Can cholesterol lowering drugs delay aortic calcification in a biological valve?

[tigerlily]

Hello everyone, I've been studying my stress echo results from last week's test and I've been wondering about a couple of things. I'm 63 and had my bicuspid aortic valve replaced 10 years ago with a bovine tissue valve. According to my test results, I now have moderate stenosis of the aortic valve, my mitral valve shows some thickening and I have some mitral annular calcification. BTW, if anyone has some experience with MAC, I'd love to learn more. Also, my left atrium is severely dilated. Anyway, to get to the point, I have been on Lipitor to lower my cholesterol for some time but because my last lipid test was so good and also because I couldn't seem to get rid of some muscle/ligament related problems, I decided to come off of it this past February. I've read that mitral annular calcification is associated with atherosclerosis but I guess other things can cause it too. I'm wondering if coming off the Lipitor was a bad idea even with good lipid test results. Cholesterol lowering meds had improved my lipids in previous tests but there was a dramatic improvement in my last test that I attribute to going on Hormone replacement therapy. Does anyone know if cholesterol lowering drugs can slow down the rate of stenosis on biologically replaced aortic valves? Thanks for any input.

 

[epstns]

tigerlily, some time ago (maybe as long as 10 years), while I was still in The Waiting Room, my previous cardio showed me some studies then being done regarding the use of statins to slow the progression of aortic stenosis. At the time I tried statins, but I had so much muscle pain and weakness that we stopped our "test." Some time later he told me that the results of the studies were inconclusive. I have heard nothing about the idea since.

The guy who might know is pellicle. Chris - are you around today?

 

[Paleowoman]

As Steve wrote, statin therapy has not been shown to inhibit calcification of bicuspid aortic valve.

Vitamin K2 (K2, not K1 which is the coagulation vitamin) on the other hand, is being shown to inhibit coronary calcification. Several here on forum take vitamin K2 for this purpose, including me. Vitamin K2 helps put calcium in the bones instead of in the coronary arteries. Whether this works for valves is another question, but since vitamin K2 is not toxic there's no reason not to take it.

As well studies are now showing that statins may, in fact, promote coronary calcification: "Statins Deplete Vitamin K2, May Promote Coronary Calcification": http://www.siliconvalleyfit.com/blog...-Calcification and "Statins stimulate atherosclerosis and heart failure pharmacological mechanisms": http://www.tandfonline.com/doi/pdf/1...3.2015.1011125

 

[cldlhd]

As Steve wrote, statin therapy has not been shown to inhibit calcification of bicuspid aortic valve.

Vitamin K2 (K2, not K1 which is the coagulation vitamin) on the other hand, is being shown to inhibit coronary calcification. Several here on forum take vitamin K2 for this purpose, including me. Vitamin K2 helps put calcium in the bones instead of in the coronary arteries. Whether this works for valves is another question, but since vitamin K2 is not toxic there's no reason not to take it.

As well studies are now showing that statins may, in fact, promote coronary calcification: "Statins Deplete Vitamin K2, May Promote Coronary Calcification": http://www.siliconvalleyfit.com/blog...-Calcification and "Statins stimulate atherosclerosis and heart failure pharmacological mechanisms": http://www.tandfonline.com/doi/pdf/1...3.2015.1011125

Thanks for the link. I'm curious as the study showed statins lower your ability to produce k2 out of k1 but what about someone taking a statin who supplements with k2?

 

[Paleowoman]

Thanks for the link. I'm curious as the study showed statins lower your ability to produce k2 out of k1 but what about someone taking a statin who supplements with k2?

I was wondering that too. I suspect they didn't have anyone in the study who was supplementing with K2 and taking a statin since it is relatively new that people are supplementing with it.

 

[cldlhd]

I wouldn't think it would effect supplemented k2 but what do I know.

 

[LondonAndy]

I hesitate to comment, as I'm in the "but what do I know" category too, but after my op for a mechanical AVR almost two years ago the surgeon commented on how my old valve "looked like a piece of cauliflower" - ie it was extremely calcified - and I had been on statins since about the age of 25 owing to family history of heart disease. So I had been on statins for about 24 years by the time of surgery, with a cholesterol level "in the upper range of normal", so not excessive. I am also an insulin dependent diabetic, and one Cardiologist said that it seems the combination of the two (statins + diabetes) is a contributory factor for a calcified valve.

