Cardiac risk factors

I have posted before but am still uncertain as to whether I am doing all I can for my health.
I am a 56 yo male who had double bypass of LAD and first diagonal about two years ago. My only symtoms (symptoms) were transient sob at the very beginning of my running and arrythmia during exercise that got my GP excited when he was evaluating me for the wheezing I sometimes experienced while running. I never experienced any angina, probably due to extensive collateralization.
These blockages were a complete suprise in view of a very benign family history and my background of serious running and cycling since I was 25. I never smoked. LDL was about 130, HDL 60. BP normal although elevated during exercise. It was found that my homocysteiene was high but is now down to 13 with folic acid and B vitamins. Taking 20mg Lipitor, my LDL is now 71 with 73 HDL, TG 60. Lp(a), CRP, and fibrinigin are good. I do take 12.5 mg Paxil for anxiety because my lipid specialist says I am obsessing over this heart thing. My GP says I have every right to since I should not have heart disease.
I was evaluated for the apolipoproteine E4 allele since I have had these little yellow deposits under the skin of my upper lip for many years. I suspected they could be xanthomas, but I came back E3/E3. The yellow deposits were said to be cholesterol deposits (!).
My GP still thinks I should perhaps be evaluated by the Cleveland Clinic to eliminate any more subtle risk factors. Do you think a more thorough workup is indicated for me? I do think I am in the care of one of the better cardiologists in the area.

[CCF-M.D.-MJM]

Hi Tom,

I agree it is very important to pay close attention to your diet and exercise.  It sounds like you have had a pretty thorough evaluation for the known treatable causes of coronary heart disease. I higher dose of lipator may not hurt.  I use a lot of higher dose atorvastatin (Lipator) to bring down the LDL and feel very comfortable with an LDL in the high 50's to 60 range.  There are not studies to suggest that low very high dose lipator works any better--it is what I do though.

We would certainly love to see you at the Cleveland Clinic and could offer a second opinion, but am not sure we would change anything.  

I hope this helps and keep up the good work.

[long]

I am just curious about apolipoprotein E test. If there are E2/E2,E3/E3,and E4/E4 which one of the above 3 would be the best for person to have and why?What's apolipoprotein E test used for?Thank you

[BIGDW]

I'm Gemfibrozil, twice /day 500mg, to lower my cholesterol.
The result were almost fruitless.

I decided to use the tread-mill, walking 3 miles every other day and remove all fatty foods. replaced with high fiber foods.
My cholesterol drop withen six month from 220 to 170.

I'm 73+

[getalife]

I am british so forgive my tone. I cannot believe what I have just read about yourself!! What are you doing. You do not need to see the clevland clinic or any further cardiologists. You need to see a psychiatrist/psychologist urgently. This may seem like I am making fun of yourself but I am deadly serious. I am not surprised your lipid specialist has you taking paxil!!! Stop obsessing about your heart NOW before you fufill your own doom laden nightmares by having another heart attack. Take a step back. Are you really that unfortunate? What about starving billions, people in your own country who would not be able to access the obvious brilliant care you have received so far? Live life- you cannot waste your potential by spending the rest of your life worrying about something that will happen to us all one day- only to things in life are certain death and tax! I am in case you are wondering a specialist registrar in cardiology in Edinburgh.

[tickertock]

I would say besides your tone and you begged for forgiveness for that yourself , I would say with that I have to agree 100% with you concerning this particular patient.