Cardiovascular Health

#2032

He spent two hours with me!!!). But this is one thing he didn’t go over in detail.

For clarity, I’ve never had a bad ekg (no one has ever said a word, but I assume if it were bad, I would have heard something). So, I assume this is just degrees of good.

Also, he said my results from my 2022 stress test were impressive (yay)…

He said he sees that most of my plaque is in my right ventricle (I have no idea if there is any significance to this).

I talked to him at length about doing the CLEERLY CCTA.

My brother’s cardiologist said he didn’t recommend it because the plaque affects their ability to see. My internist said the same thing.

I was still thinking that perhaps it’s still a good thing to consider because at worse it’s not useful, but at best it could be lifesaving. He explained the downside of doing it with a heavy plaque burden. First there is the radiation that we all know about (I don’t know how big of a deal this is, aside knowing less is better).

He said my CAC was almost 500 a decade ago, so we know it’s going to be somewhat worse now. When the machine doesn’t have a clear view, there will often be false positives… meaning, it will mistake it for a lot of soft plaque and narrowing (he explained this in a much more technical way that I wish I could repeat to you).

He said when we see that, we have to er on the side of caution and do an angiogram which has risks… and I might have put myself at risk for no reason.

I’m still not sure what to do… if anyone has opinions on any of this, by all means do chime in.

Here is a question about a stress test for you. He does want me to do another stress test in 6 months. He wants it to be with an ultrasound instead of nuclear just to limit exposure. If we are hiking etc and have no shortness of breath, it was my impression that we are doing our own form of a stress test and don’t need an official one. If you are doing a yearly test, I’ll assume there is value…can you explain that to me? I don’t mind doing it other than trying to save the money if there is no benefit.

@AnUser yeah, what Adssx said :slight_smile:

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#2033

The stress test is part of the package I get with my concierge. There is no image. He puts on I think it’s 12 leads and gets a panel of ecg’s. He watches them as I do a 15 minute ramp up on the treadmill (Bruce Protocol if you want to try it). It ends with a run at 22 degree angle and he insists I get my HR to 140 I think. I have no problem usually I can go to 160. I think by looking at this he can tell if my heart is not being fed well enough.

I’ve been doing it for 10 years at least and I think if I’ve been running and I’m in good condition it’s harder to get to the HR he wants to see. If I’ve been in the field too much and not getting exercise I can get it right up there. The heart must have ways of being more efficient as you improve condition.

It sounds like maybe I’m not getting a stress test? Certainly not a nuclear.

I was worried about the contrast on the cleerly. It turns out to be iodine, not so bad. For some reason I thought the CCTA was MRI. It’s CT, so x rays. This makes me a little less worried about it. The MRI would use gadolinium which (to me) seems a little more dangerous. The reading I have done for my daughter, since she is imaged with CT every 3 months for the cancer, is that before a CT you should megadose with melatonin. It can help prevent damage from the x rays. She has been doing this. She does a couple hundred maybe a half hour before.

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#2034

Sorry for what your daughter has gone through :frowning:

Excellent tip on melatonin! I wouldn’t have known.

Ha, about when you are in the field too much you aren’t getting enough exercise!! You must be in fantastic shape because a day in the field would be all the exercise I could handle!!

You are definitely getting a stress test… there are just various optional add ons. I’ve done that version as well. I imagine if you showed anything concerning, then they would have you do another one with more imaging. Also impressed you are getting that yearly from your concierge doc… I get nada :slight_smile:

In 2022 I had experienced a brief period of more strenuous breathing, so UCSF cardiology did a very intensive work up to be extra cautious because they had been seeing so much heart stuff from covid… and yes, a little from the vaccines. As far as I know, I’ve never had covid, so maybe it was from the vax or just life… either way, they didn’t find anything and I was already fine by the time I had my work up.

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#2035

I’d research if it’s possible to have LDL-C/APOB between 1-19 mg/dl and if there’s a net benefit of that.

