This was indeed a tragedy.
Unfortunately, stress tests and electrocardiograms (ECG) are not 100% sensitive. From time to time an ECG or stress test may be normal and a person may have significant coronary artery disease. Also even if a stress test is finally deamed normal it means that a person maybe a low risk not, no risk.
The heart rates you have listed above appear to be within the normal range for the activities listed.
Thanks for your question,
CCF-MD-KE
Also pretty much all non-invasive testing is inconclusive in young otherwise healthy people.
It's really not the blockage that kills, but the rupture of a plaque followed by clotting within the coronary artery. I am somewhat suspicious of the cause of death because they didn't mention this.
It also goes to show that most people don't die during physical exersion, but at 5 am the following morning.
I would say that most young people with this level of disease could be saved with agressive pharmacological treatment of lipids. The problem is that most of us will never take it seriously until we have had a cardiac event.
I do think that low HDL would be the primary predictor in disease for someone in this age bracket. I would love to know what his last HDL reading was.
You are absolutley correct that none of the non-invasive tests are 100 % accurate. You appear very knowledgeable, as shown in your posts, on heart disease. Apparently, you do just as I do, and research all you can. My quest began in 1996, when, at age 36, I developed panic disorder with an immense fear of heart disease, tha still lingers with me somewhat to his day. I've gone to some of the country's top cardiologists, and still do to this day in an attempt to prevent heart disease. I have had stress tests, all the newest lipid tests, an ultrafast CT scan (which was reviewed by pioneer Dr. Ken Cooper, who assured me that my total score of 2 was fantastic.)
Has all of this convinced me that I'm healthy? Nope! Because of incidents like this where seemingly healthy men die suddenly from cardiac disease..just last week a friend of mine, age 45, no history of any problems, got chest pains, and the end result turned out to be a 6 vessel bypass! So, pay attention everybody...probably the only test that is certain is an angiogram, and they don't give them on request, plus, I'm apprehensive to even get one.
My mother had CAD with three heart attacks leading up to bypass surgery at 57 and death from heart failure at 64. I had total cholesterol readings of between 220 and 240 with HDL readings around 30, but never paid much attention to them. Somehow I thought that the bullet would miss me.
I was also overweight, ate a high fat diet, and was a workaholic - all high risk factors.
I would say that, with your test results, if your HDL is high-normal, your not overweight, and don't eat a high fat diet your risk is extremely low.
As for your friend getting a 6x bypass, remember that stents and bypass surgery doesn't stop the disease. They may last 15 years or they may last a year. There are also huge risks in either procedure, which are largely unaccounted for by the industry.
I had a heart attack at 50 which lead to the discovery that my RCA was 100% occluded (and had been for severeral years) and my circumflex 70-90% blocked.
A year in a half later, a subsequent attempt at angioplasty discovered that a large, prior undiscovered, plaque in my left main had "cratered" - that is the top had blown off and the shoulders were left flapping in the bloodstream. Although the attending cardiologist flipped out and aborted the procedure, I believe that this was the result of successful lipid therapy. I was given 40% odds of sudden death within 5 years by the cardiologist in his sales pitch for bypass surgery. Fortunately I really don't believe that estimate. I would give myself about a 2% chance of death within those 5 years, but of course he could be right.
Some people like Mr. Kyle die instantly when that happens, others like myself survive it. I think my left main popped the night after I climbed Mt. Adams for the first time after my heart attack. I felt a little bad the next day, but survived it.
I don't know if you will come to not worry about having a cardiac event or dieing suddenly, but I no longer do, even with the warnings that I have been given. Somehow I just came to resolution with it over a couple of years.
I just take my cholesterol and BP cocktail of meds, walk twice a day, and do some hiking or skiing on the weekends. I try to eat less saturated fat, but my motto is eat drink and be merry. Who knows you could worry a lot about it and a big rock could hit the earth tomorrow and wipe out all life.
I just treat it like any other chronic condition. I push up against it physically a couple of times per day, take my meds, and try to enjoy life. I monitor my BP and have a thallium test each year to check my LV size and EF for any sign of cardiomyopathy.
After quite a lot of study, I have come to believe that Stents and Bypass surgery are not the way to go unless there is no choice. Also drugs such as beta blockers, blood thinners, and nitrates are counterproductive to someone who is actively trying to push back the disease.
Don't worry - be happy :)
Thanks for sharing your knowledge. I have a question for you if you know - How do I raise my HDL significantly? Im overweight, so Im working on that and have lost 14 pounds so far - Im serious about getting right because I am only 37 and think I can turn this thing around before it's too late. My HDL is around 30 as yours was - my LDL isnt that bad - 140 and total around 200 / but with the low HDL - Im scared - now the Dr says I can only raise it 'a few points' on my own. I have read where people raise it 20-30 without meds / is this true? If I exercise, lose the 50 pounds that I need to lose, and eat low fat and eat right, how much do you think I can raise it? My parents are both ok - its my grandparents that had heart attacks in their 50's and 60's / I am also taking guggulipids as an herb - I read that it REALLY makes a difference - I take soy everyday and CoQ10. DAMNIT why doesnt that HDL want to move?? LOL! Anyway, any light you can shed on how I can raise my HDL would be really helpful! I really admire your outlook on life after what you have been through. Really makes us worry warts look like a bunch of babies! My dad was always thinking he was going to die and after many tests they say he is fine and probably wont die of a heart attack like his parents did - so I think that paranoia was passed onto me! :) Have a great day!
