Infectious agent and coronary artery disease

[runnertom]

I am a 54 year old male who has been a very heavy exerciser for the last 30 years. I generally do a combination of running and cycling averaging 7 to 15 hours per week that keeps my pulse in the 130 to 160 beat/min range. I was recently stunned with the news that I had 95% blockages in my LAD and in the first bifurcation, both very close to the bifurcation. I was told that the location made stenting very risky, so submitted to bypass surgery. I appear to have been very lucky that the blockage was found. I had passed nuclear stress test, holter monitoring, and echo with no problem. My presenting symptom was some shortness of breath I experienced early in my runs and exercise induced PVC's. Both of these "symptoms" are essentially unchanged with the surgery. I should also mention that the "blocked" area of the left ventricle was heavily collateralized which I would guess explained my lack of symptoms and failure of the stress test to find the blockage.
My cholesterol was 210 with 60 HDL and BP was normal. I am now on Lipitor and Altace which have me at 147 total and 59 HDL. My father had bypass at age 68 after 40 years of smoking. I have never smoked. Since my risk profile appears to be fairly benign, how do I "clean up my act" to prevent a recurrance? I have been reading some research where bacteria reponsible for diseases such as pnemonia (pneumonia) and periodontal have been associated with CAD. Would it be reasonable for me to ask for screening these agents? Does the heavy collaterals I had indicate that the blockages were rather old and the casuative agent no longer present?

[CCF-M.D.-RCJ]

Tom,

Sorry to read of your ordeal, but I'm glad to hear that you are doing well.

You have a chronic disease -- coronary artery disease (CAD).  It is not a disease that can be cured by excision or removal; it requires constant vigilance.

The risk factors for CAD include some that are modifiable -- like cholesterol, blood pressure, obesity, type 2 diabetes, smoking, sedentary lifestyle; and others that are not modifiable -- like genes, family history, age, and gender.

You should be congratulated that you continue to exercise and that you have lowered your cholesterol.  There is conflicting evidence as to whether or not an infectious agent may lead to coronary artery disease.  What we do know is that the trials done thus far to treat an infectious cause of CAD have failed to show benefit from antibiotics.  Therefore screening for any infectious agent only leads to a problem that does not yet have a solution.

Keep up the good work and see your doctor regularly.

[dartmouth03]

i'm sorry to hear about what happened to u.  it's sure scary when someone healthy like urself has clogged arteries.  why do you think this happened?  in someone who is in such good shape as urself, it's almost always genetic.  do u have a family history of this?  how are ur brothers or sisters?  what about ur mom and her siblings?  u mentioned ur father at 68, but that's not really a risk factor since he's pretty old.  why did u have the heart cath if u passed the stress test?  that is confusing to me.  did u not really watch what you ate?  hope u are feeling better.  god bless.
alex

[runnertom]

Thanks for the comment. I had the cath only because the 4th cardiologist I has seen over the last two years was a little uncomfortable with the shortness of breath. The stress tests which I had two of, showed no problem areas. Ironically, it appears that the shortness of breath may be unrelated to the blockage, as it has not gone away with the surgery. I am left to conclude it is due to my poor warming up habits when starting to run (and my increasing age). The blockage never appeared to affect my performance. The cardiologist was quite amazed when I showed him the results of a 5K race in November where I had placed 5 out of 180 runners in my age group (with the blockage).
My heredity appears to be as clean as one could expect. My mother is still living at age 79, as are her 3 sisters as well as my father's 5 siblings aged up to 90.
This history is exactly why I have posted my question. If I don't know why this blockage occurred, how am I to change to avoid another? This infectious agent research appears to offer a possible explanation, but even if it does, what can one do about it? From what I have read, antibiotics do not seem to be effective at reducing the chances of future cardiac events in people who test positive for the antibodies of the offending bugs .

[dartmouth03]

wow, seems so strange to me.  what about your diet?  had u been eating healthy for the past 10 years prior?  i've heard cases where runners indulge on unhealthy foods b/c they feel that they'll burn them off running.  that famous runner, Fixx, is a good example (although he had a bad family history).  what does collateralized mean?  did the doctor give u any explanations as to why your arteries were clogged?

