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ILLUSTRATIONBYAUDRIARUSCITTI ByBillElliott MarinIndependentJournal Ifyouareamiddle-aged adult, you have about 1 per- cent chance of having of a heart attack every year. We call this "intermediate risk" because you are not at high risk unless you have diabetes, smoke or have se- vere high blood pressure, and you are not at low risk because, well, you are an average American adult and Americans die of heart disease more than any other cause. All it takes is one of the following risk factors to put you at intermediate risk: increased waist size compared to your hip size, low beneficial cholesterol (HDL), recent tobacco use, borderline elevated blood sugar, a family history of heart disease or mild kid- ney dysfunction noted on a blood test. All these statistics are for those people who are generally healthy and have never had a heart attack. So if you are average, and at intermediate risk and you can only take ONE pill, would you be better off taking a medication to lower your blood pressure or lower your cholesterol? The New England Jour- nal of Medicine recently published three articles addressing this issue. In the first, 12,705 men and women at intermediate risk for heart disease who had normal blood pressure were randomly assigned to take a combination of two common blood pres- sure pills or dummy pla- cebo pills. Those who were taking the real pills were found to have a blood pres- sure decrease of six points while there was no change in the placebo group. They were then followed to assess the rates of death from heart attacks, non-fa- tal heart attack or stroke. After about 5½ years, the combined rates of fatal or nonfatal heart attacks and strokes was 4.1 percent in the blood pressure medica- tion group and 4.5 percent in the placebo group — a nonsignificant difference. Only those with the high- est pre-treatment blood pressures showed any ben- efit from treatment. In the second study, 12,705 men and women who were at intermedi- ate risk were randomly as- signed to take a statin medication (rosuvastatin 10 mg) or placebo. The LDL cholesterol dropped by 26.5 percent in the statin group. The same outcomes were used as in the blood pres- sure study — fatal heart at- tack, or non-fatal heart at- tack or stroke. After 5½ years the rate of fatal or nonfatal heart attacks and strokes was 3.7 percent in the statin group and 4.8 percent in the placebo group — a significant re- duction. There was benefit even for those without ele- vated cholesterol levels. The third study looked at combined treatment with blood pressure medica- tion and a statin and found about the same degree of risk reduction as that seen with a statin alone. The study authors con- cluded that adults at inter- mediate risk for a heart at- tack or stroke would be better off taking a mild cholesterol pill than a blood pressure pill. It is important to note that the average blood pressure in this study was 138/82 — not a level that most doctors would con- sider high enough to war- rant medication. In mul- tiple other studies, those with true hypertension (blood pressure above 140/90), benefited greatly from treatment with blood pressure medications. MEDICATION Howtoavoid a heart attack By Tracy Seipel Bay Area News Group Helen Handelsman has been waiting for this day. Diagnosed in 2013 with late-stage breast cancer, her second bout with the disease, the San Francisco resident has a few wishes: to make it to her 85th birthday in January, and to ask her doctor for a le- thal drug prescription un- der California's new right- to-die law. "I want to tell him that this is what I want," said the grandmother, who now can feel the tumors devel- oping under her collarbone. "I've watched my sister and my father and my son- in-law die from cancer," she said. "It was morally wrong to keep these people alive when there was no hope they would survive. And the pain can be so horri- ble." Eight months after it was signed into law by Gov. Jerry Brown, Califor- nia's controversial End of Life Option Act went into effect last week. The law allows mentally capable adults, diagnosed with six months or less to live, to ask doctors for pre- scriptions to end their lives when they choose. For Handelsman and many other terminally ill Bay Area residents, the physician aid-in-dying law comes as a relief. Patients may decide against using the medication, but just knowing it is there, they say, gives them solace. Yet, to opponents who continue to rail against its implementation, the law remains a dangerous overreach by the state. Foes argue that it places patients — especially the elderly — at risk for coer- cion, with little support for other options, and no requirement of witnesses to their self-administered deaths. Just this week, the group Californians Against As- sisted Suicide and its part- ners launched a watchdog website (patientsrightsac- tion.org/Stories) that asks the public to monitor "ex- amples of mistakes, mis- use, coercion and abuse" in the law. "This law does not apply to everyone equally," said Tim Rosales, a spokesman for Californians Against Assisted Suicide. He pointed to annual state reports from Oregon and Washington — where right-to-die laws have been in place for years — that say one of the biggest reasons people choose aid-in-dying is their fear of being a bur- den to their family, friends and caregivers. "That is very telling, certainly when you are looking at the economic di- versity across the board," Rosales said, referring to the pressure some low-in- come residents may feel about leaving their fam- ilies with mountains of medical bills. But the