Coronary Calcium and Coumadin

[Guest]

I feel like this topic has been discussed to death, and I still don't know the answer. But bear with me, because this is important information for me.

I have a shockingly high coronary artery calcium (CAC) score. Up in the top 1% for my age, and the opinions of individual docs like Esselstyn notwithstanding, as far as modern medicine knows, there is no way to lower your score (it increases exponentially). I'll be lucky to be below 1000 by the time I am 60, and 1000 is crazy-go-nuts high.

Vitamin K (K2 in particular) supposedly helps to slow down CAC progression. Coumadin is a vitamin K antagonist.

I am wondering if I should be looking at a bioprosthetic over a mechanical, because Coumadin accelerates CAC growth, and that is the LAST thing I need.

As I type this, I remember going down this path in the past, and coming to the conclusion that by the time I need AVR, there may be another viable blood thinner or a longer lasting bioprosthetic. Or who knows -- maybe a medication that lowers CAC. It may be that the playing field changes a lot by then, and there's nothing I can do about it NOW.

But here and now -- if a 60 year old man has a CAC in the thousands, would he be well advised to go with a bioprosthetic in hopes of skipping the Coumadin?

 

[pellicle]

You are correct

it has been done to death. I don't know why you haven't yet understood the answer. The answer is THERE IS NO CLEAR EVIDENCE that it occurs.

There are literally millions of people on it, but there is no clear evidence ... its like that's the answer man.

If it caused it then there would be clear evidence right?

If you are skipping to a tissue because of coumadin then your making decisions outside of the evidence based on your feelings ... which is entirely up to you.

Myself I've not seen a shred of evidence that there will be a viable alternative to warfarin that is as demonstrably as safe and has passed decades of open public scrutiny (as opposed to obscure trials by a company that stands to make millions from the drug if it takes off).

Follow the money trail

 

[Nocturne]

I'm not saying that there are any large scale, double blind, etc. studies that I can find out there, but...


"Several lines of evidence indicate, however, that VKA inhibit not only post-translational activation of vitamin K-dependent coagulation factors but also synthesis of functional extra-hepatic vitamin K-dependent proteins thereby eliciting undesired side-effects. Vascular calcification is one of the recently revealed side-effects of VKA."

https://www.ncbi.nlm.nih.gov/pubmed/22520397



"A large number of studies have shown that vascular calcification can be induced and accelerated in patients undergoing long-term treatment with warfarin, leading to some severe complications, such as hypertension, atherosclerosis, valvular calcification, and coronary calcification, especially in the population with atrial fibrillation, hemodialysis, and chronic kidney disease. Warfarin inhibits the activation of vitamin K-dependent coagulation factors and affects the function of vitamin K-dependent proteins via interference of the vitamin K cycle by antagonizing vitamin K."

https://www.ncbi.nlm.nih.gov/pubmed/24072176



"The prevalence of breast arterial calcification is increased in women with current or past warfarin use independent of other risk factors and conditions predating warfarin use. This effect appears to be cumulative and may be irreversible." (OK, that's boobs, not heart, but the heart is where the boobs are... Or something like that... Still, arterial calcification isn't good, no matter where it happens.)

https://www.ncbi.nlm.nih.gov/pubmed/25324574



"Warfarin use is associated with lower extremity arterial calcification in both men and women independent of age, sex, diabetes status, and other patient characteristics. This may have implications for the choice of therapies for long-term anticoagulation."

https://www.ncbi.nlm.nih.gov/pubmed/26811161



"Use of warfarin is associated with an increase in systemic calcification, including in the coronary and peripheral vasculature."

https://www.ncbi.nlm.nih.gov/pubmed/26714212


And so on.

If I had a CAC score of zero, and I was having AVR at the age of 60, I might not care so much.

But with CAC in the top 1% of the population? Eh, I think this is something for me to keep an eye on.

 

[pellicle]

I'm not saying that there are any large scale, double blind, etc. studies that I can find out there, but...




"A large number of studies have shown that vascular calcification can be induced and accelerated in patients undergoing long-term treatment with warfarin, ...."

https://www.ncbi.nlm.nih.gov/pubmed/24072176....
But with CAC in the top 1% of the population? Eh, I think this is something for me to keep an eye on.

If you ignore the first line identifying the study group ...

Vascular calcification is a common comorbidity in elderly patients with diabetes mellitus or renal insufficiency. A large number of studies have shown that vascular calcification can be induced ...

 

[Nocturne]

Yep, that's one.

