Gas station without pumps

2016 November 25

Heart risk

Filed under: Uncategorized — gasstationwithoutpumps @ 18:11
Tags: , , , ,

My 90-year-old father recently needed several stents installed, because his coronary arteries were 85–95% blocked. This came as a bit of a shock to the family, as we had thought his heart was in good shape (aside from needing a pacemaker). So I’ve been thinking a bit about my own risk of coronary vascular disease (CVD), especially since I have hereditary high cholesterol (from my Mom’s side of the family).

Like any modern academic, I turned to the web for more information. There are many calculators on the web for computing one’s risk of CVD, almost all claiming to be based on the Framingham study of heart health. Unfortunately, they disagree enormously (by  a factor of 2) on what my risk is.

I used the following statistics for all site: age 62, male, cholesterol 161 mg/dL=4.16mmol/L, HDL 43 mg/dL=1.11mmol/L, triglycerides 90 mg/dL=1.016 mmol/L, BP134/83mmHg, height 5’11” (180cm), weight 163 lbs(74 kg), race white, no treatment for blood pressure, non-smoker, and no diabetes, though these numbers are not all from the same day, and I’m doubtful of the blood-pressure reading, as it was done with a cheap home cuff that I don’t believe handles my low heart rate well.  (When I’ve had oscillometric and auditory measurements made at nearly the same time, the oscillometric ones have been substantially higher.)

I got the following risks of CVD in the next 10 years:

Site Risk
 http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score/  9.7%
 https://www.uptodate.com/contents/calculator-cardiovascular-risk-assessment-10-year-men-patient-education  10%
 https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php#  10% (using lipids), 17.9% (using BMI)
 http://www.cvriskcalculator.com/  10.1% (heart attack or stroke)
 http://tools.acc.org/ASCVD-Risk-Estimator/  10.1%
 http://reference.medscape.com/calculator/aac-aha-cardiovascular-risk-ascvd  10.1%
 http://medcalc3000.com/ACCAHA2013.htm  10.1%
 http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-risk/itt-20084942 10.1%
 https://qrisk.org/2016/index.php  11.4%
 http://chd.bestsciencemedicine.com/calc2.html  15.4% (Framingham), 11.6% (Qrisk2), 10.3% (ACC/AHA ASCVD)
 http://patient.info/doctor/cardiovascular-risk-calculator  12% (CHD), 5% (MI), 3% (CHD death), 3% (stroke), 18% (**CVD),  4% (**CVD death), 14% (JBS CVS Risk)
 http://www.medcalc.com/heartrisk.html  13%
http://reference.medscape.com/calculator/framingham-cardiovascular-disease-risk  15.0%
 https://www.cvdriskchecksecure.com/FraminghamRiskScoreResults.aspx  18.4%

I’ll have to ask my doctor whether it is worth getting a high-sensitivity C-Reactive Protein (hsCRP) test for inflammation to use one of the risk calculators that takes inflammation into account.

The risks are about normal for my age, but I’d like to reduce them if I can.  I’m already on statins (and have been for 25 years) and 81mg aspirin (self-prescribed), I already get about 150 minutes a week of moderate exercise, and I’ve been controlling my weight (though I’ve put on 4 lbs in the past year that I’d like to get rid of).  I’m not sure how much more I can reduce the risk.

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5 Comments »

  1. One thing you did not mention is keeping your cholesterol intake to under 200 mg a day.

    My husband also has generally good health: low BP, cholesterol mildly high but not awful at 185 at the time, weight about 15 pounds over ideal, age 48, ran about 20 miles per week. But he still had a heart attack last year requiring two stents. In addition to taking statins and baby aspirin, his cardiologist recommends cholesterol food intake under 200 mg, which is actually what is recommended for everyone but few actually do. A single egg has 120 mg. It can be difficult, especially for people who travel for work.

    Comment by indiana physics — 2016 November 27 @ 05:29 | Reply

    • The dietary cholesterol hypothesis was a big one 30 years ago, but subsequent studies have not shown really convincing evidence one way or the other:
      A metastudy (http://ajcn.nutrition.org/content/102/2/276.full) says “Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk. Carefully adjusted and well-conducted cohort studies would be useful to identify the relative effects of dietary cholesterol on CVD risk.”

      The problem with many of the dietary cholesterol studies is that many don’t distinguish between cholesterol intake and saturated fat intake, which are often highly correlated.

      I don’t monitor my cholesterol intake, but it is not large, as I don’t eat many eggs, nor much animal fat.

      Comment by gasstationwithoutpumps — 2016 November 27 @ 10:06 | Reply

      • Given that there were really no other lifestyle changes my husband could make (also didn’t smoke, no diabetes, etc., I think the cardiologist feels the only two things he can do is take the statins and lower cholesterol intake.

        Comment by indiana physics — 2016 November 28 @ 03:50 | Reply

  2. Have you looked at your mother’s side family history of CVD?

    I ask because my wife comes from a family whose bodies make cholesterol, particularly triglycerides, at an absurd rate. Diet has nothing to do with the level in their bodies, and statins only make a dent in it. But they don’t die of heart disease.

    Comment by CCPhysicist — 2016 November 29 @ 05:57 | Reply

    • My maternal grandfather died of a heart attack in his late 70s, I believe, and my maternal grandmother of a stroke in her 80s, my mother and her brother of cancer (his probably triggered by pesticides—he was a horticultural instructor). I believe that one set of maternal great-grandparents (mother’s mother’s parents) lived into their late 80s—he died of job-related cancer (trainman on coal-powered trains got skin cancer from coal dust). So while there is some evidence of CVD, it does not seem to be unusually early—nothing out of the ordinary—cancer seems to be at least as big a risk.

      Statins do keep my cholesterol down and have done so since 1991. I’ve occasionally stopped taking them, and my cholesterol goes way up. I have had to switch to more potent statins (atorvastatin now), as I was getting to the maximum dose with lovastatin, pravstatin, and simvastatin.

      I just found out that rosuvastatin went generic this year (though it is still twice the price of atorvastatin). I’ll talk with my doctor about whether it is appropriate to switch now or to wait until I need a higher dose of atorvastatin.

      Comment by gasstationwithoutpumps — 2016 November 29 @ 08:58 | Reply


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