DEAR DR. ROACH: I would like to ask you a basic question about COVID-19 booster shots, since no health authority seems to answer it directly. Why should I get a booster if the booster is based on the original alpha version of the virus from more than two years ago?

Even if the booster shot were based on the delta variant, that variant passed through a long time ago. I had my two main Pfizer shots last summer while delta was raging, but now that the virus has morphed into weaker variants, the booster shot does not seem relevant or necessary. People are back to doing things in large groups, and if you get the virus, most likely you’ll get just mild, cold-like symptoms. So, why get a booster shot now if it won’t be effective against current variants? — M.B.

ANSWER: You should consider a COVID-19 booster because it still provides protection against serious illness. People with at least three doses of the mRNA vaccine (Pfizer or Moderna) have more than 99% protection against disease serious enough to require hospitalization. People who have not been vaccinated at all are still dying of COVID, and among survivors, persistent COVID symptoms can be activity-limiting.

At the time of this writing, BA.2 is the dominant subvariant of omicron, but BA.4 and BA.5 are gaining ground. The vaccine manufacturers are working on omicron-specific vaccines, as well as working on vaccines that are intended to be effective for all variants. Preliminary data on the omicron-specific vaccines show there is incremental benefit. For now, we are left with what we have, and these are still effective.

DEAR DR. ROACH: My total cholesterol levels in the past five years have ranged between 216 and 250, with LDL between 75 and 90, and HDL between 118 and 156. Medical professionals have remarked about the HDL numbers being so high. That has led them to assume that even though I have a family history of heart disease (both parents), because my HDL is so high, I am somehow “protected” or at a lesser risk of heart disease or heart attack. My mother had a high HDL but still needed bypass surgery. Despite that, my current primary care put me on 5 mg of Crestor, then switched me to 10 mg several years ago. I have tolerated it well. I am now 75 and in really good health, taking only rosuvastatin.

I was hoping you might have more information about HDL and what it means to my health. — S.M.

ANSWER: High levels of HDL cholesterol are normally associated with low risk of heart disease. I suspect you have a variant type of HDL cholesterol that is not protective against heart disease. It’s uncommon but not rare.

Your case shows the need to look at the whole picture. Family history is not in the major guidelines for predicting risk, but with your situation, there is a disconnect between your cholesterol numbers and your family risk. I am not sure if your primary care doctor was aware of these families with high HDL and high heart disease risk, but I agree completely with the treatment with a statin drug.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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