Heart risk and increasing cholesterol

[Fionajnz]

I am a 43yo f, normal weight and BMI.  I have a strong hx of heart disease in both parents (stenting, Afib and MI, strong sib hx of hypertension too).  Was dx with post partum cardiomyopathy, then PE in Dec 2005/Jan 2006.  I have HTN is well controlled.  Asthma, an unconfirmed dx of inclusion body myositis or polymyositis (dx at the same time during hospitalizations), I was on steroid treatment, so did not do the muscle biopsy.  All dx were backed up by clinical picture and bloodwork. Also anemic ++.

I have just had my annual blood work results come in, and my cholesterol is rising, inspite of dietary changes.  Total cholesterol is 218, HDL 64 and LDL  135, LDL/HDL ratio 2.11, chol/HDL ratio 3.41.

Had to change cardiologists, as my prev one left.  I understood that an annual review & echo be done each yr for at least 5 yrs.  The new cardio did not order any blood work or echo and ret in a yr.  He wants me to do warfarin (a protein S deficiency, needed heparin during pgs,travel and was on warfarin for about 6 mths after the PE and cardiomyopathy).
Q's:  What should I do about my recent cholesterol numbers (fasting numbers), aside from more strict dietary approach.  I eat a good low fat,low salt, fresh vege/fruit, cereal diet already.  Also can you give me guidelines on the ann heart check with the cardiomyopathy.  My EF is 53%, per stress test late last year. I was in heart failure when I got sick.  I get min swelling in my lower legs, I gain 5lbs overnight when I miss a lasix dose.  Take diovan 160mg BID, am allergic to ace inhibitors
I have begun swimming, but become very SOB very easily.  Ten stairs in our home will somedays have me breathless for up to 20mins or more.  I see a pulmonogist and take ++ asthma meds.  My lung function recently dropped.

Last Q what is your view of celebrex 200mg being taken in the context of my overall health?

Thank you for your service to the forum and in advance for your suggestions regarding my Q's.

Fiona      

[Fionajnz]

Thank you so much :-)  I have been patiently trying to post a Q for 2.5yrs.  I have wondered about C/clinic second opinion. Any suggestions on who I could ask to see?

Celebrex is taken occasionally for back pain - +++ osteoporosis fractures from blood thinner/steroid combinations for so long.  I am wary of taking it too often, and you confirmed my hesitation.

Fiona

[Cleveland Clinic]

You have a very complicated case and it is difficult to touch on every point.
I would treat you, given FHX, HTN and hx of CHF to an LDL goal of 100, HDL greater than 45. If this goal cannot be achieved with diet alone then you will need a statin to reach it. As to the Cardiomyopathy, it seems to be resolved as you EF is low normal range. I wonder if there is some diastolic dysfunction causing some of you symptoms.I would suggest that you if you continue to take the celebrex do so carefully. THe data on the cardiac safety of this drug is still nebulous, and I would refrain from using it unless I absolutely needed it.

[Fionajnz]

additional info:  I now have an enlarged left atria and mild mitral valve regurgitation (per echo). Level of regurgitation increased in the past year or so.  

I also had 18mths of adrenal failure (through mid 2007) during the cardiomyopathy/PE.  Muscle weakness was profound Jan 2006, needing wheelchair and walker for 6-8 mths, extremely SOB.  Could not hold my body upright.  Internist with research and clinical expertise reviewed all records and dx likely incl body myositis given my heart and lung function profile.  Other second opinion specialists think myositis most probable dx, without muscle biopsy.

Current HR runs in low 90's. No recent BNP ordered.

Thx Fiona