Heart disease and allergy?

[runnertom]

I have posted before and am still searching for the "smoking gun" in my heart disease. At age 54 I was diagnosed with severe blockage of LAD and first diagonal which was treated with CABG. This was a total shock to everyone familiar with me as I have a benign family history for heart disease, have been a heavy runner/bike racer for 30 years, and a non smoker, 130 LDL/60 HDL, and normal BP. Since surgery I have found that my homocysteine was high and I am now treating it with folic acid/B6/B12. I am also taking 40 mg Pravachol which has my LDL down to 80. 18 months post surgery I am back to all my former activities and feel that my exercise capacity is as high as ever.
   My problem is that I don't know whether I have found the root cause of my disease which must be rather agressive to cause problems at an early age in light of my positive risk profile. I was wondering whether there has ever been any association made or suggested between severe seasonal allergies (hay fever) and CAD risk. I have such allergies and for 15 years was having desensitization shots every week. I know that inflamation (inflammation) is a big player in progression of artery disease and wondered whether irritation/inflammation from the allergic response could also be significant. Am I "off the deep end here"?

[CCF-M.D.-MJM]

Runnertom,

sorry to hear about recent health problems.


1. I was wondering whether there has ever been any association made or suggested between severe seasonal allergies (hay fever) and CAD risk?

There is no association between coronary disease and seasonal allergies.


2. wondered whether irritation/inflammation from the allergic response could also be significant

There are no studies to date that show that seasonal allergies or shots to reduce seasonal allergies contribute to coronary disease.

It sounds like you are doing a lot of the right things to decrease your risks of future events.  Your allergies are not contributing to this.  Unfortunately there is a portion of the population that develops coronary disease with no known risk factors.

I hope this helps Thanks for your post.

[knicks30]

Hold up a portion of the population that have CAD dont know what caused it??

Ok there is

Cholestorol
Hypertension
Diabetes
Family History
Obesity
Sedentary lifestyle
Homocysteine
C-reactive protein
Smoking

What else is there?? Ive heard that low testosterone levels is also a risk factor, ive read that on Life Extension Magazine.

I have a question....Does chronic inflammation cause CAD or does the CAD develop from other risk factors and the inflammation causes a piece of plaque to break free, which is which??

[knicks30]

I have heard that low Testosterone levels are linked to Coronary Artery Disease.

There is Smoking
High Cholesterol
Hypertension
Diabetes
Family History
HomoCysteine
CRP

what else am i missing? Is there any other risk factors out there that are being investigated?

[runnertom]

I think the list of risk factors is much larger than you present. For one thing, there is fairly strong evidence that bacterial infection in the body have a role. A fairly large percentage of diseased arteries show evidence of bacteria that cause pnemonia (pneumonia), periondontal disease, and stomach ulcers. (Unfortunately, antibiotic treatements have non been shown to be useful in changing the outcomes). Stress is suspected to be a significant player. Lp(a). Sleep apnea is another. The list goes on...
I don't think there is general agreement at this point whether CRP and homocysteine are independant risk factors or they are actually markers of something else going on. For example, CRP is an inflamation (inflammation) marker that goes up from other inflamation (inflammation) in the body from infection or whatever.

[Blumoon]

Certain "supplements" and Weight-Loss HERBAL things like Ephedra and other medications that you can be taking. Raise you hand if youhave heard of "died of Natural causes" or "thier heart just stopped one day" associated with your long gone ancestors,. Pollution can put you at risk.. It doesn't matter how you got it, you can fix it and live quite healthy from this point on. Today is my 2 yr anniversary of my Quintuple Bypass. I lost all my grafts a year ago, have 3 of the new stents in, Have a diffibulator implant, my pumping action has gone from 35% to 49%. I still have angina and am a high risk but do 10 miles a day on a stationary bike, do "wellness" clinic 2 times a week at the hospital and take some really super vitamins. My stamina and turn around time from procedures is stunning my doctors. I had 5 caths in 3 months last year, none this year. just a stress test. The determined the "chest pain" I was having was a severly blocked gallbladder. Out came the gallbladder,liver biopsy done, cirrohsis and the a Hep Panel adn yep Hep , so now I am going through the Interferon stuff and my doctors can't believe I am doing this well,. It is a positive attitude and very good vitamins. Stressing or worrying about "how did this happen to me" will get you no where but high BP aand stress. Not worth it. Take today and go with it. I see a rainbow in everyday no matter what. It is good to even be alive.

