Do I have "Heart Disease" or just "Bad Numbers"

[amacld]

I recently got my blood tests back and am not sure if I have "Heart Disease" in the classical meaning of the phrase or just a bad reading or "Bad Numbers" which need to be addressed. Can someone please clarify this for me? First off, I'm a recently turned 60 year old man who used to be an athletic type during my younger years and over the years let it all go down the drain it seems. I was diagnosed with Diabetes 2 almost exactly 2 years ago, and also hypertension for the first time. Although my Hypertension was on the low side then the Dr. Still prescribed Lisinopril 20 mg a day for me which I have taken until recently (he upped it my last visit to 40 mg a day predicated on my own readings showing that 20 mg was not enough (he said that even if there was some disparity that 40 mg a day "wouldn't hurt me' or lower my blood pressure any further and it was ok-and even said I could break the tablets in half after 20 mg and take 10 followed with 10 later if my blood pressure went up again. At that time, 2 years ago he also prescribed 500 Mg of Metformin to be taken twice daily which I have followed to the letter since then, plus 40 mg of Simvastatin or Zocor once a day. I cut the Simvastatin out back in December after having experienced the worst vertigo episode one could imagine-cat scan Dr. ordered at the ER showed no problem like stroke-but the reoccurrence of the vertigo and he prescribed it to probably an inner ear infection or something in that nature. I was prescribed Meclizine for the vertigo if it came back again, which it did (he called it positional vertigo as one position stopped the terrible spinning of the world around me-and the med with some valium did the job..until the next and then the next episode days apart. Then I got on the internet and saw all the horror stories and similar symptoms that Simvastatin caused and stopped taking immediately-Dr. or no Dr’s advice. The vertigo disappeared the next day until 4 months later where I’m back in the ER again and again CAT scan showed ok-but ER Dr. said I did a good thing by eliminating the Simvastatin, citing other problems it could cause besides vertigo down the road. So I took Simvastatin for only 1 ½ years-until the symptoms showed up. My Dr. who is a heart specialist and has been around for a long time was given the ER results and after putting off my visit to him for a long time (ok I don’t like going to the doctor!) realized I needed blood tests done as I was feeling, and still am feeling, absolutely miserable. The results are as follows-just under 2 weeks ago-total cholesterol 199-not bad as it has been worse in the past..but he said my “now” cholesterol reading was not good-somewhere around 274 or 279-my HDL is 25 (has always been bad and fluctuated over the years-highest 38 and never reached that 40 number in this decade), Triglycerides 505 (was over 700 2 years before, got it down with walking and exercise and a fish oil prescription called Lovazo to 180-then back to my unhealthy ways-lot of stress-death in the family and so on-did not help as I have stayed home and secluded for 10 months now-and probably why my vitamin D count according to the Dr. is very very low at 11.6) VLDL is 101, Dr. guesstimates my LDL is around the 140 area due to improper calculation because of high triglycerides, Glucose serum is 116 but the Dr. said because my A1c is 5.4 that’s good as the Metformin is working as it should be. The Dr. made the following changes in my prescription-he finally gave in to my saying that I would NOT take impastation again and prescribed Niaspan 500-wants me to take twice daily if the (“side affects“) improve (improve? “Fahget bout it!”) in a week or so. I read what the side effects are on Niaspan and they are not good at all and I don’t need to go through all that now. He was about to add a new statin to that until he realized that he was giving me too much all at once-as he said later. New Statin down the road (A big Maybe on that one)? I am going to do exactly what I did the last time 2 years ago-sans the impastation-take fish oil omega 3 over the counter-the Dr. said that was ok as long as it did not exceed 4 grams per day-similar to Lovazo-walk and walk and walk, which I did the last time and my lipid results improved dramatically going from about 220 total cholesterol to 167 and my triglycerides dropping from a whopping over 700 to 180 and my HDL going from 27 to 34-some improvement anyway-all in 6 weeks. Then I will tell him I didn’t take the Niaspan (which I believe he suspects I will not take anyway), and after the blood tests see where I am. During the 2 years I had a cat scan done to check on a suspected nodular opacity which was not there as shown incorrectly on the exray (with contrast and one reason I don’t need to go through that horrible toasted sensation all over my body which Niaspan causes plus other side affects). I know this was a long story but since I have not spoken about this and seen the Dr. very rarely in the past 2 years I felt I needed to tell all to the experts on here or people that I consider experts with their vast experience judging from the posts as compared to my limited experience. I’m 5’9 and approx 224 lbs. by the way-and that’s the first thing that is going to go-if I don’t get a heart attack first! Seriously though, wondering if I have “Heart Disease” in the classical meaning of the word (Never asked my Dr. and he’s a bit evasive on such direct questions anyway). Anybody care to help please let me know what you think. I am contributing my 199 total cholesterol to eating a lot healthier these past several months but don’t know what that “now cholesterol” that the Dr. talked about is-as that seemed to be of some concern to him. One last thing-my Dr. made me feel great before I left his office when I asked him what my chances of getting a heart attack were now and he should me this rectangular plastic thing where I saw little lego miniature type blocks-very little and then this block as big as the Washington Monument next to them (that’s me he said insofar as my chances of getting a heart attack) and a slightly taller lego type next to that. Boy I needed that! He did say-”Keep walking” as I was leaving his office which was encouraging of course.

[amacld]

"particularly when I have been doing next to noting for a year or so"

"noting" should be nothing instead  

[amacld]

Thanks but still have some doubts about Niaspan or Niacin. Your post only confirms what is out there already as to the many bad side affects of Niaspan or Niacin. Jon was very helpful and I appreciate his input a great deal as I do yours, but it' is I who has to decide at the end of the day.