As I said, no perfect double blind etc. studies. But if a fellow is in my position, I think he's a bit of a fool to neglect keeping his eyes on this.

 

[Agian]

I've said this before. Calcium doesn't just magically appear. It evolves from soft plaques.
One can always take a Vitamin K2 supplement and adjust for any changes in INR. No biggie. That's what I'm doing now.
Godless Heathen sent me a study suggesting K2 can stabilise a fluctuating INR.

 

[pellicle]

Hi

. But if a fellow is in my position, I think he's a bit of a fool to neglect keeping his eyes on this.

Agreed, but just be rigorous in your literature review and pay attention to scope and relevance. For instance if you found a study suggesting a linkage between warfarin and cancer ; but the study was a sample of emergency workers from Chernobyl you may wish to weight other factors (such as exposure to radiation)as more significant.

Given that warfarin is not related to renal clearing (it's hepatic) then the cohort with renal failure may quite likely have some other actually causative correlation factor than just warfarin.

 

[Nocturne]

Sure. And silly me, I was not considering that many people on this forum already HAVE mechanical valves, and are not in my position of thinking about a future choice. The perspective must be completely different.

This is another article from earlier this year:

http://www.amjmed.com/article/S0002-9343(15)30031-0/fulltext

"In conclusion, warfarin causes an increase in systemic calcification through its effects on MGP. This calcification can result in arterial and tracheobronchial calcification. In addition, warfarin use has been associated with impaired bone health. Further studies on the long-term vascular and systemic effects of warfarin need to be performed."


This is the latest from 2016.

So the smart money would seem to be on, "Coumadin hasn't been PROVEN to accelerate CAC growth -- but stay tuned, especially if you've got a serious CAC problem to begin with."

 

[Agian]

... And you may never have to be on Warfarin, so stop fretting.

 

[pellicle]

Sure. And silly me,

I'm glad you are beginning to see that.

You've spent way too much time on USENET and come here acting like a drive-by shooter ... you consistently fail to engage in discussion on the points (even the ones you raise) and resort to either sarcasm or ridicule. When pressed you say you're too busy to engage.

When I did my Masters (and not a spoon fed course work masters, a Masters by Research) we regularly had to (with our peers) defend our propositions. You seem to feel you're above that. You're happy to site smith and smith (2013) but not actually engage in critical analysis of the applicability of that study. Perhaps you simply can't. For in stance in your rush to sledge rather than discuss why that study was not applicable (or was) you simply dished out sarcasm which included " ... double blind .."

This is actual hard science not mushy soft science like psychology ... double blind is not needed. The facts do not need to be sheilded by possible participant biases. But (as I observed with my example intended to get through your head) if there is something about the cohort that makes it in-transferable to you then perhaps its not relevant.

This is another article from earlier this year:

http://www.amjmed.com/article/S0002-...031-0/fulltext

"In conclusion, warfarin causes an increase in systemic calcification through its effects on MGP. This calcification can result in arterial and tracheobronchial calcification. In addition, warfarin use has been associated with impaired bone health. Further studies on the long-term vascular and systemic effects of warfarin need to be performed."


This is the latest from 2016.

So the smart money would seem to be on, "Coumadin hasn't been PROVEN to accelerate CAC growth -- but stay tuned, especially if you've got a serious CAC problem to begin with."

Correct, the smart money would seem to be on HASN'T been proven ... perhaps you can't see evidence for what it is? Evidence that bears examination. The examination on this topic is FAR from concluded and nothing is proven. If you go back to the original post you will read the OP sought definitive answers.

Try reading the study and its methods ... not just the conclusions. But you're a teacher aren't you? You probably weren't trained for critical thinking or analysis.

The answer is firmly that at the moment there are no definitive answers yet, only a VAST weight of experience to suggest its not dangerous and a small emerging amount of studies showing that in specific conditions it may be.

And you can jam your attitude up your hole with respect to your snide remarks. In the past you have accused me of not being interested in researching this topic and your latest ironic twist on mechanical valvers (knowing full well I am one) is misdirected. It happens that I've spent a lot of time researching this. You have also obsverved that you and I process our need to know differently. Yes, we do ... I research and attempt to find how the studies may be applicable to me ... you research to prove to yourself that you're going to die and to worry everyone.

Have a good weekend ... please ... stress about the horrors of your future ... please

 

[Agian]

Actually, he is trying to extract reassurance. But he's doing it in a very selfish and manipulative way.
Each to their own, I guess. Meh.

 

[Warrick]

Well I have to say as a lay man some of those linked articles don't look too flash for the rat poison users... I want to bash people when they say that to me that I'm on rat poison.. so I'll flagellate later....

