Heart disease covers several conditions which affect the heart. This includes ischemic heart disease, heart failure, heart arrhythmias, heart valve issues – this list is not exhaustive. Causes of heart disease often include a history of high blood pressure, smoking, high levels of bad cholesterol, low levels of good cholesterol, a sedentary lifestyle, drug abuse, genetics, and other diseases. For my wife’s father, a virus attacked his heart leading to heart failure and eventually death. The list of causes in developing heart disease are long. Knowing the warning signs can be the difference between life and death, affect the quality of your life and impact family members as well. From the CDC:
Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for more than 35% of all deaths. More than 870,000 Americans die of heart disease and stroke every year, which is about 2,400 people dying every day. Although these largely preventable conditions are more common among older adults, more than 148,000 (17%) of Americans who died of cardiovascular diseases in 2004 were younger than age 65 years. Heart disease and stroke also are among the leading causes of disability in the U.S. workforce. Nearly one million people are disabled from strokes alone.
Wow, what a difference a year makes. As many of my readers will notice, I have been given a top blog award from disease.com. I am pleased this blog is recognized as helpful for those suffering from heart disease. That is my goal and continues to be my goal.
Updating has been sparse of late, partially due to other demands on my time. However, I actually do plan to begin paying this blog more attention and although I believe the current information to be quite comprehensive, there is always the latest news and breakthroughs that I would like to begin covering once again.
My last appointment with my cardiologist was last week. It has now been 18 months since my last stent, and 6 months since my last stress test. I am overdue some blood work and I intend on addressing that issue after the holidays when I get a chance to lose some of the weight I know will gather about my waste. Until then, have yourself a wonderful Thanksgiving, merry Christmas, and a happy New Year.
I consider the pastor, Larry Coulter, an influential, inspiring and entertaining speaker. His presence can lift even the lowest of spirits and his sense of humor hints at the possibility that had he not chosen being a pastor, he could have ranked among the best of comedians.
From PTCA.org comes an excellent article converning the use of IVUS (emphasis mine):
A study, published in the current issue of JACC Interventions, details 120 drug-eluting stent cases as viewed by intravascular ultrasound (IVUS) in order to examine characteristics that may lead to in-stent restenosis (ISR) or stent thrombosis.
Underexpansion of stents, both drug-eluting and bare metal, has been long identified as a significant predictor of adverse clinical events. Prominently discussed by Dr. Antonio Colombo in the early days of stenting, inadequate expansion of the stent struts is known to increase these problems.
Fractional Flow Reserve, or FFR, is a guide wire-based procedure. Its utilility is that it can accurately measure blood pressure and flow rate through a specific part of the coronary artery. Is is performed through a standard diagnostic catheter during the actual coronary cathaterization. Using Fractional Flow Reserve, the interventinalist can assess whether or not to perform angioplasty or stenting on “intermediate” blockages – blocakges that may or may not cause angina symptoms or lead to serious ischemic events.
The entire point of using a stent in the coronary arteries is to increase blood flow to the heart. However, a number of studies have shown that if a “functional measurement”, such as Fractional Flow Reserve, indicates the flow is not significantly obstructed, the blockage or lesion does not need to be revascularized (angioplasty) and the patient can be treated safely with medical therapy.
The Interventinalist’s tendency to stent is well documented. Some more aggressive than others. In the case of my cardiologist, if he notices a blockage of 75% or greater, he will stent it. Some cardiologists will stent a 50% blockage. But what if FFR indicated that an intervention won’t have a significant impact on a particular blockage? Being able to better select cases not only saves health care costs, but contributes to more appropriate patient care.
I can only say, “Thank you God”. It seems like being put on the prayer list at my church really worked a miracle. Only two minor blockages were noted on my heart nuclear stress test, something of little significance, especially given my diet for the last four months. Steaks, hamburgers, nachos, cheese, Scotch – you get the picture.
My total cholesterol did increase from 99 mg/dL to 141 mg/dL, with my Triglycerides topping out at 197 mg/dL (140 is the maximum). HDLs were 44 (they were 41 last time). LDLs were 58 (they were 33 last time). CRP was still very low at .3 mg/L (anything less than 1 is great).
My kidney function was off (creatinine of 1.54 mg/dL and eGFR of 50L). Creatinine should top out no higher than 1.34 mg/dL, but I have often seen numbers higher than this. This is the first time for an eGFR measurement and it registered low (it should be greater than 60L). My physician did not seem too concerned, given that I lifted weights the day before and was taking my wife’s Naproxen for a pulled muscle for the week previous to the test. I concluded after studying eGFR lab online in medical journals that it is on shaky ground as far as viability is concerned. My physician’s greater concern was my A1C – a measurement of the average blood sugar for the past 6 months.
If you are a reader of this blog, you will recall my last stress test was, in my opinion, poor. It was taken six weeks into my cessation of testosterone therapy with no attempt to renormalize my testosterone levels. I only made it ten minutes, which is 5.5 minutes less than my best. However, I passed the test. When my performance was the best, I failed. Go figure.
This time I made it 13.5 minutes, two minutes shy of my personal best and post testosterone renormalization. I won’t know the results for a week, but fingers are crossed that I won’t be in for another angiogram and possible stent.
Also, this week I should receive the results of my latest set of blood work. As soon as I know, I will post them here.
Hoping, hoping, hoping.
From CBS News:
How do you treat something that has no symptoms and goes undetected on standard screenings?
