Coronary Calcium and Coumadin

[Nocturne]

Again,

Your frothing vitriol does not much more than convince me further of the conclusion I already came to above.

I do apologize for bringing up this sensitive and potentially disturbing subject. I should have realized what would happen, given the population here.

 

[Nocturne]

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.

The point, Dick, is that I have a choice up ahead -- hopefully in the very far future, and hopefully when the choices available are flat out better than they are now.

We all know the importance of making the best choice we can make for ourselves when it comes to which valve we have installed.

Because of my incredibly high CAC score, I have a special concern about anything that might accelerate its growth. If recent studies hint that Coumadin might accelerate CAC growth, that is a subject I would be wise to pay attention to as the years pass.

But this is clearly not the place to ask about or discuss it.

Meanwhile -- my silly stressing got me to realize last night that my Vitamin K2 supplement contained only MK-7, not MK-4, and I ordered another brand that has both. Who knows? I might have added years to my life.

 

[Agian]

Again,

Your frothing vitriol does not much more than convince me further of the conclusion I already came to above.

I do apologize for bringing up this sensitive and potentially disturbing subject. I should have realized what would happen, given the population here.

How would my terror and fear contribute to you being a tosser, anyway.

You live in a dream world. I bet this isn't a one off either. The only sensitive topic is your sense of entitlement.

If you don't like the population here, piss off and go and annoy people on a dialysis forum. Just don't bring up kidney disease, because it's a sensitive topic and you might scare them.

Boo.

 

[Warrick]

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?

It was more the fact that I called the rat poison rat poison my self ,if you have to explain the joke (ok it might have only been funny to me..) it isn't funny.... doh

Sad .. this post has just turned out sad, no analogy needed

 

[Agian]

It was more the fact that I called the rat poison rat poison my self ,if you have to explain the joke (ok it might have only been funny to me..) it isn't funny.... doh

I was going along with the joke. I wasn't being serious.

What I think is funny is that the rats survived the rat poison and died of coronary artery disease, in the experiments.

Don't be sad about the thread. I was as annoyed as someone's dog taking a dump on my lawn. I didn't lose sleep over it. I made a comment and Nocturne asked me to elaborate, so I did. Nuff said.

 

[Superman]

Nocturne,

All you can do is make the best decision for you with the information that you have available. That's it. It's what we all had.

I will suggest though, that if you already show a high CAC score, tissue valves can be subject to calcification. Calcification of our native valve can lead to "Stenonis". A narrowing of the valve. For many (myself included), it wasn't just a bicuspid valve that wasn't closing properly, but we also had a stenotic valve that wasn't opening all the way. Who knows how long one would last in an individual who has a natural tendency to build up calcium?

I guess I'd be looking into both and trying to determine the least unpleasant option. If I know my body would calcify a tissue valve more rapidly than the general population, maybe a slightly higher CAC score in a mechanical valve that could tolerate it would be worth the trade off?

Who really knows for certain. Bell curves are funny things. There are always outliers.

I'm 44, and have spend 26 years on warfarin. Depending on your faith, Lord willing (or leave it to science), I'll be the dick0236 of this community someday talking about 60 plus years on warfarin and still ticking.

 

[Superman]

https://www.ncbi.nlm.nih.gov/pubmed/23993324

RESULTS: AVC (Artic Valve Calcification) was more prevalent than MAC (Mitral) (64% vs. 2.5%, p < 0.001), with 34% having both. Absence of CAC was noted in 12.7% of the study population. AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC+MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score >400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score >400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC.
[h=4]CONCLUSION:[/h] The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification.

Just one quick search.

 

[pellicle]

Hi

firstly while I do not have any faith in the Lords intentions, I do indeed sincerely hope that you are are here and talking about 60 years plus on warfarin.

I'm of the view what's more likely is that this place will be gone well before you are ...

Now, this study:

https://www.ncbi.nlm.nih.gov/pubmed/23993324

doesn't seem to mention warfarin, so if I'm reading it correctly it seems to imply that there is concominant Coronary Artery calcification with observation of Aortic or Mitral calcification (Stenosis), with no mention of warfarin therapy whatsoever.

This is interesting as my own Coronary artery has no evidence of calcification yet my aortic valve (my homograft and my original) were highly calcified when removed. I wonder it this suggests an entirely different mechanism at work? For instance calcification of the AV or MV (and then also the CA) due to disease (rheumatic fever for instance)?

Interesting.