Blumoon

[Blumoon]

Forgot, they put the Guidant ICD in July last year, 3 months ago during my "download" they discovered my 5 year battery had drained in half,. I told my doctor it made sense to me since I stop watches and change radio stations when I walk by a radio, he laughed and said sure. Well knowing he didn't take me seriously, I told him I would revese my polarity and stop the drainage.. he smile and said see you in a month. well for the past 3 months the battery has not moved. It stopped the drain. I just smile and said good because it is real hard work reversing your polarity you know! Doc finally laughed and told me to keep up the good work. He would see me in 3 months! so..hmmm did it really work or did the battery wake up (oh, the ICD had not given any shock since they put it in,. I had VT)

[knicks30]

Ive noticed that older individuals like Runnertorm(im not calling you old!!!) that are very active and athletic and have for some strange reason a blockage that its always a blockage in their LAD?? Coincedence?? What is up with that artery!!

I know with the blood pressure for so many years they said 120/80 now they are saying thats hypertensive its suppose to be 115/75! Man can you guys get a last number already! Sheez!!

Ahhh i say lets live life, and whatever happens happens right?

[runnertom]

Knicks30,
   I also have run into an number of long term heavy exercisers that have experienced the LAD blockage. I for a while had a theory that the heavy turbulence associated with great extended periods of max blood flow thought this artery (especially at the point of the bifurcation) may have something to do with the blockage. I had this theory partially validated for me when my surgeon told me that stenting at this point was very risky due to the high turbulence and likelihood of early restenosis.
   In my case, the occurrance of the blockage seemed so perverse in light of my doing everything that should be cardio protective, I was feeling I was in some way responsible due to my overdoing the exercise thing. I have yet to get any cardiologist to agree with this.  I have been saying that I am the American Heart Association's worst nightmare-someone who is following all their guidelines yet still get early heart disease while so many couch potatoes doing all the wrong things get away with it.

[StoneReader]

Another cause of "heart irregularities" may be running itself;

See JA Pantano & RJ Oriel, Prevalence & Nature of Arrythmias in Apparently Normal Well-Trained Runners, AM Heart Journal 104, 762-768 (1982). ~40% of runners showed some symptoms.

Thickening of the heart wall and enlargement of the heart in endurance atheletes makes more heart muscle volume.  The increase volume of heart muscle, in turn, may increase the probability of chance foci to misfire and cause an arrhythmia.

[runnertom]

First let me say that I agree that extended endurance training may result in atrial arrythmias. I have seen the studies and my own younger brother who has run and ridden with me over the years develop A-fib that had to be ablated (for him to maintain his activity level). In general though, I don't these atrial problems are life threatening-only activity limiting. I myself had developed exercise induced PVC's that were one of the issues that got me to the cardiologist. The jury is still out on whether these were secondary to the "athletic heart" or the ischemia from the blockage. They persisted for a year or so after the surgery but have largely disappeared now.
   I have never exercised at the high level for fitness purposes. I do it because I like to do it. It makes me feel good. Racing used to be a goal but I seldom do it now. I like to feel the fitness that you could never get from walking, no matter how fast. Walking a brisk pace gets my pulse to about 80, not even in my "target zone".
   I guess I will never know whether my exercise cause my problem or saved me from it. It was transient shortness of breath in the first 1/4 mile of running that got me to the doctor asking for an inhaler. The SOB would go away after that and I could run 7 minute pace without pain for any distance after that 1/4 mile. I had no clue of any problem on the bike, even when hitting pulse rates of 175+ on difficult hills. The angiogram showed impressive collateral development that was apparently sustaining me that no doubt developed due to the heavy exercise.
   I have read replies to postings similar to mine where the doctor suggested that bypass may not have been necessary if there was not pain and the heart function was not being impacted. Unfortunately, I had not read these prior to my bad news and felt like I had a time bomb inside my chest and wanted the surgery that day. My cardio had in fact told me that he was not letting me out of the hospital without surgery.
   In retrospect, I'm glad I had the surgery and I am very thankful to know I have artery disease. I am now on guard and will listen to my body even more than before.I may never know the exact risk factor responsible, but I think its very unlikely that any single factor working alone would be responsible. Thus, I can monitor and hopefully control the remaining recognized risk factors and hopefully match the longevity of the rest of my family.

