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Q I have recently started taking statins to reduce my cholesterol and note that it is recommended that they should be taken in the evening as cholesterol is produced by the body during the night. Would Benecol drink (and other products) also be more beneficial if taken at night time? Julie Martyn, Oxford

A Statins are more effective if taken in the evening because as you rightly say more cholesterol is produced by the body during the night and early hours of the morning. This is only a marginal effect. One of the side effects of the statins is that they may disturb sleep by either causing insomnia or bad dreams. If a patient is suffering from these common side effects they should take their statins early in the morning, rather than at night even if it results in having to take a slightly larger dose of statins. All statins have slightly different side effects and their power per milligram differs. By changing from one type of statin to another it might be possible either to avoid sleep disturbance as a side effect or having to take a larger dose.

The reader should ask her doctor's advice about taking Benecol and other products. I would suspect that in order to derive the maximum benefit it would be ideal if the time of taking Benecol could be varied according to the nature of the menu enjoyed by the reader at different meals. Some non statin cholesterol lowering drugs such as Bezafibrate are taken three times a day whereas Benzalip Mono is a slow release tablet and is taken once a day in the morning. Colestyramine is taken in increasing doses at variable times throughout the day and likewise so is the similar preparation Questran.

Q I am 69, retired three years ago and was diagnosed twenty months ago with two vessel coronary artery disease with normal LV function, CX - mild diffuse atheroma, severe stenosis (90%) proximally in OM2 and RCA - mild diffuse disease, severe stenosis (80%) mid-vessel.

Since then I have continued a regular exercise pattern of 40 minutes power walking five times per week and have eaten very sensibly. I only drink alcohol two times per week - three units each time. I have medication of 40mg of simvastatin and a precautionary BP tablet every day - also 75mg of soluble aspirin which I have taken for 15 years. My cardiologist does not recommend stents as there are no symptoms other than a high risk EBCT scan and a subsequently abnormal ETT at 7'30" Bruce with ST-changes but no symptoms.

On August 24 I played a game of golf on a course with a severe gradient and had to stop because of exhaustion after fifteen holes. My heartrate until 11.30pm continued at 84 beats per minute (normally 60) and I was exhausted the next day and even somewhat the day after. Would you think that this was a symptom of my condition as above and/or would stents help in the short or long term? Name and address withheld

A The reader has already achieved the first goal of anyone suffering from heart disease. They know that they have it, they know its extent and they have obviously obtained the advice of a good cardiologist. It is impossible to lay down hard and fast rules or be didactic about treatment for it is not a question of one size fits all but of bespoke tailoring treatment to the patient. Although the degree of the obstruction in the reader's coronary arteries is rather greater than that of my wife we had very similar decisions to make in her case. She had had symptoms. The first teaching hospital opinion was that she should have an immediate bypass, the second was that she should have stents fitted. Finally the tertiary referral centre, one of the most prestigious hospitals in the country who carried out very esoteric tests, suggested that her prognosis would not be improved at this stage by either stents or surgery and that she should have intensive medical treatment (pills). She has taken their advice and has now been symptom free for eighteen months.

The reader's last description does show that he is now developing symptoms. Both these symptoms, the prolonged period of irregularity of the heart rhythm during exercise and the extreme exhaustion may be induced by myocardial ischaemia - coronary insufficiency. That is to say the coronary arteries may be no longer supplying an adequate supply of blood to do their job. This reader should go back to his GP and cardiologist and obtain his or her opinion. They will then, amongst the general review of this case, decide whether he should play golf. I wouldn't recommend it.

3. My dearest brother has just been told that he has high blood pressure and was put on a pill right away. Could you please explain in depth blood pressure as he knows nothing about it and his doctor did not explain it very well, just said he needed to take this pill for the rest of his life. He is a smoker also and that worries me. Thank you so very much. Elma, address withheld

A If the heart didn't pump blood out at a certain pressure it wouldn't be pumping the blood around the body to all the essential organs that needs the oxygen and other nutrients carried by the blood. Blood pressure is measured by two figures, the systolic pressure which is the pressure in the blood vessels when the heart is contracting, and therefore the pump is pumping, and the diastolic. The diastolic pressure measures the residual pressure within the arteries when the heart is relaxed. The systolic pressure is the figure on top of the fraction, the diastolic the lower figure underneath.

Patients are encouraged to have a blood pressure of under 130/80. As the small arteries, the arterioles, narrow because of loss of elasticity and a general furring up the blood has to be pumped at a greater pressure if it is to pass through them. Pumping the blood more vigorously puts a strain on the heart. The heart initially grows bigger and more muscular to achieve the same ends but eventually no further adaptation can take place and it begins to fail. Similarly raised blood pressure is associated with arterial troubles that result in the essential organs receiving an inadequate blood supply.