Even more evidence that CVD confusion reigns supreme among PCPs.

http://www.theheart.org/article/1020935.do

Dr. Davis,

In June you kindly profiled my "near-miss" CT angiogram, where I had to take charge and make sure I was getting only a CT calcium score scan.

The good news was that my score was a zero.  I can't really explain that; while I was a vegetarian for many years, I also ate too many refined carbs and until recently was carrying a few too many pounds. There is heart disease in my family.  I am 54 years old.

Is it genes, luck, or inadvertantly prudent lifestyle?   How often should folks with low scores be re-tested?  I know you probably cover this at TYP but I'm sure the blog readers would also find it informative.  Thanks again for reporting my story.

Roger

Hi, Roger--

Genes enter into the equation in a big way. Lifestyle is important, but it is not everything.

For people starting with a score of zero, I generally suggest waiting 3-5 years before thinking about another scan.

I'll second the motion about catherizations being malpractice!

My mom died three years ago in a cath lab!  After having chest pains after a chemical stress test, she was hospitalized overnight and the next day had a catherization with two stents implanted.  

Something went wrong during the procedure, and an artery was torn. She became unconscious, she stopped breathing, and they were unable to insert a breathing tube.  They did an emergency tracheotomy but it was too late.  No cardiac surgeon was in the facility at the time.

The cardiologists explination to us was that "she had very small arteries".

I would think it would be reasonable for a patient to request that a cardiac surgeon be "in the house" during this procedure.

My dad about hit the roof when he saw the cause of death listed on her death certificate as "myocardial infraction". He requested that the coroner check the circumstances, after which he changed the cause to "cardio-pulmenary arrest due to long term heart disease".  Sorry, but it should have read: "Due to complications during catherization procedure".  

Not a benign procedure folks!  Ask whether drugs can perhaps be used in lieu of this invasive (and very lucritive for the hospital) action.

"gobs"


Hahaha... I can so tell you are from Milwaukee. That is such a Wisconsin expression.  

Another take on the Greek philosophical question: what is time? Even tho' they could count days and years, their answer was: "time is the measure of change". But perhaps that should be reversed to: "change is the measure of time".

Doc, it seems to me the burden of proof was on the guy. You simply say: you only left high school three years ago? Gosh, there are no reports that any male has undergone the developmental changes I can see, in such a short time!
Another point, the number of telomeres at the end of cells has to be calibrated against other measures, such as the sun going round the earth. All any particular individual has to claim is: my telomeres are lost 10 times faster than any one else's, now YOU prove otherwise.

Y'all have a good day, now.

"If George were a tree, I'd cut him down and count his rings"
Too funny, Dr Davis.

George's telomere's....reduced to T-stumps.

Ellie

Lovely blog...it is scary the way we are being attacked by the diseases at very early ages also.

Al Sears says that high homocystein levels shortens telemores three times faster.

I take vitamin D and I want to live longer.  I believe it will help because you said so,and I believe everything you say, including when you say you're not sure.

Regarding "gobs", this is a popular expression in Oregon, too, and I'm not sure how you tell where an expression originated.

Very cool post, Dr. D!!!

I've been into telomeres for awhile!!  Mag-deficiency is associated with reduced telomeres in vivo in rats(and reduced glutathione). HERE

NAC can ameliorate some of the Mag-deficiency oxidative stress in vitro. NAC is the precursor for one of the most potent antioxidants, glutathione. HERE

Glutathione peroxidases which generate more protective glutathione are selenium-containing enzymes. Selenium was correlated to longer telomeres and lower BP. Selenium.

Glutathione strongly and positively affects telomere lengthening and telomerase activity. Role of nuclear glutathione as a key regulator of cell proliferation

Curiously, (?via epigenetics and X-related telomere genetics?) maternal diet can shorten telomeres in rats. Epigenetics: maternal diet shortens aortic telomeres.

Precursors of glutathione are:
--NAC (sulfur proteins)
--undenatured whey protein (sulfur proteins, like glutamine, arginine, taurine)
--SAMe

(PO suppl w/ GSH apparently doesn't work well)

Of course there are many other ways to increase glutathione... Like the TYP program -- flavonoids, fish oil, alpha lipoic acid, MELATONIN, silymarin (WCCA's fave), selenium, magnesium, zinc, etc.

