Elevated CRP with Family History of CAD

[InDireNeed]

Recently I had some lab work done by a G.I. specialist for stomach related problems and one of the tests done was a C-Reactive protein level test.  I received the results from a friend who works at the hospital but have not spoken with the G.I. spec. as of yet.  My reason for concern is that the CRP level is 26.70 and the range states it should be between 0-7.9.  I believe that I am in a very high risk category for heart problems because my mother was diagnosed with Coronary Artery Disease when she was only 38 and had 2 quad bypass surgeries and 2 angioplasties.  I have done some searching on the interent and found recent reports indicating that an elevated CRP level can be a predicator of a heart attack.  One article states a 5-fold increase of developing Cardiovascular Disease in women with the highest CRP levels. I am 31 years old, about 50lbs overweight and have been experiencing pressure in my chest and lightheadedness on and off for a year or so.  Most recent problems though, have only been g.i. related.  Back when I was experiencing the pressure in my chest I told my PCP.  He told me I probably pulled a muscle lifting my 1year old.  On return for same issue, they ran an ekg and said that it was fine other than a little bit of an irregular heartbeat.  My heart seems to pause and then kick back into rythym.  Seeing what my Mom went through terrifies me and I am scared to death that I may be following in her footsteps.  My PCP does not seem to be concerned about this,  what do I do?  And what does this all mean?  Should I be a concerned as I am?

[Addie]

My son in law is following the THI doctor's to a tee. He takes  200 mg.Niacin, twice a day, after breakfast and after lunch.  They do not want him to take it in the PM as this is when he takes his Lipitor and Plavix. He also takes Folic Acid and Vitamin E. This regime has reduced his triglycerides down to 170 from 400 and his cholesterol from 210 to 193.  We asked his cardiologist at THI if there was a Niacin med that had less side effects than the plain over the counter Niacin but the doc said that he does not want to change him now. He is also on baby aspirin.

Pravochol has done very well for me.  My LDL has dropped 20 points and my HDL went up 10 points. My tryglcerides have never been an issue. (100) Taking Lipitor (2 others, I know the same)had such strong side effects that the three of us had to switch meds. Like my doctor stated, "it is trial and error for all meds".  

The viral infection my son in law had 5-6 years ago is being addressed now. I discovered the connection on the internet, recently.

Thank you for sharing your information.  I wish you the very best.

[No Bypass / No Stents]

400 mg of Niacin daily is not really enough to have much effect on HDL.  You need to get up to at least 1 gram and probably more than that.

I currently take 1.5 g or Niaspan.  The best way to take it is all at one time before bed time.  

They say that you can get used to large doses of regular Niacin, but the Niaspan is easy to get used to.  I don't take it if I have had a few drinks that evening, as I have had flushes when taking it after drinking.

As far as the statins go, Lipitor is best of breed at reducing LDL.  I found that Pravastatin was only about 1/2 as effective.  Even the 10 mg dose of Lipitor is quite effective.  Of course a few people have side effects and shouldn't take it.

There are better drugs than the statins in the pipeline and it will be possible to innoculate against high cholesterol, but I can't see the drug companies wanting that one to come to market.

I do believe the infections can cause lesions in the coronary arteries.  I would suggest a 3 month round of Clarithromycin for anyone beginning to treat confirmed coronary artery disease, especially if they have had a stubborn, sinus, respiratory, or urinary tract infection.

I am not a doctor, only a person with severe CAD, who has experimented on himself, in an attempt to stop and reverse the disease.

I do believe that the right drug cocktail, plus moderate changes in lifestyle can stop the disease and even reverse it over time.  The problem is that it took me 2 years to get on the right drugs for me, mainly because my doctors weren't up to speed on the research.

I Think that it's important to get on a very aggressive lipid an BP drug therapy immediately after a person is diagnosed with CAD if they want to avoid stenting or surgery.

Many drugs such as blood thinners and beta blockers are recommended and commonly prescribed but are counterproductive and dangerous to people trying to manage the disease.

[Addie]

I use to be just like you.  Scard to open my mouth as I had all the docs on pedestals.  No More. Please find another PCP if you are able without the insurance hoopla and if not...call your provider and tell them what has happened. Visit or call your gastro doc and rule in/out any gastro problems.

My father died at 39 of a heart attack. mo family history.  My wonderful son in law (36 years old) had a heart attack in January...No family history and his parents are in their eighties and still swinging. His tryglercides(sp) were 430 which were too high.  His HDL was 40 and even though this is acceptable it should be higher. His LDL was 135.  Just a tad over the normal range.  His PCP knew all this but wanted him to  exercise more.   Little did anyone know what was about to happen to him. He had 100% blockage in the main artery.  They stented the blockage at an ok small hospital but then I had him seen at the Texas Heart Institute and is now under their care.

Trying to piece this puzzle together for WHY this happeend to an active, non smoker who watched his diet, I feel a severe viral infection he had 5 years ago and treated for months with cortisone may well of been a contributing factor to his blockage.

Your glucose is high normal.  Did you fast 8-10 hours before your blood work?  I had a glucose of 100 last year and the doctor repeated this as he would like to see glucose under 95. It did come down to 85.