As an aside, I have been taking part in the FOURIER Study, a phase 3 clinical trial into a new cholesterol lowering drug. It has been a double blinded study involving around 28,000 people that is now nearly finished - and although I don't know (yet) if I have been on a placebo or the real thing, but one positive for me has been the extensive range of blood testing that they do every 12 weeks. This has identified some issues (such as excess potassium and mild anaemia) that have not been picked up by my normal doctor, and has generally been quite educational for me as a complete layman.

 

[tigerlily]

Wow, thanks for the responses everyone. I've read about statins contributing to coronary calcification but I've read contradictory reports also. It's very confusing. I stopped my statin drug last February but haven't told my cardiologist. I'd had plantar fasciitis for three years that wouldn't heal and I also had shoulder pain. Both are much better now but I've done other things to help these issues as well. My last lipid test looked very good but it's time for a new one since it's been over a year. I'm interested to see what that looks like now without statins. Something else I came across that disturbed me are articles/studies saying that warfarin inhibits K2 production and without enough K2, calcium can cause heart problems by ending up in the wrong places like your heat and arteries. My next valve may need to be mechanical so I didn't like reading this at all. Has anyone heard about that?

 

[Paleowoman]

My last lipid test looked very good but it's time for a new one since it's been over a year. I'm interested to see what that looks like now without statins. Something else I came across that disturbed me are articles/studies saying that warfarin inhibits K2 production and without enough K2, calcium can cause heart problems by ending up in the wrong places like your heat and arteries. My next valve may need to be mechanical so I didn't like reading this at all. Has anyone heard about that?

Yes, warfarin inhibits K2 production which is probably why osteoporosis is listed that it can be a side effect of taking warfarin. Also, someone on warfarin may not be able to take K2 supplements - this is if they wanted to - again there is some controversy about that, but it says on K2 supplement containers not to take if you are on warfarin. It might actually be a matter of adjusting the warfarin dosage or your INR would be affected, there again, K2 is not K1 which many docs don't know ! Re your cholesterol - your lipid numbers may be higher off lipitor, but you should look into this whole cholesterol thing and look at your lipid profile too. (Read a book such as Dr Malcolm Kendrick's "The Great Cholesterol Con" , or read something by Dr Duane Graveline (US astronaut/doctor/critic of statins/cholesterol sceptic) or Dr Uffe Ravnskov, another statin critic/cholesterol sceptic.). My cholesterol level is very high - 9.1 UK numbers which is 351 US numbers, but HDL, the good one, is 3.5 (UK) which is 135 US, and triglycerides 0.4 UK, which is only 35 US - my profile is extremely protective so I don't need a statin !

 

[tigerlily]

Paleogirl, my gosh you read so much. I haven't the patience but I will scan books on medical or supplement information. My hat is off to you. Anyway, concerning K2. My question is if someone takes it and their warfarin has to be adjusted to a greater amount. Since warfarin inhibits the action of K2, what would be the point? I suppose I'm way ahead of myself but I'm just wondering.

 

[Paleowoman]

Warfarin appears to inhibit the production of K2 from K1, that's what it showed in the study. We don't know if any of the study participants were taking supplemental K2. Supplemental K2 may not be affected by warfarin. However, there are warnings on the containers of K2 to not take it if you are taking warfarin.

I really enjoy reading books about various health issues so it doesn't require any patience on my part - maybe patience on my dh's part as he puts up with me with my nose in a new book LOL But seriously, I think it's very important for people with health isues to educate themselves as much as possible so that they can help themselves, with the aid of their doctors of course.

 

[pellicle]

Hi

Warfarin appears to inhibit the production of K2 from K1, that's what it showed in the study. We don't know if any of the study participants were taking supplemental K2. Supplemental K2 may not be affected by warfarin. However, there are warnings on the containers of K2 to not take it if you are taking warfarin.

I don't think this is quite correct (nor your earlier point), its more complex than that and this simplification leads people to make assumptions and join them to other assumptions (also being simplifications are incorrect) which appear to join but don't.