[runnertom]

Collateralized (that may be own word) means that the heart has grown new vessels to provide blood to the areas starved by the blockage. My cariologist's comment during the cath was that there were a great number coming from the right coronary artery going to the other side of the heart. I remember him saying that that may be an ominous sign of a blockage on the other side. He was right. I also think it has been noted elsewhere that heavy exercisers develop a lot of collateral arteries even in the absence of a blockage.
My judgement of my diet is that it is pretty good. Although I do eat meat, I often eat fish and red meat is only once or twice per week. The dietician at the cardio rehab I took thought my diet was fine. I guess the bottom line is that I fall into the group of roughly one third of CAD victims for which there is no obvious obvious big risk factor.

[schaeff]

Two comments for you.  First, at age 51, I run four miles on a treadmill every morning at varying paces and heart rates. I stretch my legs, then begin at a 2% grade at 10 min/mile (6mph). I always feel short of breath for the first 2-3 minutes and then settle into a familiar rhythm.  

Second, I think I recall reading in the Cleveland Clinic Heart Newsletter (one of those short newsletter type things they sell by mail order) that the belief that strenuous exercise promotes collateralization is NOT supported by the research. I wish it was!

Hope your recovery continues unblemished.

[ect]

Tom, our situations are similar, except I have normal cholesterol levels but have a family history of CAD. A stress test approx. 8 years ago showed no sign of blockage. 4 years later I developed symptoms while walking my tread mill and subsequently had bypass surgery (blockage in the same area as yours and collateralized). I've done a lot of research trying to find an answer, but all I get from doctors is the same as that provided by CCF-M.D.-RCJ on 04-May-03 (I'm assuming he is a medical doctor). Although my cholesterol levels are normal (ldl 100, hdl 45) my doctor would like to put me on a cholesterol lowering medication (apparently there are other benefits besides lowering ldl cholestrol). I'm inclined not to go on the medication.
Contrary to what CCF-M.D.-RCJ had to say, everything that I've read lately supports the idea that infections may be associated with CAD. However, I've had my blood levels of C-Reactive Proteins checked and they are within normal limits.  
At any rate, it's very frustating. I'm still exercizing regularly and trying to eat sensibly (same as before the surgery) and still trying to find answers. If you come up with anything promising, please post-it.

[runnertom]

ECT, I don't think the doctor was saying that there was no evidence of infectious agents being involved. He was saying that antibiotics have not been shown to be effective in changing the prognosis of those whose CAD may have been associated with them. Thus, even if we knew 100% that our blockages were caused by some bacteria, there is really no therapy to improve our outlook. If one were to take the optimistic view, I guess we could hope that whatever infection was responsible is now either gone or inactive and won't cause further harm.
I would like to see data comparing the history of those people whose blockages were thought to be associated with infectious agents to a matched segment of the general population whose risk profile is similar but does not have the antibodies.

[valger]

Hi, I just wanted to say thanks for all the valuable info, I didn't know any of this!  I've been having PVC's and PAC's for about 10 years now, they went away except for a few here and there for about a year, and now, out of the blue, they are back each and every day.  My concern is something you mentioned on the first post, that exercised induced PVC's can be a sign of coronary artery disease.  I am 43 years old, female, and in otherwise good health, but I notice this time, with the PVC's, that they seem to come around when I get up and get active, not as much when I'm sitting or laying around.  It's strange, though, I've been walking, and I get them while I'm walking, and it's hard to keep going since I get scared, but after I'm done exercising, it seems to calm the PVC's down a bit after.  I'm having a treadmill test on Monday, but according to the above posts, this might not tell much, right?  Well, thanks again!!  Val

[paulus]

I wonder if you have been fully tested for some of the newer factors that specialist clinics screen for now.  In Sydney (Australia) the clinics tend to include the following in thier heart check (and recommend treatment if they are high):

CRP  -  recomend treting with asprin and general healty diet
Homocystiene - treat with Folic Acid and Vit B supplemets
Lipoprotien A or lp(a) - treat with Vit C and Lysine/Proline
Fibrogen (?) level  - not sure of treatment

I think the cardiologists here would say that were patients present with symtoms without tradtional risk profiles then the answer is often in these newer tests

Have you had these tests?  If not you should insist on getting them

Regards and best wishes to you - Paul

[runnertom]

Paulus,
No, I have not been evaluated for these agents. It seems like I discussed one (either CRP or homocystein)with the cardiologist at one point and he thought the medications I am taking(statin, aspirin, and ACE inhibitor) were appropriate therapy for whichever it was. I have on my own started folic acid and will discuss this at length at my next appointment. Thanks for the input.