Eugene Braunwald might be doing this in his practice.
Heard about it on this podcast:

questions is how low do you go um that is um you know Eugene Brown Wald who we all know and love they’re in Boston he’s last time I got together with him he was getting his LDL down to close to zero with various tactics that might be extreme

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#2036

THX… my ldl c is 38 and apob is aprox 42

I have a pretty great diet, on repatha, ezetimibe, and bempedoic acid, so I’m not sure it’s in the cards for me to get my numbers any lower, at least with anything I’m aware of? I’ll google him, though!! Thx

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#2037

I would wonder if there’s a net benefit to have like 5 mg/dl and 5 mg/dl apoB in your scenario. Do we have data on this? I don’t know.

You’re not taking statins and other drugs are on the way.

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#2038

I really appreciate this comment. In medicine and public health there are so many modeling studies that are absolute nonsense but are treated as meaningful. It is frustrating.

There is much to be said about the limitations of the linear no-threshold (LNT) model, for instance. If one does not understand that, one is not really in position to evaluate the limitations of the study.

But your point about pilots and flight attendants is well-taken. This simple observation should have prevented the study from being published in the first place.

In any event, most modeling studies, if one digs in, amount to this: we input into our model the assumption that X is harmful at rate Y, and lo and behold, our model shows X is harmful! Science, baby!

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#2039

Hey Beth, my opinion (though I’m not a doctor, cardiologist etc)

In your case, I don’t think there is too much point doing more diagnostics, since you are symptom free and already very proactive with managing risk factors. As you know, your previous CAC can only get worse, so the question is - what use would updating the number give you? If it’s gone up to 550, 600, 800, 1,000 - how would that meaningfully change your current plan? Would you do something different if the number came back as 1,000 rather than 550?

Same for the angiogram, which is invasive and does have some (small) risks. The benefit of that test is that if you actually do have artery stenosis (narrowing), they could potentially stent it. That is primarily done for a patient when they have chest pain during exercise, and the stent opens the artery and provides symptom relief. Whether it reduces risk of heart attacks is still up for debate. But, you did a treadmill test with no ECG changes (thus, no obvious inducible ischaemia), and you go hiking without any chest pain or shortness of breath. So I’d argue that you are symptom-free. And again - it’s not clear how knowing you have a 10%, 40% or 70% occlusion would change your treatment plan.

Your LDL of 38 and ApoB of 42 are really good numbers, and you’re on multiple methods of lowering - each of which has “other” benefits like lowering inflammation. Combined with good diet, not smoking, and exercise, I think you’re doing everything you reasonably could. I assume your blood pressure is well managed?

I recall from a previous post that your Lp(a) is also high (mine too). When those drugs come onto market, of course you’ll want to get on them ASAP.

You could go for even lower ApoB, but I assume that could only come from increasing the doses of the medications, and the potential side effects, which would have to be balanced against ApoB lowering. Do I read it right that you’re not taking any statin? If so, that would be the one remaining option which is still on the table.

IMO Eugene is a very credible person, with a long history of research and top publications in this field. So I would weight his opinion quite strongly. However, I think you need to think about the methods of achieving this, which can only really be done by higher doses of multiple medications - each of which has their own potential side effects.

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#2040

What do you think about having a LDL-C or apoB of 0 mg/dl? Based on everything we know you shouldn’t fall over dead and the people with hypobetalipoproteinemia (LDL = 0) has no plaque or MI secondary to plaque rupture, but disease correlated with the low levels (related to affecting synthesis in e.g gut, fat soluble vitamin deficiencies). Liver would really get rid of all of the apoB particles maybe before e.g apoB48 could do its job?

I mean we will know eventually as CETP inhibitors come online to stack on top of existing treatments, specifically obicetrapib. Someone will run such a trial for sure right?

Since 99% have calcified plaque around 70 years old I’m thinking it’s plausible LDL-C or apoB needs to be even lower for plaque to be stopped than below 5th percentile LDL-C or apoB.

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#2041

I just had an acquaintance who dropped dead of a coronary. He looked great with no symptoms and then sudden death. No one saw it coming. He was in his 70s, so probably the normal cardiovascular disease men have at his age did him in.

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#2042

What do people here think of egg consumption? Lately I’ve been eating hardboiled and softboiled eggs. I take psyllium husk in water prior to eating them as I saw some evidence it can stop uptake of cholesterol.

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#2043

Eggs do have cholesterol. Dietary cholesterol is a health negative in susceptible individuals. Psyllium is good in general (as long as you get the one not laden with lead and other heavy metals), but to counter egg cholesterol you’re probably better off with ezetemibe.