I recommend this page as a good primer

http://lpi.oregonstate.edu/mic/vitamins/vitamin-K

For example as visible in that above diagram where Warfarin is shown:

The anticoagulant drug warfarin acts as a vitamin K antagonist by inhibiting VKOR activity, hence preventing vitamin K recycling

There is a LOT in there and I think it will assist you on your journey if you read it carefully. If you find it challenging to read due to its volume then as its a summary I would suggest that shows that there is so much to know on this subject that making clear statements about the efficacy of Vit K suppliments is as much a statement of personal bias as it is anything else. Quite simply because we do not have clear evidence and we certainly do not have a well understood pathway which supports any theory. Let me quote from that again:

Vitamin K deficiency may impair the activity of VKDPs and increase the risk of osteoporosis and fractures. Yet,observational studies have failed to isolate vitamin K intakes from overall healthful diets, thus warranting cautious interpretation of positive associations between vitamin K intakes and markers of bone health.

my underline

Instead of caution what I tend to see here is enthusiastic interpretation of exactly these associations. While its good to have hope, a well educated researcher SHOULD apply a measure of isolation from their emotional desires for outcomes and their reading of data. In other words don't attempt to read into things what you want to see : for you will see it.

Discussions of how this may effect valve calcification are even more so conjecture as far as I know or have yet read. If there are results I don't know about I'd be interested to read them, but myself having a mechanical valve (and otherwise having good vascular health) its only of general interest to me.

 

[Nocturne]

I've been looking at this, as I have redonkulously high coronary artery calcium for a guy my age (score of 156 at 42 years of age). I know it just gets worse and worse over the years, and I know I'll likely need my aortic valve replaced sometime in the next 10-20 years, so I'll still be pretty young when that happens.

I'm feeling in a bit of a bind, because at a young age I'll likely be steered towards a mechanical valve, but even at a modest CAC increase of 10% per year, my score is over 400 ("high risk") in 10 years, and over 1000 ("Crazy-go-nuts-high-risk") by the time I am 60. I'm pretty sure I want to avoid anything that speeds up the progression of CAD, and if warfarin does that then it would seem that a mechanical valve would be a bad idea for me.

My wife is a cardiologist and she believes that by the time I need a valve replacement, there will be blood thinning options other than warfarin. I'm not sure about that as all of the ones bubbling up the pipeline seem to be ill-suited for mechanical valve replacements for one reason or another.

Pretty sure I don't want the doc sniffing that there's "no conclusive proof" about K2 and pushing me into a mechanical valve, then suffering a massive coronary at 63. Pretty sure I don't want that.

 

[Agian]

Nocturne, you remind me of myself.

Massive coronaries aren't caused by calcified plaques. By the time a plaque becomes calcified, it is stable. This type of plaque causes angina. A heart attack is caused by an ulcerated soft plaque. The fibrous cap becomes too thin, breaks, and a clot forms blocking heart supply to heart muscle. Guess what stabilises the fibrous cap, making it resistant to rupture?

We know from people who have familial hypercholesteraemia that cholesterol causes heart attacks, because people with this condition have heart attacks in their 30s.

Calcium doesn't just form on an artery, it evolves from fatty streaks. Risk factors are LDL cholesterol, Lipoprotein (a), triglycerides, homocysteine and anything that causes inflammation. I've researched all this stuff because I had a stent put in last year. Yes, statins are a multibillion dollar industry, so are stents and so are antibiotics, which are the reason we don't have leprosy or TB anymore. Don't get sucked into pseudoscience.

 

[Nocturne]

Agian, you are right about calcified plaque not generally causing heart attacks, but from what I have read, the amount of calcified coronary arterial plaque is consistently about 20% of the plaque in one's coronary arteries. So if you have measurable calcified plaque, you've got plenty of dangerous soft plaque as well -- that's why CAC score is the single most reliable marker for predicting who will and will not have a heart attack.

I'm not disputing the efficacy of statins (I'm on one now), just cognizant of the fact that I am somewhere in the worst 1% of CAC scores for men my age, and that that is a seriously bad thing. If warfarin accelerates CAD, then I probably want to avoid it like the plague.

 

[Agian]

Of course Nocturne, the calcium score indirectly reflects the presence of soft plaques. It also makes a lot of money for some people and exposes their customers to radiation.

Your best bet is to prevent, stabilise or even reverse the soft plaques, so that the evil calcifiers have nothing the corrupt. The idea that statins increase heart attacks by causing calcification is stupid and ignorant. Have you checked your Lioprotein (a)?