My decision (for now anyway) is to do what I did the last time I was on a campaign to bring my total cholesterol down-which was over 200 3 years ago-plus Triglycerides over 700. I exercised almost every day with long walks and Lovaza which is a fish oil with Omega 3. I have since learned that most fish oils with Omega 3 do the job just as well-even my Dr. said that. No more than 4 grams per day and exercise plus eating right as I have been and I will see what happens.

If after say 6 weeks or two months my numbers are not the good numbers I got the last time I did this then I will seriously consider the Niaspan and or statin as I will have no other choice. "Steady as she goes"-and doing it with a plan is what counts for me now. The only thing left is to address the 11.6 very low vitamin D level and am leary about taking 2000 mgs of vitamin D right off the bat as the Dr. recommended. I'm looking at something more like 400 mgs a day and more walking and sunlight, which I have denied myself for 10 months now (really longer and more like a year). I'll see what the new blood results will show.

Any other suggestions will certainly be appreciated but at this point I do not believe I need to do something as radical as the Dr. suggested I do-particularly when I have been doing next to noting for a year or so. At least I am doing something definite and positive now and with a purpose as well as a plan.

Thanks,

Al

[heartfluttersflyawayplz]

please take a reg aspirin with the niaspan because i to took the med and after two weeks decided i didnt need the aspirin anymore boy was i wrong. the burning started at tip of my head went to my chest. when it hit my chest my heart went wild beating so hard and so fast  and burning so bad after it passed my chest it wqent all the way to my feet. wow it was scarey. after it was over i got up went to bathroom on way back to bed i blacked out, never have i fainted before .  should went to er but didnt. called my cardio dr next day he told me not take again that i had a cardio attack from it and that he also had took it did him same way. so plz take aspirin with it no matter how long you have been on it .

[amacld]

Thanks again Jon, I will do that!

Al

[erijon]

You may want to try the Niacin (Niaspan is Niacin), it will definitely increase your HDL. I'm told that if you take it with aspirin it lessens the effect of the facial flushing. Also, a fatty liver is common in overweight individuals, the doctors I volunteer with have no issues prescribing cholesterol meds to individuals with fatty livers. It is very important, however, that you get your blood panel checked every 6 months or so to watch out for changes in your liver function.

Good luck and let us know how it goes!

Jon

[amacld]

PS meant to write Niaspan and not Niacin the severall times I wrote Niacin after I did state Niaspan. It is in fact Niaspan of course.

[amacld]

Thank you for your well thought out and knowledgeable reply Jon! Actually my story was so long (and sorry about that) it sounded a bit confusing even to me after I read it. I actually did not take the Niaspan as I am concerned about the possibly severe side effects. Plus the Dr. warned me about them himself. The patient gets all kinds of things like body heat all over, face swelling, and some even passing out (these are the worst case scenarios of course, and I am still not over what Simvastatin caused me after a year and a half with all that vertigo and how the vertigo went away after I stopped taking it). But this does not mean I must be afraid of either Niaspan or the other statin he wants to give me later. I realize this now and you helped to drive that point home. He is a well known cardiologist with 38 years experience.

It has become increasingly clear to me now that my condition is very bad and as you astutely pointed out-as did he-My HDL being at the low number it has been at for quite some time now is a big risk. I have decided to take the Niacin of 500 mgs he prescribed (and increase the dosage to another 500 mgs a day if everything goes well as he instructed)-take the added statin when he thinks I am ready for it based on the tolerance of the increased Niacin-plus the fish oil-and Exercise as he said, and which you also said as well!

Perhaps the only other thing that was holding me back from taking the Niacin is the “moderately fatty liver’ which was found on my CT scan when looking for something else back in May. The Dr. must have taken that into account as when I told him he replied-”Diabetics usually have fatty liver”. I have neglected my health for far too long and as far as the Metabolic Syndrome goes-You hit the nail right on the head! I was diagnosed with that, and as you said what used to be Syndrome X back in 2005. I did something about it then but not enough as my condition developed into Diabetes and then the Hypertension came as well. This is probably my last best chance to do what needs to be done-and do it right. I thank you very much for your very astute observations that were right on point and you have encouraged me to do everything that is necessary to get well!

I will also look up the Google Framingham Risk Calculator and calculate my risk for a heart attack. Thanks again Jon!!

Al

[erijon]

That's quite a story. The most important thing I take from your numbers is your low HDL. Even if your LDL is just slightly over 130 as you suspect, your low HDL makes your system act as though it's really higher than that. Personally, I think a statin is still a good idea. In addition to lowering your LDL, statins are shown to have a slight impact on raising HDL as well. The easiest way to raise HDL is through exercise, working out at 85% of your max heart rate for 30 or more mins per day most days of the week with your doctor's approval. You have tried Niacin without luck so you need to try other options. With your above normal glucose level, High LDL and low HDL you may be experiencing Metabolic Syndrome. Metabolic syndrome (also known as metabolic syndrome X) is a grouping of cardiac risk factors that result from insulin resistance (when the body's tissues do not respond normally to insulin). A person with metabolic syndrome has a greatly increased risk of cardiovascular disease and premature death.
The risk factors seen in metabolic syndrome include: insulin resistance, obesity (especially abdominal obesity), high blood pressure, abnormalities in blood clotting, and lipid abnormalities.


I understand your concern over statin side effects, but ALL drugs have side effects. Your doctor will weigh the benefit and risk to recommend the best treatment for your situation. A statin makes sense from what I read in your story.

Also, if you want to calculate your risk of heart attack, Google Framingham Risk Calculator and you can calculate your risk.

Good luck,

Jon