Eggs seem pretty nutritious, but I would not overdo them (2 eggs a week max), on account of very high methionine.

However not all eggs are created equal. There are some with higher omega-3 content, if you’re looking to minimize saturated fat intake (I’m very focused on that).

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#2044

That’s unfortunate. Could also be A-fib. But you’re right, likely atherosclerosis. You wouldn’t know if he was on any medication? Many people take foolish pride in not taking any meds, or are simply not aware of MACE dangers, because they “feel great” meanwhile they have extensive atherosclerosis and high BP.

You have one body. If it cr@ps out, it’s game over. So learning to take care of it should be priority number one. Instead many folks put more effort into reading household appliance user manuals than learning how their bodies work. Obvious to us who frequent this site, but look at our subscriber numbers vs most game or entertainment sites.

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#2045

Ezetemibe huh. I’ve had my eye on that. From my understanding psyllium husk acts as a weak natural form of that so I’ve been increasing my dose of this.

I guess the 5 hardboiled eggs I had today was a bit much haha.

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#2046

Well, you could go with the egg industry funded studies approach. They found that increased egg consumption did not elevate serum cholesterol. All you have to do is show that if you are eating 4 eggs a day, adding a fifth egg does not further increase your cholesterol compared to just eating the four. That way you can state that ”increased egg [beyond the four] consumption did not [further] elevate blood cholesterol [which is now sky high due to the first four eggs]” - of course you don’t use the words in square brackets :nerd_face:.

So if you’re consuming two, three, or four, you can “safely” throw in a fifth😭.

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#2047

I put it on top of a bed of rocket and drizzled on some EVOO if that makes Bryan Johnson feel better lmao.

image

I’m going to strongly consider ezetimibe. I’m assuming you take that? Have you noticed any side effects or positive effects?

I also am curious what you think of fat free yogurt? I’ve been doing fat free yogurt mixed with vanilla whey protein, hyaluronic acid and psyllium husk with added blueberries most nights.

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#2048

Re: ezetemibe, I’m actually running a n=1 experiment, where I’m comparing head to head the following combinations (1) statin alone {pitavastatin 4mg/day}; (2) statin + bempedoic acid {180mg/day}; (3) statin + ezetemibe {10mg/day}; (4) statin + bempedoic acid + ezetemibe. Each intervention is 6-8 weeks long, with extensive blood tests looking for impact not just on blood lipids, but a whole slew of biomarkers. It’s pretty pricey (tests at LabCorp) and time consuming, but in a few months and a few thousand $ later I should have some pretty definitive data. I’ll be happy to report them here pour l’éducation de folks who are interested. It might however be more relevant to me, but possibly of general interest.

Re: fat free yogurt - I approve with qualifications. In general, fermented foods are a win, but some caution for people who may have subclinical dairy sensitivity (and without symptoms you might be unaware), which is pretty common - a low level inflammatory state, not good. I would substitute soy or pea protein for the whey (amino-acid profile), but otherwise fine. Some limited evidence that the very common practice of adding berries to dairy is suboptimal, on account of dairy protein possibly binding to the fruit polyphenols rendering the latter less effective (though likely not as bad as mixing banana with berries). And of course, yogurt without added sugar or artificial sweeteners.

And good that at least you’re consuming the eggs with some healthy veggies and EVOO. Let us remember, that we have to see diet in its totality, rather than focusing on individual foods. Amounts, frequency and other nutrient interactions all add up to the final health effects.

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#2049

It’s more than I eat for the whole month! :grinning:IMHO so many eggs will increase your cholesterol. I would remove yokes in half of them.

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#2050

I’d certainly be interested.

I have reduced fatty red meat intake and replaced it with lean chicken. Increased greens. Increased fiber.

Never tried plant protein but I’ve heard they are quite high in heavy metals unless you’re careful.

I don’t eat this many all the time. Sometimes I don’t eat them for months. Removing yolks seems like a sin lol.

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#2051

Yes, plant protein powders can have heavy metal contaminants and not only - all kinds of added junk, salt, sweeteners, flavoring etc. In fact, it’s hard to find decent quality powders. I consume soy and pea. My go to brands are Now Sports Soy Protein Isolate and Folona SOLO Organic Pea Protein Isolate.

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