data from those states also reveal that rela- tively few people each year use the law, and about one- third of those who receive prescriptions never take the medication. Of 218 prescriptions written in Oregon in 2015, 132 people had died from taking the medication as of mid-January. Similarly, of 176 prescrip- tions written in Washing- ton in 2014, 126 patients died after ingesting their medication. Given California's larger population, state officials estimate that 1,500 resi- dents annually will seek lethal prescriptions. Anotherchoice For 91-year-old Stew- art Wobber, the law simply gives him "another choice." Until three years ago, the retired Los Altos Hills busi- nessman was still active in his community, helping to raise money for different causes, from scholarships for low-income high school students to services for at- risk children. But a few years ago, a chronic lung disease wors- ened and left him confined to his bed, relying on hos- pice care, and dependent on oxygen tanks and nasal tubes to breathe. "My lungs are collaps- ing," said Wobber, who has six grandchildren and four great-grandchildren. "I lay in bed wondering how to find out how to close my life if I want to." The patriarch said he has brought up the subject with his doctor and his children, but only briefly. For now, he just wants to understand how the law will work if he decides to consider using it. And he would like to be familiar enough with the process should any friends ask him to explain it to them. "I get calls from peo- ple asking me about many things," Wobber said. "I'd like to be prepared to an- swer their questions." Law offers comfort In Santa Cruz, Allyne Hammer also is reviewing the law, recalling memories from working as a hospice volunteer with Bay Area AIDS patients 35 years ago. The images of that time — and the lack of any med- ical aid-in-dying mech- anism that could have helped those victims — still haunt her. "People were suffering and dying horrible deaths, and looking for help," the 74-year-old former union activist said. Now it is Hammer, di- agnosed in 2010 with in- curable blood cancer, who is preparing for her own mortality. When her time comes, she said, she can turn to the End of Life Op- tion Act if needed. "I am comforted by the fact that I can control my suffering in the end," Hammer said of her dis- ease, which is slow-mov- ing. "That's what the law offers me." Hammer's only sib- ling, Dr. Douglas Ham- mer, a family physician in Raleigh, North Carolina, said his sister has men- tioned the law to him and told him she would con- sider using it. If that's her choice, Ham- mer said, she should have that right. But with palli- ative and hospice care, he said, doctors can help ter- minally ill patients control their pain, allowing them to die "fairly peacefully and fairly comfortably." "You don't have to rush them along," he said. Choosing to live longer For Matt Chaney, the de- cision has been made: Stay alive as long as possible. Diagnosed with Lou Gehrig's disease in 2001, the 55-year-old Lafayette resident has little control of his arms and hands, and his speech is almost unin- telligible. His breathing has got- ten worse over time, and some day he will be unable to breathe on his own. But waking up every day to the love of his wife and two grown sons makes every day a miracle. Eventually, however, he will get to a point when he will need to decide on an invasive breathing regime, 24-hour care and what he fears would be a "huge fi- nancial burden on my fam- ily." "Being able to end my life on my terms is an op- tion I'd like to have avail- able," Chaney said. Yet, Chaney knows that by the time he has a six- month window to live, he likely will be unable to meet the law's self-admin- istering requirement to be able to sign a document or ingest the medication. "Will a power of attorney or medical directive be ac- ceptable under the End of Life Option Act?" he asked. Under the law, neither will suffice. Back in San Francisco, Handelsman continues liv- ing to her fullest every day. She takes some pills and shots that, her doctor said, will keep the cancer from rapidly spreading. She said she hasn't dis- cussed with loved ones her decision to use the law, if needed. "My choice is to live whatever time I have out doing as much as I can, and the oncologist I found was perfectly OK with that," Handelsman said. Most of her children live in the Bay Area, friends are nearby, and she can still play a mean game of dou- bles tennis, several days a week. "I'm not afraid of dy- ing," said Handelsman. "I've lived a good, long life. But I am afraid of hav- ing that pain, and I don't understand why anyone should have to suffer that." END OF LIFE OPTION ACT Facing death on their own terms New studies indicate taking a cholesterol pill may be all you need KARL MONDON — BAY AREA NEWS GROUP Helen Handelsman, 84, who has terminal cancer, says that she is grateful that she will have the option of using California's controversial new End of Life Option Act should she need it. redbluff.mercy.org CommunityBLS 6:00pm-10:00pm 6/14 2nd Tuesday Columba 888-628-1948 Lupus/Fibromyalgia Support Group 5:30pm-8:00pm 6/21 Tuesday Columba Jackie Kitchell 529-3029 HIRE (Head Injury Recreational Entity) 10:00am-2:00pm 6/27 Mondays Wright Rusty Brown 529-2059 Endsnoring An estimated 80 million people in North America snore. Taking into account the snorer's spouse and children, as many as 160 million people are negatively affected by snoring. Snoring not only interrupts your sleep cycle, it can also be a symptom of a condition called sleep apnea. 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