Who says you have a choice?
The good news is that a recent study from Dr. David Hoâs lab at Columbia University found that the current Covid-19 vaccine, which was designed to boost the bodyâs ability to fight of the XBB family of variants, also offers good protection against BA.2.86 and its offshoots, including JN.1.
https://www.cnn.com/2023/12/19/health/what-to-know-about-jn-1/index.html
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Itâs kind of you to ask, Vee. My GP didnât know what to make of it. The arrhythmia detected by the heart monitor didnât coincide with any symptoms I reported. Thereâs quite a bit of cardiovascular issues in my family and I have an appointment with a cardiologist next week to have the results of the monitor explained, as well as to talk about getting testing to establish a baseline of where my heart health is. It could be nothingâŚmy GP just was outside her knowledge baseâŚbut asymptomatic symptoms need checking out as well. In a way I am grateful for the long Covid triggering the need to investigate. With my family history, a healthy diet and active lifestyle is not always enough. Fortunately, I am someone who thrives on data, and find the prospect of testing calming rather than anxiety producing. Canât make an informed decision without information.
Happily I am no longer experiencing long Covid and am back to 8 mile hikes in rough terrain and 2 hour sessions of non-stop hard hitting pickleball. Thatâs a great thing.
IP
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Scream this from the rooftops!! As loud as possible.
Itâs my experience (as in personal) that, as important as anyone with gumption is aware, that healthy lifestyle choices are protective when it comes to a whole slew of modern day maladies, displaying evidence of those healthy lifestyle choiceâŚa lean body with good body composition and a track record if athleticismâŚcan also act as a smokescreen to appropriate diagnosis. At least, as far as diseases that are viewed increasingly as a side effect of craptaculous choices. I have a shrewd idea thatâs the case even when folk ought to know better. Meaning some medical professionals. Understandable in a way, as any physician under the age of, say, 55-60 has graduated into an environment where obesity/metabolic syndrome and their sequelae have slowly become the norm. At least, in the US.
Iâm going to recommend a read of Peter Attiaâs Outlive book. As a library get. I purchased it and, as useful as it is for quick reference, is a bit like a âliteâ, Cliff notes version of his podcastsâŚwhich are, in effect, lecture series by heavy hitters in the respective fields of all manner of subjects pertaining to health and well-being. Including, but not limited to, ASCVD and heart health.
I have to be honest that, without the kickstart from his podcasts and further reading around lipidology, cardiovascular pathology etc, I absolutely wouldnât have known to ask for the further testing that gave me the heads-up on my CAD status.
Iâve long considered him something of a huckster based on his strong but temporary association with Gary Taubes and wouldnât have gone the podcast route but for this teaser that crossed my radar screenâŚ
I SO wanted to hear it all that I did a monthly subscription initiallyâŚintending to listen to this and anything else I could findâŚand then cancel. Iâd converted that to the annual subscription towards the end of the month and renewed it ever since.
Iâm currently listening to this (for about the 4th or 5th time) for my Z2/MAF/ASCVD mitigation training this very week (ask me a questionâŚany question 
) Srsly, couldnât have timed it betterâŚ
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Another suggestion for light readingâŚ
Iâve followed this poster for a number of years and it was this actual article that prompted me to go with a CAC scanâŚreasonably confident that I would find myself in the flaneurâs situation (my lipid profile was similar) Well, we know how that turned out. Agatson score of 700 and change. My PCP was surprisedâŚand theyâve since included details of the test on a couple of their newsletters since.
Heaps of resources here
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Does your PCP have a newsletter?
Yes. Itâs a comparatively small practiceâŚ3 physicians (one part time) a couple of PAs, MAs and a slew of support staff. Still holding out against the corporate tsunami thatâs hitting Colorado so, I guess, pulling out all the stops to distinguish themselves from the chaff.
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Vee, thanks again for the links. I listened to #255, which was disconcerting to say the least, given that both CVD and Alzheimerâs runs in my family. I confess that podcasts have never been my thing, (particularly 2+ hour podcasts,) preferring the printed page, but I made my way through and it was helpful. Cholesterol has only been starting to be a problem for me at about 57, so I had been very hopeful that I was going to dodge that hereditary gift, but it doesnât appear to be so.
