Heart Disease at age 39

[Scemel]

I had angioplaty in April 2006 for a 99 pct blockage at age 38. I am on 40 MG Lipitor, 75 MG Plavix and 81 MG asprin daily (plus I take the fish pills, although they have not had an impact on my cholesterol).

I have always had good blood pressure. Last check was 118/80 and I have a low resting pulse, often under 60. I have terrible family heart history -- early heart attacks and premature death in men on both sides. Yet, I have generally been healthy in life. I have been a 3 mile a day runner, 4-5 days a week on average most of the past seven years.

My cholesterol has usually ranged around 200-220, but with Lipitor it is way down -- total 127, hdl 32, ldl 76, triglycerides 94 at last check. My liver enzyme is elevated on Lipitor (94 at last check), but my doctor said not to worry about it unless it goes 2x to 3x normal. He has not put me on a beta blocker or ACE inhibitor because he says my blood pressure/pulse is so low, he is afraid the drugs might cause me to pass out.

Here are my questions:

1. Should I be taking more asprin daily?

2. Should I be asking my doctor to reconsider ACE inhibitors and beta blockers? I don't know that much about them, but I know most heart patients are on them.

3. How much should I worry about the elevated liver enzyme?

4. Should I discontinue the fish pills? Other family members saw dramatic changes in their cholesterol with them, but I have never noticed any impact on my cholesterol in the past year.

[Forum-M.D.-MJM]

Hello,

Sorry to hear about your heart disease.  As you know, family history is an important predictor of heart disease.

1. Should I be taking more asprin daily?

81 mg per day is the recommended dosage.

2. Should I be asking my doctor to reconsider ACE inhibitors and beta blockers? I don't know that much about them, but I know most heart patients are on them.

There is data to support being on them, but for the most part patients take the maximum dose they can tolerate.  If you want to do everything possible, it is not unreasonable to take an ACEI and beta blocker.



3. How much should I worry about the elevated liver enzyme?

I would not worry about that, I agree with your doctor.

4. Should I discontinue the fish pills? Other family members saw dramatic changes in their cholesterol with them, but I have never noticed any impact on my cholesterol in the past year.

There is some data for fish oil pills. It is certainly not as well studied as statins and ASA for prevention of future events.  In general I don't recommend people take them but I also do not stop them if they are taking them. The verdict is still out on this issue.  That being said it is a polarized topic and some people feel very strongly on both ends of this debate.

I hope this helps.  Good luck and thanks for posting.

[RMC32]

I am 35 and like you had a 99% and 70% RCA blockage stented 2 weeks ago. Terrible family history here also. I have been active all of my life with sports military etc. I think I'm still in shock this happened. Went to the doctors after chest tightness when running. Have you had any limitations since April? Did you return to regular excercise and weight lifting?

[Healthyself2]

Your problem seems to be familial HDL deficiency.  You CAD problems are caused by your cholesterol imbalance, particularly low HDL.  This can easily be remedied with drugs.  The body has a tremendous capability to reverse disease, once things are put back in balance.  

After my heart attack, eight years ago my cholesterol profile was very similar to yours.  HDL around 30 and total around 220.  It took me a while to get on the right drugs, but I have been able to maintain a perfect lipid profile for over 6 years.  My disease is now in full remission.

The Lipitor should do a good job of bringing down your total cholesterol.  It's pretty easy for me to maintain a TC of 150, even though I'm a large animal.

Raising your HDL is the key to survival and regressing CAD.  It seems like you already do a lot of exercise, so you probably can't raise it further by exercising more.  Currently the only drug (on the market) proven to raise HDL is high dose Niacin.  I take Niaspan.  My HDL was 55 at last reading which is about and 80% increase in my case.  That is a consequence of the Niaspan, exercise, and perhaps red wine.

Don't use the no-flush Niacin from the drugstore.  The formula is different and won't do a thing for your HDL.

[Healthyself2]

In your case, with already a slow heart rate and normal BP, beta blockers may cause you some real problems such as syncope or near syncope.  

I have a low heart rate but have developed high blood pressure.  I take Altace and Norvasc at almost maximum dose to keep it under control.  The Altace doesn't do much, but supposedly is a good drug for people with CAD.  The Norvasc is very effective against BP, but at my dose, I now have side effects.

I'm hoping that my semi-retirement in a wilderness area will allow me to relax and do more outdoor activity allowing me to cut back the BP meds.

I would say that an ACE inhibitor might be good and probably won't have much effect on BP and none on heart rate.

Best or Luck