[runnertom]

I appreicate your view that walking is sufficient exercise for cardiac health. I have no problem with walking except that that I want more. I enjoy hiking in the woods but that is not available to me on an everyday basis that I would need to maintain a fitness program. I enjoy walking in the neighborhood with my wife occasionaly, but it gets to be a chore if done every day.
   As previously stated, I am quite ready to accept the idea that "overdoing it" was involved in my disease-but please define what amounts to overdoing it. Unfortunately, I have seen absolutely no studies even suggesting the idea (other than the A-fib). If you can produce any references supporting your supposition, I would welcome them. Otherwise, I have read a number of authors proposing that greater exercise volume and intensity has a positive effect on lipid profiles and other objective measures of cardiac risk. For example, please see study of over 8000 runners finding improvement in cardiac risk profile with no point diminishing returns up to 50 miles per week.(Archives of Internal Medicine, 1997;157;191-198).

[fizzixgal]

I was just wondering if you had had a nuclear stress test prior to the angiogram and whether it showed anything. I have been troubled by similar symptoms even though my PVCs are now under control with verapamil. To be specific I have not SOB but vague chest pains, not usually exercise induced but that go away gradually during exercise, and I can sustain a much higher workload 45 minutes into a workout (I'm a cyclist) than in the first 5-10 minutes. Had a cardiolite stress test in May up to 98% of my maximal predicted HR that was negative for both ischemia and perfusion defects, but am starting to wonder if it was a false negative.

[StoneReader]

Even though heavy endurance exercisers such as runners may have higher rates of arrhythmias during exercise,  aerobic exercise is a effective preventitive to Sudden Cardiac Death SCD when you have an arrhythmia.

Aerobic Exercise can also successfully treat some arrhythmias. See, for example, an invited review article, "Aerobic Exercise Conditioning: A NonPharmacological AntiArrhythmic Intervention" by George Billman, J.Appl.Physiol 92, 446-454 (2002).

Experiments on dogs have shown a similar effect.  In one study (referenced in above article),  a number of dogs had their hearts ablated to make them susceptible to induced arrhytmias.  The dogs were then split into two groups.  One group was kept as controls and the other group was exercised vigorously on treadmills everyday.  Although arrhythmias could be easily induced in all of the control dogs,  virtually no arrhthymias (<1%)could be induced in the dogs that had daily treadmill exercise.

As is well known, some pharmalogical treatments while sucessfully preventing the arrhythmias counterintuitively actually double the incidence of SCD.  So if you have any choice,  exercise instead of taking drugs.

And there are many other benefits to exercise that are reviewed in a nice article by Harvard epidemiologists.

http://www.harvardmagazine.com/on-line/030407.html

Here is how the article begins:

"In the bottle before you is a pill, a marvel of modern medicine that will regulate gene transcription throughout your body, helping prevent heart disease, stroke, diabetes, obesity, and 12 kinds of cancer — plus gallstones and diverticulitis. Expect the pill to improve your strength and balance as well as your blood lipid profile. Your bones will become stronger. You'll grow new capillaries in your heart, your skeletal muscles, and your brain, improving blood flow and the delivery of oxygen and nutrients. Your attention span will increase. If you have arthritis, your symptoms will improve. The pill will help you regulate your appetite and you'll probably find you prefer healthier foods. You'll feel better, younger even, and you will test younger according to a variety of physiologic measures. Your blood volume will increase, and you'll burn fats better. Even your immune system will be stimulated. There is just one catch.

There's no such pill. The prescription is exercise."

[runnertom]

No, I did not have a nuclear stress prior to the angiogram. In retrospect, it would likely have been negative due to the action of the collateral circulation. Maybe not. I did have a couple of non-nuclear treadmill tests that showed only PVC's starting at a pulse of about 120 and ending at 145 or so. I did a holter in which I intentionally ran one day and rode hard the second. It showed the same PVC pattern and a couple 4 to 6 beat runs of v-tach during exercise recovery. An echo was negative.
   In your case, I would feel pretty good about a negative nuclear stress test. The composite of 6 or so studies I have seen shows a sensitivity of about 95%, meaning you have only one chance in 20 of having ischemia with a negative test. Unfortunately, the test's specificity is in the range of 56%, meaning there is almost a 50% chance that a positive would be a false positive.
   Could your discovery of being able to handle a higher workload later in a workout be due to a normal warmup response? I have found that on a bicycle exerciser that I find 200 Watts difficult to do in the first 10 minutes, but its much easier later and I find myself doing 250W. I have always wondered whether it was me or the machine that was getting warmed up. I have also found that my legs are really reluctant to do hard enough work in the first 10 minutes on the road to get my heart rate to 135. After I am warmed up, 160 seems to be a reasonable level of effort.