[netrox]

EAT OILY FISH AND PLANTS RICH IN OMEGA-3!!!!

It seems that so many of you ignore the power of omega-3 acids for your heart health. In fact, omega-3 (specifically from fish oil containing DHA/EPA) is a potent anti-arrythmic drug, even better than traditional drugs. It works by stabliziing electrical transmission of heartbeats. That is why people who eat diet high in omega-3 have significantly reduced risk of sudden cardic death (as much as 60%), even when they have heart disease.

Common anti-arrythmic drugs can be very dangerous and can kill more than help in some studies. You simply cannot go wrong with adding more omega-3 in your diet.

Studies have shown that when they put fish oil in animals and delibrately induced arrythmia with drugs, virtually all survived while most of those without fish oil died.

Having omega-3 in your diet is FAR important than anything else for your heart health. Avoid eating transfat acids because they interfere with omega-3 metabolism.

-jeff

[dartmouth03]

thanks for the tip! what kinds of fish or foods have this omega-3 that you're talking about. thanks.
best,
alex

[netrox]

you asked: "thanks for the tip! what kinds of fish or foods have this omega-3 that you're talking about. thanks."

Salmon is the best. Tuna is excellent but don't think you'll get enough from canned tuna tho. Canning destroys EPA/DHA, unfortuntely. You have to get them fresh. (nothing beats the freshness anyway!) If you like sushi, eat salmon sushi liberally!

Flaxseed is one of the richest source of omega-3 acids altho it doesn't have EPA/DHA. Your body converts some of omega-3 acids into EPA/DHA but it is clear that for optimal health, you need to eat fatty fish twice a week.

What you really need is a better ratio of omega-3/omega-9. We have way too MUCH omega-9 and way too little omega-3 thus increasing our risk of sudden cardic death. Transfatty acids interferes with omega-3 metabolism so avoid anything that contains "partially hydrogenated oil" of any kinds, like cakes and margarines.

For more sources, you may like to read:

"Men who ate about 3 to 5 ounces of fish one to three times a month were 43% less likely to have a stroke during 12 years of follow-up."

http://www.usatoday.com/news/health/2002-12-24-fish-strokes_x.htm

"Eating fish benefits those who are at high risk for ischemic heart disease (IHD), and sudden cardiac deaths occur less frequently in those who habitually eat ocean fish, a major source of omega-3 fatty acids."

http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/28815/352901.html

"A daily fish oil supplement may help heart attack survivors reduce their risk of sudden death by as much as 42%, according to a new study. Previous studies have already shown that eating oily (fatty) fish such as tuna, salmon, and mackerel can reduce the risk of sudden death caused by a particular type of irregular heartbeat. But this study suggests that fish oil supplements -- rather than eating the fish itself -- may be an effective therapy for heart patients."

http://my.webmd.com/content/article/17/1671_53157

"It appears that omega-3s protect the heart in several ways. They may lower the risk of abnormal heart rhythms; reduce the "stickiness" of blood cells, which makes them less likely to form clots and block arteries; and lower high blood triglyceride levels."

http://www.healthandage.com/Home/gm=2!gid2=1691;jsessionid=PEjRAKuiMQFXQIVAna19fYiSb12cvpf1lDDVBl1fbX4T0JJdLQIJ!8876910089091682276!180357125!80!7002

"Omega-3 fatty acids appear to protect against arrhythmia by enhancing the electrical stability of heart cells and increasing their resistance to becoming "hyperexcitable". In cultured cardiac myocytes of rats, for example, omega-3 fatty acids terminated toxin induced arrhythmias mainly by reducing the electrical excitability of the heart cell... Omega-3 fatty acids appear to enhance the mechanical performance and electrical stability of the heart and to protect against fatal arrhythmia in both humans and animal models. Their mechanism of action likely includes modifying the fatty acid composition of cell membrane phospholipids, affecting cell signaling and controlling ion transfers across the cell membrane."

http://www.flaxcouncil.ca/pdf/arr.pdf

-jeff

[dartmouth03]

thanks a lot for the info! i'll read up on it.  i actually had some sushi sashimi tonight, yellowtail, albacore tuna, and salmon!  take care.
alex

[Ianna]

Hi Jeff,
-
Thanks for all the (fishy)-info on Omega 3 and 6 and the rest...
-
Grateful -*Ianna*-