Best Prognosis

Original status as of February 2009 - 50% stenosis in carotid artery; treadmill revealed 142 BPM, 10.5 mintues, asymptomatic,  ST depression at about -3.8 (V3); Total choloesterol at ~258, HDL at 54 and LDL at 185, triglycerides at 96; angioography revealed LAD diffusley narrow in mid and distal regions of about 2mm in diameter; Proximal LAD has 50-60% stenosis, first diagonal with the ostium observed at about 90% stenosis and more distal stenosis of 75%; Right coronory artery was dominant and had a short discrete stenosis of 75%.  Prescribed simvastatin and two heart medications to prevent arrythmia and slow heart as well as blood pressure reducing medication.

Current status as of May 2009 - exercising daily 40-90 minutes; diet changed dramatically, at rest systolic blood pressure in the 105 to 135 range; treadmill revealed 136 BPM, 12+ minutes, asymptomatic, ST depression at about -1.0 (V4 and V5); Cholesterol at 139, HDL at 60, LDL at 72, triglycerides at 36, no new angiography.

Assuming that I maintain and or increase my level of exercise and keep my cholesterol levels at the current levels or improve them, can I expect that my treadmill performance will continue to improve?  If I get to a negative treadmill, what metric can I use to determine if I am continuing to improve?  What is my best prognosis as far as CVD?  At what point can I begin to think about going off of the heart medications?

[Lee Kirksey, MD]

Hello
How are you? Congratulations on your improved endurance and physical conditioning. Physical conditioning is not a metric for the degree of stenosis in blood vessels. That is to say, a person with a well conditioned heart muscle which utilizes oxygen efficiently is less likely to have symptoms with exertion.  Your exercise tolerance will continue to improve as your heart muscle, lungs and extremity muscles become better conditioned. You are correct that if you were indifferent to your cholesterol, then your heart disease would worsen. However, your cholesterol does not determine your physical endurance

With regards to looking for a metric to determine if you are improving- the question is unclear to me. Your improving cholesterol and blood pressure are indicators of the benefit of medication and physical conditioning. It is unlikely that the blockages that you currently have will regress. your goal is to prevent them from progressing


Based upon your labs and cardiovascular anatomy, it is unlikely that your physician would want to stop your meds. You need tight control of your parameters to prevent disease progression