Cholesterol and death certificates: Doctor Rosemary Leonard answers your medical queries

Q I take clopidogrel and atorvastatin following a mini stroke. I now bruise easily and have very low cholesterol. With thinner blood is there more of a risk of a brain aneurysm?While lower cholesterol is good, are there any negative aspects of it being so low?

A We all need a small amount of cholesterol for normal cell function but most of us have far more than we need. Excess cholesterol can lead to fatty deposits in the walls of arteries, increasing the risk of them becoming blocked, leading to heart attacks and strokes and also transient ischaemic attacks (TIAs) or “mini strokes” where a blood vessel to the brain is temporarily blocked.

Although some cholesterol comes from saturated fat in food most of the cholesterol in the blood is made overnight in the liver.Statin drugs work by reducing the liver output of cholesterol but even in high doses they don’t reduce the level too low – there is still enough for the body to function properly.

Blood clots are made up of clumps of tiny cells called platelets in the blood sticking together. Clopidogrel, which is known as an “antiplatelet” drug, helps to stop this process and this does mean that if you knock yourself you will bleed more (and get more of a bruise) than before.

An aneurysm occurs when a blood vessel wall becomes weaker and widens. Such areas have a higher risk of bursting.

Taking clopidogrel does not increase the risk of this happening, although anyone known to have an aneurysm should be given antiplatelets or anticoagulants only under specialist advice as there is an increased chance of greater bleeding should the aneurysm burst.

Q My 82-year-old mother died last month. The cause cited on her death certificate was impetigo of the scalp – but how could she have caught this in a residential home? She also had Dementia with Lewy bodies and chronic obstructive pulmonary disease but I cannot believe someone could die of impetigo in the 21st century. I hope you can shed some light on this – i am finding it very hard to accept.

A On death certificates there is usually more than one condition listed. The top one is the one the doctor feels is the main cause of death, then other conditions are listed which could have contributed.

Impetigo is a skin infection and I agree that on its own it is unlikely to kill anyone. However if the infection spreads into the bloodstream then it could lead to septicaemia (blood poisoning) which can be fatal, especially in an elderly person with underlying poor health.

I suggest you speak to the doctor who wrote the certificate. I would advise that you make it clear you just want to get the situation clarified and do not want to make a complaint.

If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or email health@express.co.uk. Dr Rosemary’s reply will appear in this column. She regrets that she cannot enter into personal correspondence and that due to the volume of letters she cannot reply to everyone. Find out more about Dr Rosemary at drrosemaryleonard.co.uk