Particularly of interest in this podcast was the discussion of statins and how big Pharma mishandled it, the newer LDL lowering meds on the market, one of which DH takes and was pretty miraculous in itâs ability to lower his LDLs. Depending on what the tests show, I may need to get past my reluctance to take meds to treat symptoms, but donât know how else to fight genetics. Certainly my diet and lifestyle is dramatically different from the rest of the family and has been for decades, but that may not have been as protective as I thought, and can certainly still be made more heart healthy.
Am looking forward to my appointment next week and hoping to get a decent baseline of the state of my heart, data beyond a basic lipid profile. I am faced with having to find new health insurance in the Spring, when DH goes on Medicare and we lose retiree health care, so this really is both the best and worst time to realize one may not be as healthy as one thoughtâŚbest because sooner is always better than later, worst as it may impact getting health care, though it may also guide me to buy into a plan that covers more than a high deductible plan I was considering. I am not eligible for Medicare for another 4+ years, but happily we can afford to do what needs to be done.
Have you checked out Rhonda Patrick, (PhD,) at Found My Fitness? I believe she and Attia have been on each otherâs podcasts. I find her articles to be pretty educational and well researched with links to research studies, some of which she has published herself. I confess to having the same issue with the podcasts, but since you seem to be a fan, itâs another resource.
FoundMyFitness Episodes
To go even further off topic, I hope everyone has a great holiday weekend, whether it is your holiday or not. We are not big celebrators of the commercial Christmas, with this year spent prepping the house to be listed for sale in about a month and going pretty much decoration free. We told the kids we would get together at a vacation rental when the listing was in the hands of our Realtor, but Youngest still chose to drive up for a few days. The gift of self is always the best, IMO.
Have a very merry!
IP
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Oof! Tackling the whole podcast straight offâŚyouâve got more staying power than I have. I listen to these whilst doing my Z2/ASCVD mitigation/collateral circulation enhancing training on the treadmill. I began doing/calling it this (minus the ASCVD reference) shortly after listening to the first podcast on Z2 training benefits. I too prefer readingâŚand actual printed page reading at that. I usually have to print the show notes âŚespecially for this one.
This particular podcast is what brought it home to me just how important early intervention isâŚespecially with a strong genetic component. Obviously, neither of us are in the boat that many of the guestâs patients found themselvesâŚwith one of the mercifully few monogenic forms of FH that have kids with an LDL-C of 300+, strokes in their teens and heart attacks in their 20sâŚbut considering the genetics and how late in the game measurable signs and symptoms start to show and folk start to take it seriously, itâs no wonder that âheart diseaseâ is still the worldâs #1 killer.
For accuracyâs sake, the discussion on a pharma fail wasnât statins but rather CETP inhibitors which I donât know much about but hereâs one article discussing themâŚ
Christmas just started for me unofficially. We always thought the Lessons and Carols from Kingâs College Cambridge broadcast by the BEEB was our kick off. I think this is the first time Iâve heard it here in Colorado (8am Mountain) Finished my workout just in time to catch the processionalâŚit gets me every time.
Sneak peek at my intended FB greeting for my cronies tomorrow.
âOh little town of GoldenâŚâ
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P.S. âŚanother similarity. My first inkling of âmildly elevated cholesterolâ was when I was about 56 or so. Selling my practice and daughter on her way to graduating vet school, I decided to reduce my life insurance. The basic medical I had initially had the nurse who ran through it enthusing that Iâd get lowest premiumâŚfollowed by a call from the company advising me I wouldnât because of a total cholesterol reading of about 230 IIRK. Follow up with my internist had him dismissing my concerns because a) HDL-C of 80 or so b) triglycerides in the 70s, c)hs-CRP of .8âŚand LDL-C of âonlyâ about 130 or so. Low risk of events per the standard ASCVD profile so, given that plus Righteous Lifestyle Choices ⢠not a problem. Pretty much the same ever sinceâŚbasically benign neglect, knowing what I know now.
Had, say, CAC scans, CT angiography, advanced lipid testing etc been easily available (known about?) back in the mid aughts, Iâll wager that I would already have had a non-zero Agatson score.
VeeEnn,
The Agatson score is one thing. How is the plague? Is it that bad?