Below a certain LDL, coronary artery disease stops dead in its tracks!!! This is what the literature shows. But I mean very, very low LDL. Is it possible that an LDL equal to that of a newborn can slow the progression of aortic stenosis? No one really knows, because we haven't previously seen the LDL's this low. Getting your cholesterol to what is considered normal by western standards, doesn't mean a lot, when that goal is still too high. It's a bit like asking whether smoking 18 cigarettes a day, instead of 20 can prevent lung cancer.

 

[cldlhd]

Interesting thread. I had a cardiac cath because my ct angio said I had some calcified plaque in one of my arteries but the cath showed it was all clear.

 

[Nocturne]

Of course Nocturne, the calcium score indirectly reflects the presence of soft plaques. It also makes a lot of money for some people and exposes their customers to radiation.

Your best bet is to prevent, stabilise or even reverse the soft plaques, so that the evil calcifiers have nothing the corrupt. The idea that statins increase heart attacks by causing calcification is stupid and ignorant. Have you checked your Lioprotein (a)?

Below a certain LDL, coronary artery disease stops dead in its tracks!!! This is what the literature shows. But I mean very, very low LDL. Is it possible that an LDL equal to that of a newborn can slow the progression of aortic stenosis? No one really knows, because we haven't previously seen the LDL's this low. Getting your cholesterol to what is considered normal by western standards, doesn't mean a lot, when that goal is still too high. It's a bit like asking whether smoking 18 cigarettes a day, instead of 20 can prevent lung cancer.

Thanks for your responses, Agian.

I think the research is pretty solid that statins PREVENT heart attacks, especially in people with high CAC scores. About ten years ago, there was an expectation that it would be revealed that statins slowed CAC progression, but other than a couple of early studies that were funded by the statin companies, this has not been borne out by the data. In fact, there is some evidence that statins INCREASE the growth of CAC, which seems incongruous given that they demonstrably reduce the incidence of heart attacks. The current hypothesis seems to be that statins convert unstable "soft" plaque to stable "calcified" plaque -- sounds reasonable, but if that were true then we could expect that the ratio of soft to calcified plaque in the hearts of statin users would be something other than 20/80, and to my knowledge there have been no studies proving that.

(I'm not saying it's NOT the case, just that I don't think the data is in on it yet.)

My LDL was 185, and I got it down to 133 on my own. After starting a statin, it is now down to 85. HDL is holding steady in the 35-40 range (ain't genetics a *****?). I've heard that the ideal for HDL/LDL/Trigs is 60/60/60; I am now 40/85/55 (never had a problem with the Triglycerides).

 

[Nocturne]

Interesting thread. I had a cardiac cath because my ct angio said I had some calcified plaque in one of my arteries but the cath showed it was all clear.

That is not uncommon. To a point, your arteries will reshape themselves to accommodate plaque, and remain very clear. Eventually, they just can't expand any more, and the plaque begins to fill them.

There are people walking around with CAC scores in the 1000s and no blockages -- they are pretty damned rare, but they exist. Most likely they will not remain that way for long, as plaque tends to grow and CAC scores tend to increase by 10-20% per year.

How old are you, and what was your CAC score? A CAC score like mine (156) isn't alarming for a 65 year old man. For a 40 year old man, it is abominable.

Think about it -- at 65, how many more years are you really going to live? 20, maybe 30. With a low CAC growth of 10% per year, a score of 156 at 65 hits the 400s (high risk) around 75, and the 1000s (crazy high risk) around 85. You might get lucky and live another ten years without a heart attack at this score, if you take your statins and manage everything else. Then again, you might not. But even if you die at 85, you live a pretty long life.

At 40, with the same score, you're talking about hitting that "every day is a gift" territory that most people hit in their eighties, at 60.

I can already hear someone saying, "Every day is a gift for EVERYONE" -- please. Yes, we could all be taken in a motor vehicle accident at any time. That's peripherally relevant at best, and you have to know it.

 

[Agian]

CAD has actually been shown to reverse, if we're talking soft plaques. It's lowering the LDL that causes regression. Statins are just one type of drug.

Statin companies fund research, so do stent companies and the food industry etc etc. Agreed, there's a massive conspiracy out there to make money at sick people's expense. No arguments there. The guy that made Type A personality popular (driven, high stress people that get heart stacks) was funded by the tobacco industry.

That's why we need to educate ourselves bro.