Gas station without pumps

2016 November 25

Heart risk

Filed under: Uncategorized — gasstationwithoutpumps @ 18:11
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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.

2012 March 28

Non–HDL cholesterol level and statins

Filed under: Uncategorized — gasstationwithoutpumps @ 18:59
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A meta-analysis was just published in the Journal of the American Medical Association, Association of LDL Cholesterol, Non–HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins, March 28, 2012, Boekholdt et al. 307 (12): 1302 — JAMA, that suggests setting statin dosage by the non-HDL cholesterol, rather than LDL, as is more commonly done.

They looked at a number of studies and tried to determine the effect (in terms of increase in cardiovascular “events” per standard deviation change) for three measures: LDL cholesterol, non-HDL cholesterol, and apolipoprotein B.  They found that non-HDL cholesterol was the best predictor of risk (hazard ratio of 1.16 per standard deviation, compared to 1.13 for LDL cholesterol and 1.14 for apolipoprotein B). That means for each standard deviation of increase in non-HDL cholesterol, there is a 16% higher chance of a major cardiovascular event (which includes myocardial infarctions, strokes, and  unstable angina).

I looked at my own LDL and non-HDL levels from my most recent blood tests and saw that I was near the average of the top quartile for both, making my hazard ratio (relative to the bottom quartile) 1.26 based on LDL and 1.42 based on non-HDL.  That means I have about a 42% higher chance of a stroke or heart attack than someone with the same age, gender, body mass index, … whose non-HDL levels were in the bottom quartile.

What I don’t know is whether more aggressive statin therapy is warranted in my case.  How does the increased risk of liver or muscle damage from higher doses of statins compare to decreased risk of heart attack or stroke?  Other than the inherited high cholesterol levels, the only risk factors I have are being male and over 55—I get a fair amount of aerobic exercise, don’t smoke, am not overweight, and don’t have high blood pressure.  According to online cardiac-risk factor calculators, my risk of a heart attack (or death from coronary heart disease) in the next 10 years is 8%–12% (depending on which calculator I use and what it considers).  Small changes in cholesterol (about what is achievable based on my 20 years of statin usage) can move me more solidly into the 8% risk category, but not really reduce the risk lower than that.  If the calculations were based on non-HDL cholesterol, they might assess my risk slightly higher.

2012 February 25

USA causes of death

Filed under: Uncategorized — gasstationwithoutpumps @ 20:44
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A few weeks ago I came across an interesting statistics site, which shows causes of death in the USA as maps.  It is really astonishing how the life expectancy changes geographically, and how many different causes of death show the same geographic distribution.

You can get maps of individual states (down to the county level).  The county I live in is doing pretty well on most health measures (8th longest male life expectancy in California, at 78.1 years—compared to 77.79 statewide and 75.93 nationally, and 9th longest female life expectancy at 82.6 years—compared to 82.76 statewide and 81.07 nationally).  A big part of the difference is probably from more exercise and less smoking here than elsewhere, but there are probably other factors (since death rate due to accidents is also low).

Although the black-background web pages are a bit annoying to read, the data and the maps are cool.

2010 September 3

Colonoscopy

Filed under: Uncategorized — gasstationwithoutpumps @ 11:14
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™Yesterday I had a routine colonoscopy, the second one I’ve had. The colonoscopy itself is no big deal (they knock you out with an injection and you wake up half an hour later), but the “preparation” is a pain.

The first time I had a colonoscopy, I took the recommended over-the-counter laxative to clear out my intestines.  I believe it was sodium phosphate, but that was 5 years ago, so I don’t really remember.  The doctor reported “poor preparation” in the colonscopy report, which sounds somewhat insulting, particularly after having spent all night awake with the induced diarrhea.

This time, we opted for a different laxative and a more aggressive “preparation”.  I started my clear-liquid-only diet 60 hours before the colonoscopy was scheduled, and used a split-dose MoviPrep® regime. This calls for drinking a liter of rather nasty lemon-lime-flavored stuff twice. Mine were 30 hours and 18 hours before the colonoscopy.  The diarrhea only lasted about 4 hours for each dose, but gas pains kept waking me up each night.

The report on the colonoscopy this time? Still no polyps found, but once again the doctor reported “poor preparation”. According to the package insert on MoviPrep, that is a problem with about 11% of patients. I suspect that next time they’ll try 4 liters of polyethylene-glycol-plus-electrolytes solution, which has about half the failure rate (according to the MoviPrep insert), though it involves twice the volume of liquid.  It should be cheaper, too, as the MoviPrep is way over-priced at $45 (and not covered by my insurance). I also may have to do a clear-liquid-only diet for longer than 60 hours, which will be a nuisance.

Actually, I’m hoping that there won’t be a next time, and that RNA blood tests (like ColonSentry™), DNA tests, or virtual colonoscopy will replace the need for colonoscopies for routine screening.  I suspect that the medical establishment will be slow to replace colonoscopies, though, as they represent a major cash flow for gastroenterologists and hospitals.

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