 

[Superman]

Now, this study:


doesn't seem to mention warfarin, so if I'm reading it correctly it seems to imply that there is concominant calcification with Aortic or Mitral Stenosis, with no mention of warfarin therapy whatsoever.

That's my point. Were I in Nocturne's position, I would be looking into the likelihood of a tissue valve calcifying earlier in me because of my tendency toward high CAC scores.

So, benefit of the doubt, if he's correct and Warfarin leads to an accelerated build up of calcium, he clearly can't choose a mechanical valve because he should avoid Warfarin.

However, if people with high CAC scores are more likely to calcify a tissue valve faster than the general population of BAV patients, then tissue doesn't appear to be a great choice either, even if he does avoid Warfarin.

It still all boils down to the same decision we all had to make. Pick the option that you can best sleep at night with. The best choice would be to have a perfectly functioning native valve, but that isn't available to us.

 

[pellicle]

That's my point. Were I in Nocturne's position, I would be looking into the likelihood of a tissue valve calcifying earlier in me because of my tendency toward high CAC scores.

thats what I inferred .. just wanted to be sure. Its an interesting subject and complex. I would like to discuss it, but every time I attempt to engage with N he just either bullshits around our craps on about how its a sensitive subject and still doesn't engage.

My view is that its entirely possible that (given this information, and given its only a small study group) that the issues that have been identified (correlation does not equate to causation) in the studies raised by N that it may indeed be a correlation that is not indicative of cauation.

I'm not even sure that the same mechanisms are at work in the cause of tissue valve calcification as in the above ... although as I've said in other posts on other threads, its entirely possible that the cause of valve calcification is the death of the very fine tissue and cellular systems which are valve tissues and then (as they are dead) are calcified in similar metabolic processes as calcify tissue valves. It may be that warfarin is not the factor at all and that its just a co-relation of those who have had valve replacements cause by this calcification you've identified.

 

[Superman]

I'm interested in this apparent obsession with being able to make the "right" choices that will allow you to pinpoint your exact moment of death. It reminds me of an old Dennis Leary bit where he's smoking a cigarette having just witnessed a jogger get hit by a car.

Seems like a great way to lose sleep, which unfortunately can lead to an early grave (not getting quality rest I mean).

 

[Nocturne]

Good point, Superman. You've given me something else to worry about, which I guess I can always appreciate. ;^)

Hopefully there are alternatives to Warfarin by the time my time comes, but I know people have been predicting alternatives to Warfarin being "right around the corner" for well over ten years now. Well, they ARE here now, just not for us.

Pellicle, it is my understanding that for a person with BAV, it is not that unusual for there to be calcification of the valve but not the coronary arteries. The shear stress and other stuff a BAV has to deal with can promote lesion formation and subsequent calcification, even if those issues are not present in the rest of the body. So, happily, someone with BAV might well be in the group with pristine coronary arteries despite the presence of severe valve calcification.

(I myself have "light" valve calcification, which doesn't mean much outside of the context of my age. My CAC score, for example, is pretty typical for a guy of age 65-70 -- nothing to write home about -- but for a 42 year old man, it's crazy-go-nuts, "How many packs a day were you SMOKING?!?" high.)

There is, as I have been reading, some growing evidence that one's CAC percentile is largely determined by genetics, and is very difficult (if not impossible) to change for the better. Doctors like Esselstyn and Davis claim that extremely restrictive diets can do so (hope you like leaves and sticks), but this has not been accepted by mainstream medicine, probably in part because of the difficulty involved in running any large scale study involving extreme dietary restrictions.

The genetics aspect seems to hold in my family -- my father has four brothers, three of whom have heart issues (CHF in two and triple bypass surgery in another, all before the age of 65). My father and one of his brothers seem blissfully free of cardio issues for now, and they are both in their sixties. They are currently claiming that they didn't develop heart disease because they both smoke a lot of marijuana, whereas their brothers did not. Who knows? Maybe they are right.

 

[pellicle]

I'm interested in this apparent obsession with being able to make the "right" choices that will allow you to pinpoint your exact moment of death.

have you ever seen the movie GATACA?

As a biochem major I found it interesting (it was released long after I finished studies Blade Runner was released while I was still in them) .. its quite interesting.

 

[Superman]

have you ever seen the movie GATACA?

As a biochem major I found it interesting (it was released long after I finished studies Blade Runner was released while I was still in them) .. its quite interesting.

I do love my dystopian science fiction. Saw it. Really liked it.