I believe the omega-6:3 index is one of the best biomarkers for aging, at least until we can count our 'tree rings'! In post-MI rats, n-3 PUFAS increased glutathione and was incredibly protective. HERE

The traditional 1960s rural Cretans shared the same low CAD rate as Japan with a high fat diet. To me,  the Cretan diet is  associated with high glutathione, selenium, low n-6, high high  n-3 ALA EPA DHA, 41% fat (like TYP Diet 3), intermittent fasting (Greek Orthodox practice), pastured-raised eggs, chicken, goat, mutton, wild seafood/snails, and very fatty sheep/goat yogurt and cheeses (rich in taurine and saturated fatty acids). HERE and HERE. And Simopoulus.

-G

Very cool post, Dr. D!!!

I've been into telomeres for awhile!!  Mag-deficiency is associated with reduced telomeres in vivo in rats(and reduced glutathione). HERE

NAC can ameliorate some of the Mag-deficiency oxidative stress in vitro. NAC is the precursor for one of the most potent antioxidants, glutathione. HERE

Glutathione peroxidases which generate more protective glutathione are selenium-containing enzymes. Selenium was correlated to longer telomeres and lower BP. Selenium.

Glutathione strongly and positively affects telomere lengthening and telomerase activity. Role of nuclear glutathione as a key regulator of cell proliferation

Curiously, (?via epigenetics and X-related telomere genetics?) maternal diet can shorten telomeres in rats. Epigenetics: maternal diet shortens aortic telomeres.

Precursors of glutathione are:
--NAC (sulfur proteins)
--undenatured whey protein (sulfur proteins, like glutamine, arginine, taurine)
--SAMe

(PO suppl w/ GSH apparently doesn't work well)

Of course there are many other ways to increase glutathione... Like the TYP program -- flavonoids, fish oil, alpha lipoic acid, MELATONIN, silymarin (WCCA's fave), selenium, magnesium, zinc, etc.

I believe the omega-6:3 index is one of the best biomarkers for aging, at least until we can count our 'tree rings'! In post-MI rats, n-3 PUFAS increased glutathione and was incredibly protective. HERE

The traditional 1960s rural Cretans shared the same low CAD rate as Japan with a high fat diet. To me,  the Cretan diet is  associated with high glutathione, selenium, low n-6, high high  n-3 ALA EPA DHA, 41% fat (like TYP Diet 3), intermittent fasting (Greek Orthodox practice), pastured-raised eggs, chicken, goat, mutton, wild seafood/snails, and very fatty sheep/goat yogurt and cheeses (rich in taurine and saturated fatty acids). HERE and HERE. And Simopoulus.

-G

Dr. Davis,

Have you heard about ELC (earlobe crease) as a possible key sign of aging? It seems that tons of studies show a very strong positive connection between younger people with an earlobe crease and CVD. What do you think?

3) The Ornish diet.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(08)70234-1/fulltext

Doc Davis,

Last week, the U.S. Preventive Services Task Force came out with a review and with recommendations about using emerging risk factors for predicting and managing heart disease.  I think there's a lot in there that you'll agree with.  But they were negative about calcium scoring.

Sandy Swarz, whose scholarship is pretty sharp, gives a summary.

I'd really like to see your response to all this.

It is scary how many young people are getting elderly diseases. I know someone who died of a massive MI at the age of 26. I am also proof of that. I have CAD, hypothyriodism, Low Vitamin D, Low B12, gastritis, and valve disease and I am only 35. I am looking forward to being able to reverse some of these diseases naturally.

Michelle

Hi, Matthew--

I believe there's some evidence that ear lobe creases are associated with increased coronary risk, but I don't know of any data relating them in younger people specifically.

I have one myself, and it's been there for as long as I can remember and does indeed correlate with my family's aggressive heart disease pattern.

Hi, G--

As always, you are full of unique observations.


Hi, Ellen--

Perhaps I should have said "oodles."

Dr. Davis,

See David Throop's comment above.  I actually came looking to see if you might have commented on this yet.  Curious your take.

Scott Pierce

Hi Dr. Davis,

Have you observed a correlation between earlobe creases and coronary calcification among your patients?

Thanks,

David

Hi Dr. B G,

Interesting.  Magnesium deficiency vs telomeres length could also be explained as a secondary effect caused by the excessive metabolism of carbohydrates as the primary factor.  High magnesium intake is required for glucose metabolism, see for example Implications of oxidative stress in high sucrose low magnesium diet fed rats

Similar situation may exist with glutathione, high glutatione may be a secondary marker for a diet high in dairy and (thus automatically) lower in carbohydrates.  This paper you linked Maternal diet influences DNA damage, aortic telomere length, oxidative stress, and antioxidant defense capacity in rats seems to be pointing to a high carb diet as one of the factors that may cause accelerated growth of low birth weight babies (the paper discusses human studies as well), which then is correlated with higher CVD risk, shorter telomeres and worsens other markers (bones abnormality etc).

