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Predictive value of Echo and other questions
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Predictive value of Echo and other questions

Dear Doctor:

1. Does an echocardiogram have any predictive value for future CAD? I once had once chest pains, normal EKG, but the cardiologist ordered an echo, then said "that was the most perfect echocardiogram that I've ever seen." I was 24 at the time.  I'm 26 now.

2. I'm trying to quit smoking cigarettes, since they are the most preventable cause of death and illness today, and I am wondering HOW EXACTLY smoking affects the heart...does it cause plaque within the arteries? Does it constrict arteries? Does it actually damage the heart muscle?

3. As for cholesterol, my HDL is usually over 60, but am wondering whether the ideal LDL is actually 100 or less or somewhere between 100-130..does it depend on the presence of other risk factors?

4. What do you make of the EBT scanner released several years ago that noninvasively and quickly determines the level of calcification in the arteries? Is calcification predictive, and if so, is that test worth it for me, let's say, in ten years?

5. I've read some research that second-generation statins have a protective effect against Alheimer's Disease (in addition to heart attack and stroke, two big killers).  Do you think there is any relation between elevated cholesterol and apolipoprotein 4 -- elevated levels of which are associated with AD?

6. Finally, what are the parameters of acceptable blood pressue? Mine varies from 110/70 to 130/80 and I guess they are both acceptable, but I'd prefer the former over the latter.

Thank you in advance for your time and insight.
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ontherecord,

You must be a journalist or lawyer. I should make these comments off the record!

1) No, an echo is very limited in it's predicitve ability for CAD if it's normal.  For a 26 year old, the most important predictors would be the common risk factors of tobacco, diabetes history, hypertension, family history and cholesterol.

2) Actually smoking causes all of the above.

3) It is unclear where the best LDL level is, and our current practice tends to be more strict than guidelines.  In the absence of other risk factors and an HDL of 60, an LDL of 100-130 is fine.

4) I'm not a fan of EBCT as far as calcification goes. CT is also not to the level of imaging individual arteries. As such, currently ist more of a research instrument, or used in cases where other risk determination are unclear.

5) Yes. I think that statins will be more conclusively tied to benefits in the neuroprotective arena in the future. Human apolipoprotein E is what your are referring to.  it is a blood plasma protein taht helps facilitate the transport and uptake of cholesterol and lipid via its interaction with different cellular receptors, including the low-density lipoprotein (LDL) receptor.  

6) Your BP is fine.

You are 26, with a good cholesterol profile and BP. As someone who is very focused on their overall health, the most important thing I can tell you is to QUIT SMOKING. It will have more impact than any medication, or trip to the doctor that you will ever have.

Additionally, live a healthy lifestyle and exercise regularly.

good luck
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