Heart attacks aren't just for geezers anymore...

[Nords]

Cut-Throat is laughing as he reads this, but during the recent spate of age 50- & 60-something heart attack stories I was honestly deep-down thinking to my 45-year-old self "Good thing this can't happen to me!"

This morning I got an e-mail from a high-school classmate: "My husband's heart attack was mild, some tightness in his chest and a little of the left arm tingling thing ... occured while he was at work ... he didn't say anything to anyone and aside from popping a few Tums, he stayed at work and went right on doing his project managing thing - he thought he just had some heart burn! Such a stubborn mule! (This is the same man, who 4 years ago, suffered appendicitis and not only stayed home long enough to eat dinner but then insisted on driving himself to the hospital.) We didn't actually discover that he had the heart attack until he went in for his annual flight physical out at the base at the end of February. During the stress test they picked up on the irregular EKG and sent him immediately to a cardiologist, who sent him down to the hospital for further testing. Last week he had a "64 slice CT scan", supposedly the latest and greatest technology. It gives doctors a "3D" image of his heart and they can pinpoint the extent of the damage. He has an appointment with the cardiologist on Thursday to find out the results and where they want to go from here. The worst part is waiting to get the results. His father passed away from heart disease/heart attack when he was 54 (DH is 48), so there is a family history and DH also takes Lipitor for his astronomically high cholesterol level (300+)."

This is a guy who flies with the Air National Guard, gets regular military exercise & checkups, and recently finished a two-week deployment to the high mountains in South America. He's not your typical desk jockey and he keeps up his basketball/football/water sports with three active teenagers. Although he's clearly in serious denial about his genetic burden, it could be argued that he was in great shape and apparently didn't even realize he'd had a heart attack. He's also pretty lucky that he didn't drop dead during the physical's stress test...

I had two shipmates induce their own myocardial infarctions in their 30s, but they were the typical chain-smoking coffee-swilling high-fat/salt-diet only-exercise-during-the-semiannual-PT-test sailors. They survived to reform their bad habits, but this active 48-year-old only has a couple years on me and doesn't smoke. No excuse for ignoring the family history but again I wouldn't have exactly put him on the bleeding edge of the risk curve.

Me? I went a double session (two hours) of tae kwon do sparring last Friday because our sister dojang has four new fighters over six feet tall and they invited me over for a little change of pace. We're all over 180 pounds-- pretty unusual in Hawaii-- and we were shaking the room. I was drenched & staggering by the time we were done but I'm not in denial. Nope. Not me.

It's like we're always telling our teenager... listen to your body.

 

[Rich_by_the_Bay]

We can calculate your likelihood of a heart attack from some basic information (cholesterol and triglyceride panel, gender, fam hx, etc.).

The average 50 year old man has about a 7% chance of one in before he reaches age 60. It's 10% if he smokes. It makes a big differenct taking care of yourself.

 

[Rustic23]

There is a cardiologist in Seattle that wrote a book “Low Carb the New Way”. As a diet book it is ok, but as a heart book I thought it was super. Talked just about as much about cholesterol as it did over weight. Short book and worth reading for most of us.

 

[OldAgePensioner]

58 yo friend of mine is avid (everyday) golfer and health nut. Only fish, lean trukey, veggies, whole grains and fruit. 6'3" about 175-180.

Two hearts attacks, one in 2003 and another end of last year. Not related areas of heart. Zero family history.

Smoked only as a teenager. Drinks wine in moderation.

Is it possible that there really is nothing which will predict your chances. Reason I ask is Ted Kennedy is 90% lard, drinks like a fish and he lives on.

 

[Rustic23]

In the book I mentioned the author says that in his early years of practice he made nightly trips to the emergency room for heart attack patients. He now does ‘preventive cardiology’ i.e. loose weight and take a statin drug. I am not a doctor, and I don’t even play one on tv, but he seems convinced.

 

[OldAgePensioner]

Rustic,
Dr. David Mehlman and Dr. James Rosenthal at Northwestern Medical Faculty Foundation told me exactly the same thing.

1. Lose from 165 to 150 at 5'10-1/2" height.
2. Increase 1 mile run at 15 minutes to 2 miles at 10 minute rate.
3. TAKE STATINS (Lovastatin)

And both agree #3 is the key.

I did ask why Lovastatin and Not Crestor. The answer, "they all do the same thing, it's marketing and smoozing". Older guys as doctors is fun. No need to lie.

 

[Rich_by_the_Bay]

58 yo friend of mine is avid (everyday) golfer and health nut...

