Assessing the risk

[ncsnapple]

My question is - should I decide to proceed with a heart catheter after 2 abnormalities (the internalist and cardiologist believe it to be only one location) were detected from a stress test?  I am a 42 year old 5'11" 168 lb active healthy male who runs 3-4 a week.  I have familial high cholesterol - initially 400 two years ago.  At that time, I began meds treatment.  Currently I'm on 1500 mg niacin, 80 mg Zocor and 3750 mg Welchol all which has reduced my total chol to 210.  I have no other risk factors.  My doctor and I agreed to a thallium stress test to get a baseline indication of heart health.  I expected that it was possible to have some amount of blockage after 40 years of high chol.  To me the abnormality was not a surprise.  My internalist said that the blockage is probably 60% or greater to show on a stress test and there was no evidence of any past heart damage.  Accepting that the only way to know what % of blockage is to do the heart cath, if it would be 60%(which my doctor says is not threatening), will it stay at 60% with the current drug therapy?  Will plague continue to accumulate or decrease?
Other info that might help - CRP test = 0.22
I am not yet convinced that the heart cath is warranted given that I am asymptomatic and have the one risk factor of an abnormality from the stress test due to a past high chol level.
Thanks in advance for your advice.
Sincerely,
Mike Busch
North Canton

[CCF-M.D.-RCJ]

Mike,

The answer to your question depends on at least 2 additional pieces of information not provided: (1) why did you have the test?, and (2) were there any "high-risk" features of the stress test?  High risk features would include technical things such as LV cavity dilation on the images, BP drop during the test, significant ST abnormalities on the ECG, arrhythmias during the test, etc.

Most cardiologists would agree that you likely have some degree of blockage to cause the imaging abnormality.  The question is what to do about it.  If you are not having symptoms AND you had no "high-risk" stress test feature, then the having the cath would be strictly to know what the arteries looked like.  There is no evidence that opening a partially blocked artery prevents death or heart attacks in someone without symptoms or high-risk features.

On the other hand, some people experience significant anxiety with the unknown.  If this is you, then a cath might provide you with peace of mind.

Talk to your doctors to see why they might want you to have a cath.  Maybe they have a reason I've not considered.

Hope that helps.

[No Bypass / No Stents]

It sounds like you are on a good drug regimen and have healthy exercise and dietary habits.

Even if you have plaques, it's likely that you will suck all of the lipids out of them and be at low risk for one of them to rupture causing a heart attack.  If you give it a couple of years you will probably have some regression of any existing plaques and improvement of test results.

Recent studies done by Dr. Gregg Brown of the University of Washington show significant regression of plaques for patients on a combination of a statin drug and niacin over a 5 year period.

If you let them cath you, make sure that you have established criteria for dropping a stent in advance of the procedure.  If they put a stent in a 60 or 70% blockage you may be putting yourself at much higher overall risk because of the risk of restinosis.  You will also be losing the ability to ever bring that artery back to health again.

[gppgh]

It sounds like you are doing all you can to optimize your control of the situation.  I agree with the other comment regarding the possible outcome from any proceedure (balloon, stent, etc.) being done during a cath.  But a cath,  done only as a diagnostic may be helpful.

Last year,  at 58, in good health and cholesteral down to a respectable 155) and no symptoms except a change in shortness of breath while running the dog, I asked my family practicioner for a stress test,  which I failed.  My next step was to do a diagnostic cath with clear instructions to Drs. NO PROCEDURES. The images showed 90% blockage in two and 65% in third,  and one of the 90% guys was bulging and described by the cardiologist as a "widow-maker.".  I wound up having a triple and it probably saved my life.

My point is,  you are doing all you can to control your situation based on what you know.  But it could be what you don't know that could kill you.  If there is no reason not to do the cath and just 'see' what's there - I'd say go for it now,  while you're young and in such good shape.  

Good luck.