Lipitor is only one of many Statin meds for cholesterol lowering.  Some work better for HDL and some work better for LDL.  I was not able to take Lipitor as I suffered great muscle weakness and stomach pain.  But, some can handle it well.  My son in law can.  I tried Zocor and this did the same thing. Pravachol worked better for me.  As with all meds, it is trial and error.  My son in law is also on 200 mgs. x 2 per day of Niacin.  He has the flushes with this med but this lasts only for about 1/2 hour. This is also helping to bring down his lipids.  We want him around for a long time.

So, Dire Need, do not let anyone intimidate you, especially when it comes to your health.  No one cares more about their own health, than the person affected.  I heard the other day that people ask more questions to the car mechanic than they do the doctor.  Why?  because the car mechanic is not wearing a White Coat.  White Coats tend to scare people and the patient leaves frustrated.

Everyone is entitled to good health care and be seen by good doctors. You owe this to yourself.

Good Luck and God Bless.

[No Bypass / No Stents]

Heart attacks in the early 30's happen.

You didn't say anything about your cholesterol readings.  HDL cholesterol is probably the best predictor of CAD risk.  It should be at least 40.  If it's 60, you probably don't have to worry.  If it's 30, watch out!

You know what you have to do.  Get on a diet, daily exercise, and get your lipids under control.  If your ldl is high, get on a statin drug.  If your HDL is low, get on Niaspan.

It's important to do that now while there is still time.

My mother had CAD, several heart attacks and bypass surgery.  I had an event at 32, which was most likely a heart attack.  I stayed in bed for almost a week. At 50 I had another episode which I was hospitalized for and turned out to be a heart attack.  Several EKGs had shown evidence of a prior heart attack and an subsequent catheritization revealed a totally occluded artery, which I was told had probably been that way for many years.

With the drugs available today, and permanent diet, exercise, and lifestyle changes, you can duck that bullet.  It's not necessary to go down the road your mother did.

Best of Luck

[No Bypass / No Stents]

The current standard says that total cholesterol above 200 is high.  Ldl between 130 and 160 is borderline high.  Hdl below 40 is considered low so you just squeaked by there on 2/1.  With such a variation between the 2 HDL readings you should get a third after fasting.

So on both 2/1 and 4/2 your total cholesterol was in the high category and ldl was in the borderline high category.  Your HDL is above minimum standards, but just barely.

If you have no liver problems I would suggest a low dose of Lipitor to get the T/C and LDL down.  The statins also lower your risk of heart attack and seem to have an effect on inflammation as picked up on your reactive protein test.

If you start doing 30 minutes or more of daily walking, you will raise your HDL somewhat.  If you want to raise it significantly higher than that, Niaspan would be the best choice, but it can be rough to get used to large doses of Niacin.

With your heredity problem, I would say that you should try to get your TC down to 160 or below and your LDL down around 100.

The best thing that you can do besides that is start working toward an ideal body weight.  When I had my heart attack, I was classified as obese at 245 lbs.  That's just asking for it.

You have time to work on this and avoid a bad outcome, but you have to start now and make it a lifelong priority.  It's much better to learn about this and start making changes at a young age.

There are several cholesterol guides available on the web and phamplets from your doctor.  Here is a URL for one at Heart Info.

http://www.heartinfo.com/search/display.asp?Id=1114

Good Luck To You.  

[InDireNeed]

I looked at the blood work that I had run over the past 9 months and I am not sure if these are indicators or not;  Neutrophils:
06/01 68.7, 10/01 66.5, 1/02 72.1, 4/02 84.0  with normal range being between 54.0-62.0.  Lymphocytes 6/01 27.5, 10/01 29.1, 1/02 22.6, 4/02 11.0  with normal range being between 25.0-33.0.  Monocytes 3.1, 3.0, 3.8, 1.0. with normal range 3.0-7.0.  Also there is a test called ABS NEUT CT 16.20 with a normal range of 1.8-7.  Glucose 110, and finally Cholesterol 213 both 2/01 & 4/02, HDL 41 2/01, HDL 54 4/02, LDL 132 2/01 & LDL 143 4/02.  I have no idea what all of this means and I don't seem to have the nerve to stand up to my doc and ask.  Any ideas?

[Bob56]

You might think about getting a new PCP. You should not feel bad about "going behing the back" of any Doc. They are there to work with you, and if you are not getting the attention that you feel you should be getting, make a change. Good luck with your problems.

[InDireNeed]

I do not think that I had any type of infection at the time that the test was run, other than some g.i. problems.  I am afraid to ask my PCP for a referral, he will think that I am an absolute head case.  He does not even know that I went to the g.i. specialist because I went behind his back.  I had been going to his office several times complaining of the g.i. issues and he was just shrugging them off as well.  He has no idea of the CRP level from that test.  I don't know what to do?  Should I consult the G.I. specialist since he will have those results and see what he thinks I should do?

[CCF-M.D.-CRC]

Dear Dire,
This is a very elevated CRP and I too would be concerned.  Did you have some type of infection (e.g. cold) at the time the test was drawn?  Do you have any rheumatological conditions?  Given the family history I would not take your chest pains lightly.  Your cardiac status needs to be evaluated before other causes of your symptoms are looked for. I would ask your PCP for a referral to a cardiologist so that this can be sorted out.