Start today and don't wait...your attitude will improve, believe me.
Thanks again for all your support! I love this forum!
I agree with the previous person on exercise. It's important to do at least 30 minutes of light cardiovascular exercise each day, but I wouldn't overstress yourself until you are very fit. I walk a hilly 2 mile course before work and before lunch to maintain tone and relieve stress during the week. Although good, walking on the flat doesn't do a lot for you. Going up and down a little gives you a little more of a workout.
There are currently only 3 things that raise HDL significantly:
1. Exercise
2. Alcohol
3. Niacin
The exercise will bring your HDL up perhaps 10 to 15%, but that is not enough. If you can drink a glass of red wine each evening and stop at one, that will help a little also. Perhaps between the 2 you could reach 40 or so.
The only substance that really makes an impact on HDL is high strength Niacin. Most people can't take off the shelf Niacin in high enough doses to help without experiencing flushing. The "No Flush" niacin has no effect on HDL, so don't bother with it.
I take the prescription drug Niaspan, which will raise your HDL to above normal levels. If I were you, I would ask your doctor for it.
I think that you should be at least at the 2 gram level for effectiveness, although they have a program to build you up slowly. I found it's best to take all of it at once at bedtime.
I wouldn't worry about toxicity, unless you have had hepatitus (hepatitis) or have previous liver problems. You will need to have a liver enzyme check regularly on the drug, but I don't think that there is much risk.
I have taken a lot of different supplements including CoQ10, but discontinued it because I didn't think that it was doing anything. I do take a good multi-vitamin, folic Acid, Vit-E, L-Carnitine, Lutien, and Garlic. My list of supplements fluctuates from time to time and I don't really know which ones do you any good and which ones don't.
I also think that Fish Oil or Omega 3 supplements might help you build the HDL, considering that your LDL is low.
I believe that you can prevent CAD if you start working at it at your age and keep your good habits. Good luck to you.
Anything below 40 is considered dangerous on the new cholesterol standards. With your reading, there is no reason that you shouldn't be prescribed Niaspan unless you have liver problems. You need to get that up to about 60 to get completely out of the danger zone.
I said your LDL is low, but I mistakenly read 140 as your TC reading. a 140 ldl is borderline high and you should try to get that down to about 100 and your TC down to at least 160. The Niaspan should also help with that although you might need a low dose of Lipitor also.
I take Lipitor, Niaspan, and Welchol in combination, which works extremely well, but I am willing to take more risk because of my severe condition. I wouldn't recommend that much for a healthy person.
Unfortunately, it took me almost 2 years, after my heart attack, to get on, what I consider to be, the right cocktail of cholesterol and BP meds. It tooks some study, trial and error, and lobbying with the doctors to get where I am at now. But I wasted a lot of time where my disease was progressing. Neither my PCP or cardiologist was up to date on the right drugs to prescribe. My cardiologist now seems to have seen the light. Of course he makes his cash with a heart catheter, not on the drug scripts.
I would say that if you watch your diet, exercise religously each day, and get that HDL up, you should avoid a future cardiac event.
Your lipid profile is in what I would call the "Watch Out!" category. The HDL/LDL ratio is a very reliable predictor of coronary artery disease. That's why the life insurance companies use it.
Also, I always tell the young overweight guys around the office, that you can eat anything that you want and do anything you want until you are about 50 and then the waiter will send the bill to your table. And when he does, it's going to be a whopper and it's going to hurt real bad!
If I could have gotten aware and been willing to do what you are doing when I was your age, I believe that I could have avoided the heart attack, 2 failed angioplasties, and the physical limitation that I now have.
It's your choice.
2. To improve lipid profile be sure to eliminate the all fats that are solid at room temperature - i.e. butter, margerine, lard, etc. Use olive oil when you must have oil, and eat the fresh water fish that provide the omega fatty acids. Salmon from the sea is good, and NOT the same as the salmon raised on farms - which is now so widely available at lower prices.
3. For weight loss and general health a diet based primarily on vegetables, fruits (though these are high in sugar) and whole grains (eliminate refined flour - breads, pastas) will work. Steamed veggies are delicious - really!
Check out this site:
http://www.netfit.co.uk/wkaer.htm
Let me know how it's going after a while.
Ken S.