Is it possible that there really is nothing which will predict your chances. Reason I ask is Ted Kennedy is 90% lard, drinks like a fish and he lives on.

We can predict your chances very accurately. Not to sound facetious, but the problem is that we can't "know" whether any individual will be one of those 7% or one of the other 93%. Lots of unknown variables, but the predictions are amazingly accurate within that scope.

It reminds me of actuarial life expectancies: astoundingly accurate given enough lives for the insurance company, but less useful for any individual.

 

[samclem]

Nords,
Best of luck to your friend, sounds like he's gettting good care. Of course his flight status may be in jeapardy, but being alive is definitely the most important thing.

 

[poboy]

Had mine at age 41, cholesterol out of sight. Men in my family did not live the long life. I was placed on questran and niacin while in the hospital.  Not long after my "summer cold" as I called it, lovastatin (Mevacor )came out and I was placed on it almost immediately by my cardiologist. Over the years changed to Lipitor and last year Vytorin.  Still take 2 grams of niacin a day. Just turned 62, thus outliving my dad, grandfather, his father. The doctor has my ldl in the 50s and hdl in the 40s.  Hdl was 24 post MI. We may complain about medical treatment costs, but it sure beats the alternative.  I raised so much hell with my younger brothers they finally had lipids checked and they have been on statins. 

 

[Nords]

Of course his flight status may be in jeapardy, but being alive is definitely the most important thing.

What flight status?!? I don't think he's going to get any smiley faces on his physical.

I think he's chewing over his pending survivor's guilt about his ANG unit's upcoming Iraq deployment, too. I'm sure his spouse is ready to kill him by now, anyway.

Typical "guy" behavior...

 

[MJ]

Is it possible that there really is nothing which will predict your chances. Reason I ask is Ted Kennedy is 90% lard, drinks like a fish and he lives on.

One word "genes". That's what I am banking on.
I am taking my Dad out for his birthday this week to celebrate his 95th. He is not as vibrate as he was just several years ago but still lives alone. My fear is getting killed by a tuktuk while riding my bicycle when I begin spending more time in Thailand.

 

[unclemick]

Hmmm

The males go early here - 60's and 70's - usually heart.

Therein - 5% of portfolio this year at 62.

Bon Temps Rolliere!

heh heh heh heh heh heh heh

 

[cube_rat]

Total cholesterol is not as important as ratios (so my cardiologist states). Even though my totals are in the low 300's (since my early 20's) my good cholesterol kicks major butt. The bad cholesterol is VERY low and my triglycerides are typically in the 60's. My liver just makes too much of the stuff. The ratios are controlled with diet and exercise.

My whole family is walking aorund with astronomical total cholesterol levels. We have no history of coronary disease. We have a ton of cancer, but no heart bypasses or heart attacks in my family tree.

 

[OldAgePensioner]

One word "genes". That's what I am banking on.
I am taking my Dad out for his birthday this week to celebrate his 95th. He is not as vibrate as he was just several years ago but still lives alone. My fear is getting killed by a tuktuk while riding my bicycle when I begin spending more time in Thailand.

MJ,
if you see a tuk-tuk with a dude drinkin corona and a couple of fine foxes allowing a guy to reduce their chance of breast cancer, that could be me. Airline fares from SF to BKK are pretty reasonable.

Does thinking about Thai women increase cholesterol?

 

[Rich_by_the_Bay]

Total cholesterol is not as important as ratios (so my cardiologist states). Even though my totals are in the low 300's (since my early 20's) my good cholesterol kicks major butt. The bad cholesterol is VERY low and my triglycerides are typically in the 60's. My liver just makes too much of the stuff. The ratios are controlled with diet and exercise.

That is basically the case. No single parameter seems to be a clear winner. Probably the most accurate ones are a) the ratio of total to HDL (good) cholesterol, b) the LDL alone, and c) the "non-HDL" cholesterol meaning total - HDL. Some people look OK by some parameters, but at risk by others. So, you have to look at the whole picture. When in doubt, I usually go with non-HDL as the tie-breaker.

Statins made our lives alot easier (though much more costly).

 

[wabmester]

Hey, Doc. We're all rich bastids here. Does a more expensive test (like gel electrophoresis to get LDL particle size) have better predictive value?

 

[Rich_by_the_Bay]

Hey, Doc. We're all rich bastids here. Does a more expensive test (like gel electrophoresis to get LDL particle size) have better predictive value?

Alas, no. Any minimal improvement in the assay by any methodology is quickly overwhelmed by the vagaries of the prediction rules. In other words, you get nothing for you money by using the fancier te$t. Useful primarily in research.

