant heart disease and a relatively high cholesterol level in you bloodstream. Although diet -- even extremely strict alterations in food consumption -- may improve the situation, the drawbacks are fierce and involve quality of life issues. You may more easily lower your cholesterol by using prescription medication.

To give you related information, I am sending you a copy of my Health Report "Understanding Heart Disease." Other readers who would like a copy should send $2 plus a long, self-addressed, stamped envelope to Newsletter, PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.

2001, NEA