OH! Also - I take toprol @ 25ml which isnt much - but its enough to lower my heart rate a bit - how do I get it really high when working out? Will it go to where I need it to when I really get into the exercise? My husband says no way - he doesnt believe in drugs but the toprol has really helped w/my pvcs and I would like to stay on it a bit until I lose the weight I need and get into shape - then Ill wean off it - by then I hope to have my lipids better too with the drugs - I really doubt my HDL is gonna raise all that much by itself / wow those drugs really can raise it ! No bypass - will you let me know what yours turns out to be when you have your blood tests? I hope I can have your attitude! Im such a wuss.
Thanks everyone again! Nice chatting with ya all!
Oh my email is ***@****.
That sense of failure can permeate a life in all areas:
Grades in school.
Finances
Health
Career
Relationships
etc.
Many millionaires were broke several times in their lives. World champion athletes have had cancer and other health challenges. People who have dropped out of high school have become rich, famous, or world leaders. People who have tried and have failed spectacularly have made comebacks.
You can restart every day from where you are at and build from there. The past is is not important and the future is not here yet - today is here for you to do your best and enjoy life without fear or worry.
I have learned this the hard way and don't always follow it, but I try to. I try to go to the park in the morning and listen to the birds - to enjoy at least a few moments free from fear, worry, and the so called problems of the day. Hopefully one day I will have the ability to do this all day long.
Good Luck To You.
Good Luck!
Ken S.
I am a 33 year old male with constantly low HDL. It has been as low as 24. My LDL and TC has always been normal. I have stomach probelms and cannot tolerate the Niacin side-effects. I had my doctor start me on Zocor 20mg so I would at least have something making my ratio better. My lipids are as follows:
TC-127
Tri-136
LDL-57
HDL-35
Ratio-3.5
Do you think I have done the right thing considering my options?
I would think that 35 isn't too bad in your case considering how low your TC and LDL are.
I am 34 years old, 6'6" tall and weigh 250lbs. I play basketball 2-3 times a week and am fairly active. There is absolutely no heart conditons in my family.
I have recently been going through several tests to rule out Marfan's Syndrome. The tests included: ECG and a CT Heart Scan.
The tests were done at a small hospital with a "supposedly" good cardiology department. The summary of the results for the ECG said I had narrowing of the LV, mild mitral valve regurgitation and possible diostolic dysfunction. The ejection factor was 60%.
The CT Scan summary said I had prominent dilation of left and right coronary sinuses.
I decided to get a second opinion from a very well known cardiologist in New York. He did his own ECG and Stress ECG and totally disagreed with the measurements taken across the LV, the diostolic dysfunction and the mild regurgitation. The LV was measured three tmes and could not seem to come up with the same number from the previous ECG. The LV was not narrowed at all. He told me the mitral valve was considered to have "slight regurgitation" and considered it to be normal. He did not repeat the CT Heart Scan but mentioned that for somebody my height and weight the coronary sinuses should be slightly dilated from the "average" person. The Stress ECG showed everything to be normal but the blood pressure seemed to hit 230 while the heart rate peaked out at 160 BPM. He also had me squeeze a grip-o-meter immediately getting off the tread mill while the ECG was being performed.
My questions are:
1)Should the coronary sinuses be larger on a person my height and weight and what would be the concern if they are in fact dilated?
2)Should I be concerned about with blood pressure at 160 BPM if my blood pressure is always normal at rest?
3)Should there be any regurgitation through the mitral valve?
4)What is the purpose of the grip-o-meter during the Stress ECG?
This whole Daryl Kile thing really is a tragedy and has gotten me concerned.
I'm curious to know what your calcium-score was on the heart CT scan?
Total 164
ldl 88
hdl 47
If anyone knows the formula please let me know.
Thanks.
I do not believe you can calculate Triglycrides. They must be a direct measure from a 12-hour fast. LDL is most often calcuated from lipid measurements; however, a direct LDL measurement is much more accurate, especially if the tri's are in the 200 or more level. Hope this helped.
Thanks so much for your thoughts too bypass - you are so right - I always have had a positive attitude, but I let panic and anxiety take over where I shouldn't. It helps to hear people like you who have overcome really huge obstacles. Thanks to all who gave me examples of HDL's and how to raise them etc - I like to hear examples of #'s and how exercise and eating etc really CAN raise it more than my dr is telling me. She tells me a max of 10, maybe. I need more than that at 30 / I would like to see it above 50 minimum. Bypass - did you get your results back yet? Just curious -
Santiken - you are right! I just need to do it - I think the toprol works - but I would like to get off of it someday - if I have a healthy heart - then I shouldnt worry - I am working at it but Im still afraid to PUSH it - I get a pvc when I do - but I think its because Im out of shape - Ill keep working on it - Slye thanks for the #'s! That proves that you can do it! If I coudl get to 46 that would be nice / a LOT nicer than 29 or 30! GEEZ _ WHO GAVE ME THESE CRAPPY GENES???????????? LOL!
Have a great week ALL!
My cholesterol is always in the 210-225 range.
HDL is between 40-50
LDL is NEVER lower than 150
Tryglcerides are between 98-190
I cannot tolerate any statin meds.
Thanks for this wonderful web site, I am learning a lot!
Sincerely,
KG