DE-CMR (delayed enhancement cardio magnetic resonance) is a new cardiac imaging technique that can detect if you’ve suffered a silent heat attack, which an earlier EKG might have missed.
Early Show medical correspondent Dr. Jennifer Ashton shared this new method of detection with Early Show co-anchor Julie Chen.
According to Ashton, a silent heart attack is “both silent and potentially deadly,” which is “very scary” because there are no typical signs like chest pain or shortness of breath.
“You as a patient might be unaware that you’re having one and it doesn’t leave its signature on the EKG after the fact so your doctor might not be able to tell that you’ve had one,” she explained.
Update: In the comment section of this blog, reader Angus asks what supplements I do use. I mention N-acetyl-cysteine (NAC) due to its proven liver protection. I would also like to add to that Resveratrol – basically the stuff you find in red wine but in a pill so you don’t need the alcohol. It does have a great deal of supportive evidence for cardiovascular health, but I would talk to your doctor before trying it just to ensure it will not interfere with current medications. I have noted a slight increase in blood pressure (about 3%-5%). I have tried various brands and have found them to be similar in terms of an increase in exercise tolerance. The only real difference seems to be the price. Some of it costs $80 a bottle, some are less than $50 a bottle. It has been featured on 60 minutes, Oprah, CNN, and a host of other channels. A Harvard study heralded Resveratrol as the best thing in medicine since antibiotics.
Almost everyone believes the main purpose of statins is to lower cholesterol and this lowering reduces the risk of a cardiovascular event. However, how do we explain heart attack victims with normal cholesterol levels? While there are many culprits, one of the main areas of interest is C-Reactive Protein, or CRP for short. Measuring your CRP level can be a good indicator of inflammation, and inflammation leads to unstable plaque. So what if you could lower your CRP levels and stabilize your plaque? Your chances of a cardiovascular event decreases significantly. Read Decreasing Markers Of Inflammation Is As Important For Statin Action As Decreasing Ldl Cholesterol (Jupiter Study). From Medical News Today:
A follow-up study on the JUPITER* trial has revealed that a key component of the action of statins is reduction of high sensitivity c-reactive protein (hsCRP), a marker of inflammation, as well as reducing levels of bad cholesterol. The findings are published in an Article published Online First and in an upcoming edition of The Lancet. Publication of the Article coincides with the announcement of the findings at the American College of Cardiology (ACC) meeting in Florida, USA.
Present guidelines for statin therapy emphasise the goal of reducing LDL or ‘bad’ cholesterol. However, statin therapy works best in the presence of inflammation, which is characterised by increased concentrations of the biomarker hsCRP. It is thought that reducing levels of hsCRP helps prevent inflammatory cell adhesion – the process by which inflammation promotes cells sticking together and forming plaques in arteries. Reducing hsCRP could also help by preventing these cells sticking to the endothelium (or inner lining) of the artery, and favourably affect metal-containing enzymes key to plaque stability.
I still recall the days when the reputation of statins was stained by alternative medicine and even some doctors. I also recall listening to those “reports” which showed that taking more of this or that vitamin or herb would have the same effect. Listening to junk science is why I am in the situation I am today. While I do agree there is some evidence for alternative therapies to treat various illnesses, the lack of FDA control on the quality of these supplements amounts to a patient playing Russian Roulette with their health. That is why I do quite a bit of research and self-testing prior to settling on a brand. For NAC I use the GNC brand and Resveratrol Select is my choice or Resveratrol as it provides excellent benefits for less cost than Resveratrol that has some doctor’s endorsement – which basically means they are getting paid to promote one product over another and that cost is being passed on to you.
I am also aware that statins are not for everyone. However, if one heeds the warnings and regularly checks their liver function, statins are safe. I am far more concerned about the Plavix I am on and any future non-elective surgeries I may require than I am about Crestor. Also, if you read My Story, you will note that my CRP levels are extremely low – .5mg/L, with anything less than 1mg/L considered low.
So don’t listen to the negative talk from so-called experts who are out to sell you their latest non-prescription cure for your ailment without doing a lot of research first. In my opinion, there is nothing wrong with adding an alternative approach as a complement to medical therapy as long as your doctor is aware of any other supplements you are taking. Don’t play around with your health, or you may not have it for long.
It certainly has been awhile. It is good to be back.
A lot has been happening and I know some of you are interested in my current status. As far as my latest testosterone measurements, taken 1 month after stopping the oral medications Clomid and Nolvadex, was 550 ng/dL. Not trusting this number and knowing that increases in my testosterone levels have been accompanied by increased liver enzymes in the past, I asked to be re-tested. However, a severe cold held off the latest blood test until yesterday. This time I am checking my testosterone, liver enzymes, kidney function, C-Reactive Protein, lipid profile, thyroid, vitamin-D, and a few other tests. I should have the results back in two weeks.
Meanwhile, next week on Friday I have a cardiac nuclear stress test. If I pass it, it will be 8 months since the placement of my last set of stents. My cardiologist is taking an 18 month sabattical and assisting a poor area in El Paso, TX to build a cardiology community.
For me, that meant going on a search for a new cardiologist. My previous cardiologist suggested one of his partners. This is my first option. My own research lead me to two well respected cardiologists in the Austin area. No surprisingly, they were unhappy with my number of stents, saying that most of them were probably not medically necessary. However, they both agreed that some cardiologists are more agressive than others with the use of stents.