   In contrast to this, high fat low carb nutrition seems to slow down babies and infants growth and slows the onset of puberty, which according to the logic presented by the papers discussed above, ought to reduce oxidative stress, slow down the shortnening of telomeres and reduce the CVD risk later in life.
Regards,
Stan

Hi Stan,

Yes -- there are many implications to such data and other epi-genetic data. Low protein maternal  diets increase Met Syn for 2 generations in rat pups.

Low Sat Fat maternal diets?  High carb, low protein, allergenic wheat maternal diets?  I believe we are epi-genetically affecting many future generations and their metabolism, growth hormone, thyroid hormone, leptin/ adiponectin and perhaps even vitamin D hormone pathways... This may explain why right now CAD and diabetes is rampant compared to just 1-2 generations ago. I have 80-90s year old patients how are 20x more healthier than my 30-40 year olds! Have we genetically predisposed ourselves to the 'over summer' mode that Dr. T at Nephropal has talked about by our mother's diets and her lack of sunlight, rich fatty foods, omega-3, and excess omega-6 in utero??

I believe so.

-G

Hi Stan,

Yes -- there are many implications to such data and other epi-genetic data. Low protein maternal  diets increase Met Syn for 2 generations in rat pups.

Low Sat Fat maternal diets?  High carb, low protein, allergenic wheat maternal diets?  I believe we are epi-genetically affecting many future generations and their metabolism, growth hormone, thyroid hormone, leptin/ adiponectin and perhaps even vitamin D hormone pathways... This may explain why right now CAD and diabetes is rampant compared to just 1-2 generations ago. I have 80-90s year old patients how are 20x more healthier than my 30-40 year olds! Have we genetically predisposed ourselves to the 'over summer' mode that Dr. T at Nephropal has talked about by our mother's diets and her lack of sunlight, rich fatty foods, omega-3, and excess omega-6 in utero??

I believe so.

-G

However, more recent thought among geneticists is that telomeres shorten with aging and provide the body's cells a timeline of aging. This way, George's cells act like they are 70, not 13, and don't start producing gobs of growth hormone and testosterone in preparation for puberty.

Exactly what triggers people to choose to be obese or even 20 lbs overweight? I find it disgusting.  People have to realize being overweight is unhealthly and puts that person at extreme risk for health problems. How sad it must be for young children not to have parents that can run with them in the park or worse yet lose one to heart disease, stroke or cancer.

hmmm. Me again, commenting twice.

My 5 month old daughter has "pectus excavatum ", the docs said it's mild and won't show when she's an adult, they only seemed concerned with it for cosmetic reasons.

I also have thought that the roof of her mouth seemed "deeper" or higher I guess you could say, than my other daughter's was in infancy. But, 5 monther with pectus excavatum doesn't have slender fingers, though she is quite long, repeated ultrasounds showed she had long legs. Is she possibly at higher risk for heart problems as an adult? Why wouldn't 2 different family docs know this, or tell me about it?

An ultrasound of the heart, or echocardiogram, would settle the question. It's a harmless test that requires just a few minutes. If your daughter's doctor won't order it, find one that will.

I'm saddened but not surprised that a doctor would call pectus excavatum just a curiosity.  I have quite a number of heart and lung ailments from my PE.  Had my doctor felt differently about PE when I was a kid and had suggested surgery, I would have suffered less than I have to having the surgery in my 30s. They say the teen years are the best time for surgical repair of PE. So yes, PE does cause heart and lung problems in adults.  At least this adult.

Here's a relevant cite:
Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16899852&query_hl=2&itool=pubmed_docsum

I am a 69 year old retired fysician.With a moderate congenital pectus excavatum. For more than 10 years I suffered from complaints like shorness of breath, fatigue and arythmia.Even a catheter ablation has been performed 4 years ago to stop Supraventricular tachycardia of 220.min. After 3 months a more moderate tachycardia returned. My complaints where posture dependent: bending or pressure on the upper abdomen or the pectus cavity did increase the problems.
CT showed cardiocompression!
To go short: after corrective surgery (Ravitch) my complaints have totally disappeared. I could stop with all medicines, can walk uphill agian and cycle with proper speed. Reborn without reincarnation.
Lesson: symptomatic pectus excavatum can also happen to senior people an dcorrective surgery is worth while.
See also:  http://www.spesweb.nl/SPES_English.htm

It could mean that some attention and exploration of how floppy his mitral valve might be could be useful, e.g., an ultrasound or echocardiogram. He might even require oral antibiotics at the time of any oral or some gastrointestinal procedures, since floppy valve are more susceptible to blood infections when potentially "dirty" orifices are instrumented.