As a drug that has what 64 years of use ( 4 years less than the rats) the "may" have's and "appears" is a bit like saying burnt sausages on the barbeque will give you cancer because carbon causes cancer , still taste good with a bit of sauce.
Wouldn't they have worked it out for definate by now? Is it just a warfarin witch hunt? Calcification brought on by other factors?

Years ago when my dad who has had 33 of the last 64 years warfarin has been in use on warfarin found out "warfarin makes your hair fallout" he panicked and was cooking up all these herbal remedies and crap to rub on his head to stop it, it still grayed and thinned out but I suspect that was just old age.... my hairline started receeding years ago like the polar ice caps.

My dads NEVER had an issue with CAC and if he croaked it tommorrow at 74 years old I'm sure he wouldn't mind

 

[Agian]

I want to bash people when they say that to me that I'm on rat poison.. so I'll flagellate later....

You get used to it like the ticking. When I first started people would say haha you're on rat poison and I would be like 'screw you motherfucker'. But seriously, wtf does wanting to bash people have to do with flagellating?

 

[Agian]

You've been drinking, haven't you?

 

[Nocturne]

(USENET? I can remember USENET, but how is that relevant here? The last time I remember logging in to USENET was about a decade ago...)

Your angry post is an excellent example of what I realized and alluded to earlier. Snide personal and career bashing while accusing me of being snide, rage rumbling with more assertion than fact, etc. etc.

It's OK, it really is my fault. I wasn't considering the obvious fact that many people here already have mechanical valves and the obvious following that people who have already made their choices are not going to be able to have the same level of rationality in their discussions about this matter. I really can't expect a rational discussion about this matter here.

It's too scary.

I get it -- a mech valver sees this new research and it's terrifying because they already have a mech valve, they are already on Coumadin for life. So they might react -- those studies are garbage, they MUST be garbage, they *HAVE* to be garbage -- they just *HAVE* to be. They're garbage!

And of course they can also get angry -- angry at the person who scared them -- and react accordingly.

I get it.

Sorry, Pellicle. I should have realized this before I asked about it here.

Meanwhile, as someone who actually knows he has a godawful CAC score, I'll be watching the research on this very carefully.

I'm glad you are beginning to see that.

You've spent way too much time on USENET and come here acting like a drive-by shooter ... you consistently fail to engage in discussion on the points (even the ones you raise) and resort to either sarcasm or ridicule. When pressed you say you're too busy to engage.

When I did my Masters (and not a spoon fed course work masters, a Masters by Research) we regularly had to (with our peers) defend our propositions. You seem to feel you're above that. You're happy to site smith and smith (2013) but not actually engage in critical analysis of the applicability of that study. Perhaps you simply can't. For in stance in your rush to sledge rather than discuss why that study was not applicable (or was) you simply dished out sarcasm which included " ... double blind .."

This is actual hard science not mushy soft science like psychology ... double blind is not needed. The facts do not need to be sheilded by possible participant biases. But (as I observed with my example intended to get through your head) if there is something about the cohort that makes it in-transferable to you then perhaps its not relevant.





Correct, the smart money would seem to be on HASN'T been proven ... perhaps you can't see evidence for what it is? Evidence that bears examination. The examination on this topic is FAR from concluded and nothing is proven. If you go back to the original post you will read the OP sought definitive answers.

Try reading the study and its methods ... not just the conclusions. But you're a teacher aren't you? You probably weren't trained for critical thinking or analysis.

The answer is firmly that at the moment there are no definitive answers yet, only a VAST weight of experience to suggest its not dangerous and a small emerging amount of studies showing that in specific conditions it may be.

And you can jam your attitude up your hole with respect to your snide remarks. In the past you have accused me of not being interested in researching this topic and your latest ironic twist on mechanical valvers (knowing full well I am one) is misdirected. It happens that I've spent a lot of time researching this. You have also obsverved that you and I process our need to know differently. Yes, we do ... I research and attempt to find how the studies may be applicable to me ... you research to prove to yourself that you're going to die and to worry everyone.

Have a good weekend ... please ... stress about the horrors of your future ... please

 

[Nocturne]

Actually, he is trying to extract reassurance. But he's doing it in a very selfish and manipulative way.
Each to their own, I guess. Meh.

How so, Agian?

 

[Nocturne]

My dads NEVER had an issue with CAC and if he croaked it tommorrow at 74 years old I'm sure he wouldn't mind

Good for him (sincerely).