In practice we actually don't even measure the LDL - it's calculated from the total chol and triglycerides. that's why you have to fast for it (triglycerides do the roller coaster think when you eat). Even things like CRP, lipoprotein breakdowns, etc. add very little to the basics - not enough to change your recommendation.

 

[Lusitan]

I went in for a physical at 28 and they did an EKG that "looks like you've had a heart attack." Non-smoker, not a big drinker, and in pretty good shape (running 5 miles every few days).

I was stunned, to say the least.

They did an echocardiogram and then said "don't worry about it, your echo is fine and it's just an abnormality in your electric signals".

While I've tried to take that advice to heart, I must admit it still worries me ...

Ah well, not much we can do about some of that stuff other than keep ourselves healthy ... all the more reason to not stress about having tons of $ and be sure that we enjoy life while we have the chance!

 

[73ss454]

When I was around 36 I went for a Thalium stress test and I also was told I had a prior heart attack.

I went and bought a whold life policy and paid a premium for it because of the prior heart attack.

After paying the higher premium for all these years I find out about 4 years ago that I never had a heart attack. When I asked the Doctor what about my prior heart attack he looked stunned and asked me what I was talking about.

Glad I never had a heart attack but not happy about the extra premiums.

At 57 (this month) I think I'll cash in the whold life policy and put it in the pot.

 

[REWahoo]

When I was around 36 I went for a Thalium stress test and I also was told I had a prior heart attack.

Now you know why they called it a "stress" test. I know, not funny...

 

[MJ]

MJ,
if you see a tuk-tuk with a dude drinkin corona and a couple of fine foxes allowing a guy to reduce their chance of breast cancer, that could be me. Airline fares from SF to BKK are pretty reasonable.

Does thinking about Thai women increase cholesterol?

OAP, it increases something but what I just can't imagine.

 

[mark500]

Must interject information about the latest blood lipid test. The newest lipid profile is called VAP.

http://www.atherotech.com/

No, this is not an ad, and I do not own stock in the company. But I do have high cholesterol. This newer test gives a much more detailed and useful analysis of serum lipids.

 

[califdreamer]

Must interject information about the latest blood lipid test. The newest lipid profile is called VAP.

http://www.atherotech.com/

No, this is not an ad, and I do not own stock in the company. But I do have high cholesterol. This newer test gives a much more detailed and useful analysis of serum lipids.

I've been getting the VAP test for the last year or two and it certainly gives you a detailed look at your lipid profile. It can give you some peace of mind since the media is always coming up with new risk factors for heart disease (elevated homocysteine, C-reactive protein, size of LDL paticles, etc.).

With a little help from my friend Lipitor, I appear to be safe. We have family history of high cholesterol and heart disease so, before Lipitor, I ate all kinds of stuff with insoluble fiber and cut back on sat fat and trans fat... but I couldn't quite get the numbers in the low risk range... always a little borderline. Now TC at 140, LDL<100, etc.

Knowing all of these numbers doesn't make you bullet proof by any means. There is debate about significance of risk factors (for example, some think C-reactive protein level accurately signals level of dangerous inflammation, others don't think it tells you much). Another example, homocysteine level. Usual advice for hi homocysteine is to take folate/B6/B12 supplement but new study shows that may decrease homocysteine level but does not lower risk. Could be that hi homocysteine is not a cause of but rather a marker of heart disease.

Can also give you data that you can't do anything about. For instance, small, dense LDL is risk factor but I don't know how someone would go about changing that.

Overall, good to have data but it's no panacea.

 

[audreyh1]

Did you mean to say soluble fiber? It's soluble fiber that helps absorb excess cholesterol in the intestines and thus lowers LDL. Insoluble fiber doesn't help at all.

Audrey

 

[youbet]

I've been following this discussion with great interest.  Two months ago, family doc saw something he didn't like on an EKG during a routine physical exam.  He sent me for a nuclear stress test.  The nuclear stress test showed a suspicious area while active, but everything normal at rest.  So, I went to a cardiologist.  Given my age, history and other numbers (borderline high bp and cholesterol with no meds), he suggested an angiogram.  I had the angiogram yesterday and the conclusion was that the nuclear stress test was a false positive.  Now the cardiologist is putting me on bp meds and a cholesterol lowering drug to help me move from borderline to good for those readings.  And, of course, whipping me to exercise, loose some weight and cut back on the booze (darn! ).  It's been an interesting few weeks, just prior to ER, and I'm releved not to be starting early retirement with a quint bypass or something like that.