Looking and feeling fit, don't be fooled

From the medical literature - bold is mine 1: Atherosclerosis. 2007 Jun;192(2):235-42. Epub 2007 Apr 30.www.ncbi.nlm.nih.gov/.../http:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif Links Screening patients for subclinical atherosclerosis with non-contrast cardiac CT. Ardehali R, Nasir K, Kolandaivelu A, Budoff MJ, Blumenthal RS. Stanford Hospital, Division of Cardiovascular Medicine, Stanford, CA 94305-5233, United States. rardehali@cvmed.stanford.edu Accurate risk assessment may be helpful in decreasing cardiovascular events through more appropriate targeting of preventive measures. Traditional risk assessment may be refined with the selective use of coronary artery calcium score (CACS) or other methods of subclinical atherosclerosis measurement. This article reviews information pertaining to the clinical use of CACS for assessing coronary atherosclerosis as a useful predictor of coronary artery disease (CAD) in certain population of patients. Coronary calcification is a marker of atherosclerosis that can be quantified with the use of cardiac CT and it is proportional to the extent and severity of atherosclerotic disease. The published studies demonstrate a high sensitivity of CACS for the presence of coronary artery disease but a much lower specificity for obstructive CAD depending on the magnitude of the CACS. Several large clinical trials have found clear, incremental predictive value of CACS over the Framingham risk score when used in asymptomatic patients. However, early detection of CAD by Electron Beam Tomography (EBT) screening has not convincingly demonstrated a reduction in mortality and morbidity. Nevertheless, relevant prognostic information obtained may be useful to initiate or intensify appropriate treatment strategies to slow the progression of existing atherosclerotic vascular disease. Current data suggest intermediate-risk patients may benefit most from further risk stratification with cardiac CT, as CAC testing is effective at identifying increased risk and in one study motivating effective behavioral changes. Randomized clinical trials will help determine if selective use of cardiac CT in the intermediate-risk patient would lead to more appropriate use of pharmacologic therapy and improved clinical outcomes. PMID: 17467714

Nevertheless, relevant prognostic information obtained may be useful to initiate or intensify appropriate treatment strategies to slow the progression of existing atherosclerotic vascular disease. Current data suggest intermediate-risk patients may benefit most from further risk stratification with cardiac CT, as CAC testing is effective at identifying increased risk and in one study motivating effective behavioral changes. Randomized clinical trials will help determine if selective use of cardiac CT in the intermediate-risk patient would lead to more appropriate use of pharmacologic therapy and improved clinical outcomes. I think this is the take home message. The problem with cardiac CT is that it can lead to additional, possibly unnecessary, studies.

I've had a pretty wretched, heart-unhealthy diet for years and the lipid profile to show for it (total chol 309 at one point; ldl over 190). The good HDL was highish, from swimming and too much booze. When I tried to eat a better diet, the total and the LDL went down a bit, but the HDL went down more, leaving me with a worse ratio than ever, not to mention a sense of life misery that comes from having to shun the foods you've grown up loving. Like most Americans, I couldn't sustain this long term. The one good think I have done for myself is consistent masters swimming over the last 23 years. Drinking probably helped the HDL stay high, but had other less beneficial effects, and so I quit this. I have undergone two coronary calcium scans for magazine articles. One doctor said he had seen very rare scores as high as 10,000. I was convinced that given my high cholesterol, I would have at least this record beat--and possibly they'd find that instead of a beating heart inside my chest cavity, a quivering bowling ball made entirely out of calcium. To my amazement, my score was zero. Five years later, in my early 50s, I had a repeat test out a UCLA Harbor. The doc figured that with age alone, I should show some modest increase in calcium. But again my score was zero. These tests are controversial, but researchers in favor of them suggest that the age-graded scoring is not just a risk factor of atherosclerosis, it's actual proof for atherosclerosis (the hardening in hardening of the arteries is calcium). The bottom line, from this layman's perspective, is that there are a myriad factors that go into whether person X with get heart disease. You can be doing everything right, and chances are you're heart will do well too--but not always. The flip side is also true. Guys like me, who eat 90 percent fatted corn syrup and preservatives, should have disease and many do. But there are also protective factors--swimming, I think is one of these, for swimming-susceptible types. I get all kinds of psychological infirmities, but so far--and knock on wood--my wretched lifestyle excesses have not obviously ruined my heart. I don't expect this to last forever, but something's protective, even if what this factor(s) is(are) are not clearly delineated.

I'm having difficulty keeping HDL above 30, although tot. chol. in the 130's. Has anyone pushed HDL up significantly with vigorous exercise?

I'm having difficulty keeping HDL above 30, although tot. chol. in the 130's. Has anyone pushed HDL up significantly with vigorous exercise? Exercise helps. You could try a glass of red wine (or grape juice) daily. Niacin can raise the HDL, but many people can't tolerate the side effects (flushing).

The bottom line, from this layman's perspective, is that there are a myriad factors that go into whether person X will get heart disease. You can be doing everything right, and chances are your heart will do well too--but not always. I recently took care of a 27 year old Navy Seal with no risk factors (nonsmoker, normal cholesterol, no family history) who suffered a heart attack and required a stent. Clearly there is much we do not understand about heart disease.

Gull, Thanks for concise and seemingly good advice.

Exercise helps. You could try a glass of red wine (or grape juice) daily. My newest cure in a bottle is grape seed extract, since I don't drink wine. Is that the same?

My newest cure in a bottle is grape seed extract, since I don't drink wine. Is that the same? I thought beer helped too. No beer either? Matt: Can you clarify? Are you talking about blood vessels in the eye itself?

Just heard on Dr. Dean this afternoon that one of the most revealing things to look at for an indication of future heart disease are a person's eyes. More spcifically, the blood vessels that can be seen through the eyes. Did not catch all of the reasoning and research but thought I would throw it out there. For raising HDL, aside from exercise, one could look towards some foods such as fish, nuts, and EVOO (Olive Oil)...possibly even prepared together.