Well, with a score of over 700 as the first notice that there was a problemâŚand I hadnât even started my lipid lowering therapyâŚitâs reasonable to assume so. And likely to get worse. Since coronary artery calcium deposition is a late stage in the disease progression (part of the scar tissue that forms on âfreshâ lesions and, in a way, a fossil archive of past disease) and given that a CAC scan isnât actually powered to detect non calcified tissue, thereâs reliably no way of knowing for sure. The CT angiogram is what stratified the degree of coronary artery stenosis.
Severe enough for me to think that stent placement would be automatic even without symptoms. Apparently not so and, with enough of a reduction in Apo-B/LDL-C, can not just halt further progression but actually cause a reversal.
Given my minimally dysfunctional lipid profile (at least per standard testing) I canât help but wonder how many folk are walking around totally unaware that the first inkling of a problem (firstâŚand lastâŚstroke or heart attack) is right around the corner.
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Seems to be pretty common timing. Women for the most part seem to be protected pre-menopause.
https://www.sciencedirect.com/science/article/abs/pii/S1933287422003269?dgcid=author
The independent associations of anti-MĂźllerian hormone and estradiol levels over the menopause transition with lipids/lipoproteins: The Study of Womenâs health Across the Nation
Article regarding this study, which is in English vs overly technical: https://www.sph.pitt.edu/news/hormone-may-be-missing-ingredient-heart-healthy-cholesterol-levels-menopausal-women
Dr. El Khoudaryâs team analyzed blood samples from the Study of Womenâs Health Across the Nation (SWAN), which followed a diverse group of 1,440 midlife women through the menopause transition. These blood samples were tested for estrogen and AMH levels as well as good and bad cholesterol.
Through this study, Dr. El Khoudary found that, while high estrogen level was important for lowering LDL-C or bad cholesterol levels, high AMH was responsible for lowering HDL-C or good cholesterol. This means that as women traverse the menopause transition, they lose estrogen and AMH, increasing both their bad and good cholesterol levels.
This may sound contradictory but, to Dr. El Khoudary, it supports her suspicions that good cholesterol is not always good for menopausal women. Previous studies from Dr. El Khoudaryâs group have determined that good cholesterol levels in these women could be masking other cardiovascular issues and may even be a sign of HDL dysfunction, preventing good cholesterol from performing its cardioprotective duties.
FWIW,
IP
I had that abdominal aortic aneurysm screening exam last month. (Free under Medicare for males over age 65 with a history of smoking. I smoked from from about age 18 to 32, then quit.) The ultrasound technician says to me, âThere are no calcium deposits on your aorta. You have the blood vessels of a teenager.â
Whatâs the secret? A daily diet of bacon, eggs & sausage with chocolate donuts.
intercst
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Well, if true, one secret is that youâve been dealt a very favourable genetic hand. Possibly something of an outlierâŚmuch like those poor devils at the opposite end of the spectrum with an autosomal dominant form of FH that pretty much guarantees ASCVD before even puberty.
The other secret is, of course, that you didnât have a Coronary Artery Calcium scan. Still a test thatâs not covered by Medicare, oddly enough ( unlike stent placementâŚno matter how preventable or unnecessary). Ultrasound technology is different from the scan (which utilises a CT scanner, not an ultrasoundprobeâŚobviously) and doesnât pick up calcified lesions as accurately⌠if at all âŚin coronary arteries.
Yep. The ultrasound operator mentioned that, too.
I had a cholesterol test years ago at age 32 when they were cutting that golf ball-sized brain tumor out of my head. The doctor said, âThat would even be a low cholesterol level if you were Japanese.â
intercst
VeeEnn,
Not sure I understand. How is the plaque? It is severe or an unknown?
With >80% of 3 major coronary arteries occluded, Iâd say itâs severe. The fact that so many of the plaques are fibrosed/calcified is irrelevant in the context of historical disease. This insight has come from the CT angiogram
As I mentioned upstream, the CAC scan isnât designed to identify âsoftâ plaqueâŚas in early lesions from ongoing disease. In a way, not much different from trying to identify soft intraoral plaque from the hardened calcified stuff (calculus/tartar) Yeah, different disease processes (up to a pointâŚbut very similar in other respects) but radiology is radiology.
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I am glad you are with us.
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Why wouldnât I be?
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