[runnertom]

I just want to make an observation about the concept of "overdoing it" that seems particularly relevant this week. I think that most sane people if asked what an appropriate level of exercise would be for someone coming off a year of chemotherapy and radiation for metasticized testicular cancer would be, I am sure the answer would be something like "gentle walks around the mall". Lance Armstrong would not accept that answer and jumped right back into serious training and is now arguably the best athlete in the world.

[knicks30]

Lance Armstrong is a perfect role model. I envy that man so greatly from his battles with testicular cancer to his 5 tour de france wins the man is a true warrior. Now hes going for 6 go USA!!

[fizzixgal]

Thanks for your reply! Well I did have a major problem with both chest discomfort and pvcs earlier this year starting in late February and lasting into mid-May. My nuclear stress test showed a transient minor ST deviation at about 135 bpm that was not interpreted as a sign of ischemia. And certainly it is very possible that I am experiencing a normal warmup response now and that the leftover chest weirdness is not even cardiac. There is no correlation with pvcs, they seem to be completely independent. I'm a little puzzled, though, why do you say that you would be satisfied with a 5% chance of a false negative in my situation but not yours, after all isn't extensive collateralisation rather common in athletes with CAD? BTW I've seen pretty much the same statistics as you for the general population, and am not disputing that at all, but I haven't seen any studies that focused on athletes in particular, and am wondering whether the false negative rate might be higher among athletes because of collateral development. Or does a collateral-reliant perfusion pattern look different enough on radionuclide imaging to be easily recognised? BTW I was on verapamil during the test, and still am, for the pvcs.

Liz

[runnertom]

My comment about the 95% sensitivity of the nuclear scan meant that I would have fealt fairly secure with a 1 in 20 chance that I did not have a problem. I did not have the test prior to my angiogram, only treadmill with EKG.
   It makes sense that extensive collateralization as I had would impact the sensitivity of the nuclear stress test but I am no authority in that field and have seen no research on the subject. From the pictures I saw of the nuclear stress I had after my bypass, I cannot believe that there is enough sensitivity to see the difference between a normal heart and one that has blockages "bypassed" by collaterals. The image of the heart either "lights up" due to adequate perfusion or it does not.
   An alternative promoted by Lance Gould in his writings is the PET scan that offers equivalent sensitivity to the nuclear stress and specificity approaching 95%. This is a non-invasive test but unfortunately my insurance considers it experimental and will not pay for it (in spite of the fact that its cost is about 25% of an angiogram that they would readily pay for).
   There is hope in the future. A cardiologist that I have a personal connection with (my daughter is a nanny for his 9 year old daughter)was babbling he was so excited with a new technique he had just witnessed. I think it is called an EKG gated spiral CT scan. The idea is that they do a CAT scan of the heart but take pictures only when the heart is at rest. The camera gets this info from the EKG. They can image the arteries as well as an angiogram and it is completely non-invasive except for the injection of a contrast media. Within 2 years, the test should be widely available.

[fizzixgal]

That is my understanding too, and so being somewhat athletic (I ride about 4 times a week, 1-2 hours, and push hard enough to get a good endorphin buzz every time) I wonder if that test means anything at all in my case. So if I may ask, I was wondering why your doctors ordered an angiogram as the first test? After a negative nuclear stress test my doctors now seem to consider the matter settled unless/until I present with symptoms and definite ECG evidence of ischemia.

I've heard of the ECG gating technique, I know it is used in MRI to obtain precisely timed pictures, I believe this is done for cine MRI. Good to hear that it is being integrated into CT technology as well, I would be interested to read about it.

Liz

[runnertom]

Liz,
   I have never been given a straight answer to why an angiogram was ordered for me. The cardio said that it was because of my concern over my PVCs. That sounds a bit lame to me. My GP who did the stress test on me had quite freaked when he saw the arrythmia at high effort, but that had already been seen by another cardio on my holter. My cynical side believes that this particular group of cardiologists pushes procedures as that is where the money is. In my case, it may have worked out in my favor.
   I don't want to alarm you, but I was recently told a story by a friend about another cycling friend who at at 45 was having trouble keeping up with old riding companions on a specific hill. He had passed the cardiolite stress and echo with flying colors. He finally convinced his cardio to do an angiogram because he "knew" something was not right. He was found to have a 100% occluded LAD similar to mine.
   You might take comfort in the fact that even if you do have a blockage, it is unlikely that they would cause an infarc. These larger, long standing occlusions seem to be stable and mostly cause angina and loss of exercise capacity.