I Heart You!

Today is the "Heartiest" day of the year! Happy Valentine's Day to everyone I care about!

And a shout out to President Bill Clinton, who had his own heart issues addressed this week.

I'm nearly into month 5 of my “second round” of life after my heart attack. I have been reading a lot about heart disease and what may have caused my problem, not just to reduce my chances of another "big one", but to understand how others may reduce their risk of this kind of event.

What follows is some research I did online, mostly from Wikipedia (I love that place!)

Ather-what?

Technically, my heart attack was caused by a blockage of the Left Anterior Descending artery which provides about 50% of the fresh blood to the Left Ventricle of the heart. It was most likely caused by an atheroma, which is an accumulation and swelling in artery walls that is made up of cells or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. It is an unhealthy condition, but is found in most humans. The overall result of the disease process is termed atherosclerosis or "hardening of the arteries."

In developed countries, with improved public health, infection control and increasing life spans, atheroma processes (artery hardening) have become an increasingly important problem and burden for society. Atheroma continue to be the number one underlying basis for disability and death, despite a trend for gradual improvement since the early 1960s (adjusted for patient age). Thus, increasing efforts towards better understanding, treating and preventing the problem are continuing to evolve.

According to United States data, 2004, for about 65% of men and 47% of women, the first symptom of cardiovascular disease is heart attack or sudden death (death within one hour of symptom onset.) Read that one again, slowly.

Most artery flow disrupting events occur at locations with less than 50% lumen narrowing (they were not totally blocked before the attack). From clinical studies published in the late 1990s to IVUS (in-the-artery-ultrasound) to visualize disease status, the typical heart attack occurs at locations with about 20% stenosis (narrowing), prior to sudden lumen closure and resulting heart attack. Cardiac stress testing, traditionally the most commonly performed non-invasive testing method for blood flow limitations generally only detects lumen narrowing of ~75% or greater, although some physicians advocate that nuclear stress methods can sometimes detect as little as 50%.

My translation

Most/all people have some atheroma, which begins at a young age. The conditions for a heart attack are difficult to discover before it happens. Most people will have their first indication of heart problems by having a heart attack or dying from it. Our culture lets people live longer, but the lifestyle is conducive to athersclerosis.

Well.

That's not very encouraging.

I mean, if I had been screened, even including a cardiac stress test, they probably would not have found any reason for alarm. I was reasonably healthy. I ran 20 miles each week but was a bit overweight, with a BMI of 29.4, which is the top of Overweight category. Incidentally, to make it into the "normal" weight category, I'll have to lose 30 pounds. I'm shooting for more like 20, given that I do have more muscle from running. Last time I was that skinny, I was, well, pretty skinny.

Back to the whole prevention thing: My diet was pretty high in fats, particularly those from the chicken wing and burger/fries sections of the food pyramid. I also drink wine and beer which we will see in a couple posts drives triglycerides high...but I'm jumping ahead.

Had I been able to get a PCP checkup before the attack, I don't know if they would have seen this one coming. Other than telling me to lose weight, drink less and eat better, I'm not sure I would have received the kind of medical attention or medications that I'm currently taking, or that it would have prevented the heart attack I had in October 2009.

How to lower risk?

I kept digging. Given that you can't necessarily tell if you are likely to have a heart attack, it's best to follow a path of prevention.

Many approaches have been promoted as methods to reduce atheroma progression:
(a) food choices (like eating fish and fish derived omega-3 containing fats),
(b) abdominal fat reduction (which has a significant effect on cholesterol behavior)
(c) aerobic exercise (burns fat, lowers blood glucose, gives you that nice buzz),
(d) inhibitors of cholesterol synthesis (known as statins, like Lipitor),
(e) low normal blood glucose levels HbA1c below 5.0 (Avoid Type 2 Diabetes onset)
(f) micronutrient (multivitamin and magnesium) supplements

It was mentioned that cholesterol is not the villain that causes atherosclerosis. From clinical treatment trials, changing lipoprotein physiology (good/bad mix), and lowering blood sugar levels have proven to have the most dramatic impacts on reducing cardiovascular events and death rate from atherosclerotic disease.

Summary:

- It could happen to anyone
- Not a lot of warning signs in many cases
- Staying thin, exercising and eating the right stuff lowers risk

In the next posting, I'll get into the dirty details about Lipids (eg cholesterol) and factors that influence the mix of so-called “good” and “bad” cholesterol.