I would be VERY surprised to learn that Coumadin accelerates CAC progression to a vast degree. As you point out, you'd think someone would have noticed that by now.

But a relatively small degree -- say, an extra 2 or 3% per year? That might not be noticeable in the vast majority of people.

You have to understand that CAC grows exponentially. Most men don't begin to get it until their 40s or 50s. For a guy to have my score of 156 at 42, he'd really have to have started some time in his twenties. And I was not obese in my twenties, not a smoker, etc. -- a good chunk of this appears to be as genetic as bicuspid valve.

For me, a 3% increase in CAC growth would be catastrophic. I won't be some 55 year old with a typical score of 50 or so -- even with a conservative 10% cumulative growth rate, I'll be a whopping 900 or so by then. I'm on the fast rocket to heart attack city. Increase that annual growth by 2-3% and it gets even uglier, faster.

If I can keep my CAC growth down to 7%, I can keep myself in the "high risk" category until I'm 70 or so. At 10%, I reach the crazy-go-nuts "start coffin shopping" 1000s by 60.

So while a small increase in CAC growth might not be a big deal for most people -- it would be a VERY big deal for me.

 

[Agian]

How so, Agian?

You come out with **** and throw down the gauntlet 'prove me wrong'. And when people respond, you reject it and say 'not convinced, give me more.'

You're using others to collect data for you and don't give a crap about the people who make the effort on your behalf.
You say you're surrounded by people at work who use weasel words, so you are not easily convinced, as if to say the people on the forum are weasels. You're the weasel.

You've been told you have very mild aortic stenosis and you bang on about your CAC score. I had a stent in October of last year and an AVR five months ago. When I tried to reassure you, you accused me of blowing happy rainbows up your ass, like I was doing you a disservice by trying to give you some info. Then you accuse me of giving you positive feedback in order to convince MYSELF things will be ok. Uncle Dick told you he's done well, and you responded by telling him he must've won a lottery, implying he should already be dead. You have no empathy for others. I don't think you're a bad person, just a self-serving git.

Is that enough?

 

[Agian]

(USENET? I can remember USENET, but how is that relevant here? The last time I remember logging in to USENET was about a decade ago...)

Your angry post is an excellent example of what I realized and alluded to earlier. Snide personal and career bashing while accusing me of being snide, rage rumbling with more assertion than fact, etc. etc.

It's OK, it really is my fault. I wasn't considering the obvious fact that many people here already have mechanical valves and the obvious following that people who have already made their choices are not going to be able to have the same level of rationality in their discussions about this matter. I really can't expect a rational discussion about this matter here.

It's too scary.

I get it -- a mech valver sees this new research and it's terrifying because they already have a mech valve, they are already on Coumadin for life. So they might react -- those studies are garbage, they MUST be garbage, they *HAVE* to be garbage -- they just *HAVE* to be. They're garbage!

And of course they can also get angry -- angry at the person who scared them -- and react accordingly.

I get it.

Sorry, Pellicle. I should have realized this before I asked about it here.

Meanwhile, as someone who actually knows he has a godawful CAC score, I'll be watching the research on this very carefully.

Given you have the evidence to make an objective informed decision, make a commitment to yourself that if you ever need a valve you won't go mechanical, so you don't need to take Warfarin. It's that easy. No one has tried to prevent you from posting articles, but you almost demand a response.

I wouldn't want a gutless wonder who posts YouTube clips of his students and publically makes derogatory comments about them anywhere near my kids. You could lose your job. That's how stupid you are.

If you don't feel you can have a rational discussion with the peasants, then stop wasting their time.

 

[dick0236]

I feel like this topic has been discussed to death, and I still don't know the answer. But bear with me, because this is important information for me........


.......As I type this, I remember going down this path in the past, and coming to the conclusion that by the time I need AVR, there may be another viable blood thinner or a longer lasting bioprosthetic. Or who knows -- maybe a medication that lowers CAC. It may be that the playing field changes a lot by then, and there's nothing I can do about it NOW.

Yep Nocturne, this topic has been discussed to death and it's time to move on. As you said in your thread starting post, who in the hell knows what will be available to you by the time you need surgery.......IF you ever need surgery. This thread had become silly, so I'll add another silly concern.........for a number of years after my surgery, my biggest concern(fear) was that the "little bouncing ball" in my valve would stick open....or closed, and that would be a BIG problem.......never happened. Why torture yourself with all the "what ifs"..........maybe a giant meteorite will slam into the earth and kill us all........that used to bother me a lot........when I was in the second grade.