Blade Runner was based on "Do Androids dream of electric sheep?" by Philip K. Dick. Great author in that genre. Some of his stuff is pretty out there. I understand it was written under a state of chemical enhancement. He also wrote the book that became "Total Recall" ("We can remember for you wholesale"). The movie "Screamers" was based on his story, "Second Variety".

 

[pellicle]

I do love my dystopian science fiction. Saw it. Really liked it.

Blade Runner was based on "Do Androids dream of electric sheep?" by Philip K. Dick.

loosely ... have you ever read it?

If you're a fan of BR you should try to get "Dangerous Days" which is the making of the movie ... its seriously informative.

Great author in that genre. Some of his stuff is pretty out there. I understand it was written under a state of chemical enhancement. He also wrote the book that became "Total Recall" ("We can remember for you wholesale"). The movie "Screamers" was based on his story, "Second Variety".

agreed, and I did think that second variety wasn't too "unfaithful" to the short story. Well and I'm a sucker for Peter Weller (Buckaroo Banzai across the 8th dimension among other things)

... regular programming will resume shortly

 

[pellicle]

Superman

one of my favourite Fringe Episodes

 

[Superman]

loosely ... have you ever read it?

If you're a fan of BR you should try to get "Dangerous Days" which is the making of the movie ... its seriously informative.


agreed, and I did think that second variety wasn't too "unfaithful" to the short story. Well and I'm a sucker for Peter Weller (Buckaroo Banzai across the 8th dimension among other things)

... regular programming will resume shortly

I'd say I'm more familiar with the book than the movie. Don't know if I ever watched Blade Runner completely through. I've been trying to find Screamers to watch online, but haven't stumbled across it yet. Wasn't popular enough to hit Netflix or Amazon Prime. I have seen Total Recall a couple times, and I'd say they do appear to simplify his story premises for broader appeal. Ubik is another that's pretty out there. Deals a lot in altered reality and perception.

 

[pellicle]

I'd say I'm more familiar with the book than the movie. Don't know if I ever watched Blade Runner completely through.

if you like the book (which I read after I watched the movie, as I didn't have that actuall K Dick book before) then I'll venture you'll be struggling with the movie.

They're almost unrelated

 

[Nocturne]

I'm interested in this apparent obsession with being able to make the "right" choices that will allow you to pinpoint your exact moment of death. It reminds me of an old Dennis Leary bit where he's smoking a cigarette having just witnessed a jogger get hit by a car.

Seems like a great way to lose sleep, which unfortunately can lead to an early grave (not getting quality rest I mean).

You misunderstand, then. The ideal here is to make the right choices that will extend life. How can making the right choices allow one to better know the exact moment of their death? That doesn't even make sense.

Subsequent discussion about Blade Runner seems to be leaning towards advice that "It's not the TIME in your LIFE -- it's the LIFE in your TIME!" Which is... SORT OF useful, in a glassy-eyed, kumbaya kind of way.

Although I did enjoy every piece of sci-fi mentioned here, with the exception of GATACA, which I have not seen.

As for lost sleep -- I rarely get more than six hours, despite trying. And that was well before learning of any heart issues. It's likely hormonal, as around about when my hormones went bonkers, I completely lost the ability to sleep in. Used to be I could sleep until noon, and then all of a sudden it was like a switch got flipped. Now my eyes fly open at 5:30 am or so and that's that.

 

[Nocturne]

My view is that its entirely possible that (given this information, and given its only a small study group) that the issues that have been identified (correlation does not equate to causation) in the studies raised by N that it may indeed be a correlation that is not indicative of cauation.

I'm not even sure that the same mechanisms are at work in the cause of tissue valve calcification as in the above ... although as I've said in other posts on other threads, its entirely possible that the cause of valve calcification is the death of the very fine tissue and cellular systems which are valve tissues and then (as they are dead) are calcified in similar metabolic processes as calcify tissue valves. It may be that warfarin is not the factor at all and that its just a co-relation of those who have had valve replacements cause by this calcification you've identified.

Remember that the studies I linked to did not all involve tissue valves (in fact, I don't think ANY of them looked at bioprosthetic valve calcification directly -- that's something that Superman brought up, and even then the study he cited involved natural valves, not bioprosthetics). Taken together, these recent studies show that Warfarin use appears to increase tissue calcification rates around the body.

Now, it MAY be that correlation <> causation here. But it MAY not be. I don't want to be the guy who signs up for a lifetime of Warfarin only to find out five years later that, yeah, it DOES accelerate CAC growth, sucks to be you.

But with luck I should have another decade for medical science to investigate, and hopefully come up with more information and options.