Replaced valves and heart attacks

[Guest]

So I can't seem to catch a break here. Found out the doc was wrong when he told me my CAC score was 136 -- it's actually 156! And half of that is in the "widow maker" artery (two of the other three areas scanned are totally clear of calcium). None of that is good, especially not at my age (42). My CAC should be zero all around, and even a score of 35 total would be alarmingly high!

After looking at a million studies and charts, it seems like my prognosis for the next decade is pretty good, but after that it gets ugly. With CAC increasing by 10% per year or so if you are lucky, I'll have astronomical levels by the time I am 60. Even if I do everything right going forward, I am going to be at high risk for heart attack. This is thrown into the mix of my aortic stenosis.

I'll likely have an implant by the time I am 60.

How is heart attack with an artificial valve worse than without one? Not that it would be particularly relevant if I suffered a "widow maker" and died in the ambulance on the way to the hospital anyway.

 

[pellicle]

Hi

How is heart attack with an artificial valve worse than without one? Not that it would be particularly relevant if I suffered a "widow maker" and died in the ambulance on the way to the hospital anyway.

I don't really know I understand the question because it seems to be a "vodka martini" question, except both "shaken and stirred" ...

So "How is heart attack with an artificial valve worse than without one?" ... I dunno ... to me they are unrelated questions. The valve serves to operate the pump so that the heart can circulate blood to the rest of the body, the cardica artery is just supplying blood (fuel and nutrients) to the heart muscle tissue. When people say "Heart Attacks" they are commonly talking about the heart muscle tissue not getting fuel and nutrients and failing.

or are you just worried, been googling that and found nothing (perhaps because there is no connection?)?

 

[JulienDu]

You are more clever than me Pellicle, I could not understand a thing of that messy post, was wondering if the guy was drunk

 

[cldlhd]

I understand your concern about your calcium score and your arteries but I don't think there's a connection to your valve situation. Some think you can stop or reverse calcification, who knows? However if you keep the situation monitored and it becomes an issue maybe when they're doing your valve they would be able to take care of any major blockages. Fwiw I don't think your score should be close to zero. My surgeon told me approximately 90% of American males over 30 have some calcification.

 

[AZ Don]

The Dr. that did my cardiac cath said it was to check my coronary arteries because if they were clogged they could do a bypass when they fixed my aneurysm. If needed, a bypass could be done when a valve is replaced, other than that I can't see why having an artificial valve would have any impact on a heart attack. I do think there is one big difference between valve issues and heart disease. The process of the valve failing is still poorly understood and there are no guidelines to deter the process, much less reverse it. The same cannot be said of heart disease. There are steps you can take to reduce your risk: http://www.webmd.com/heart-disease/features/can-you-reverse-heart-disease

 

[Paleowoman]

Hi, if you want to reverse the calcium, do a search for 'Track Your Plaque' . It was over nine years ago that I read on cardiologist Dr William Davis's blog, Track Your Plaque', about CT scans which look for the calcium score aka coronary calcification - even then there was a scan just for calcium score which uses less radiation, called EBCT scan. The one many of us get prior to valve replacement, CT angiogram, does more as it checks the valves and blood flow too. Dr Davis was pushing for those scans then before they were so maninstream - but pushing for the EBCT one, not the CT angiogram one. He also pushed for particile size testing of LDL. He has patients he's been able to reverse coronary calcification. Here's one link for starters: http://pi-bill-articles.blogspot.co.uk/2011/03/track-your-plaque-program-by-william.html I can't find Dr Davis's own blog now, I think you have to sign up for it these days.

 

[Paleowoman]

I Fwiw I don't think your score should be close to zero. My surgeon told me approximately 90% of American males over 30 have some calcification.

My calcium score was zero on both CT angiograms I've had - but I'm not male or American ;-) Mind you, my husband's calcium score on CT scan was also zero (age 52 then) - cardiologist had it done on him due to hubby's large family history of heart disease - and hubby is male, but not American !

 

[Paleowoman]

Well blow me down, just this morning on Dr Malcolm Kendrick's blog - currently about atherosclerosis - up pops a whole post about coronary calcification: http://drmalcolmkendrick.org/2016/03/22/what-causes-heart-disease-part-x/

(Calcification)

Yes, part X, and not at the end… yet. Before trying to sum up I thought I should discuss calcification of the arteries. This is an area I have tended to shy away from in the past, because I am not sure exactly where to place it. Association, end-result, cause… Ignore.

Firstly, what is calcification? It is generally accepted, and I think it is true, that calcification represents the final stage of atherosclerotic plaque development, or growth – or whatever word fits most accurately. The best way of looking at calcification, within the spectrum of CVD, would be to define it as the end stage of plaque development.

Having said that, this is not always the case. Not all plaques calcify. Some do, some don’t, and there are many other factors that have a key role in calcification. Various vitamins, such as Vitamin K(K2) and vitamin D are important. Warfarin, which blocks the effects of vitamin K, increases plaque calcification. The picture is complex.

You may have heard of a condition called fibrordysplasia ossificans progressiva, where muscle turns to bone. Not nice, but it does demonstrate that, in certain circumstances, various other tissues can also calcify – to one extent or another.

The main reason for mentioning calcification is that the Calcium artery score (CAC) has become the latest way of frightening people about CVD. You do a CT scan, count of the amount of calcium you can see, and score it. The more the calcium, the worse things are.

In truth, despite my slightly sceptical tone, measuring calcification seems to be one of the most accurate ways of assessing overall plaque burden, and your true risk of dying of CVD. Like everything else in this area, the CAC score is far from perfect. However, even with many provisos in place, if you have a high CAC then you are definitely at a higher risk of dying of CVD. Equally, if you have a zero calcium score, you can pretty much relax. So it is important.

I suppose you may be wondering, at this point, why would plaques calcify? What is the body doing here? Well, you might find these quotes interesting:

“Atherosclerotic calcification is an organized, regulated process similar to bone formation that occurs only when other aspects of atherosclerosis are present.” L Wexler, et al., American Heart Association Writing Group

In short – and, by the way, I fully agree with the above quote, calcification is not an accident, or an unwanted effect. It seems to be an organised, and regulated process. But organised, and regulated, for what purpose…

‘This chapter will show that vascular calcification is a physiologic defense against active, progressive atherosclerotic disease, that it is produced by physiologic mechanisms similar to those required for normal bone formation and that it is potentially reversible.’ 1

You might well then ask the following. If calcification is a physiologic defense mechanism… why would you want to reverse it? You might just be making things worse. It is certainly true that plaques pass through several different phases. The most dangerous of which seems to be the ‘unstable’ plaque. This is when the central core of the plaque is a kind of liquid goo which, if it ruptures, stimulates a massive – and potentially fatal – blood clot. Plaques in this state are sometimes called ‘vulnerable.’

On the other hand, once a plaque calcifies, it appears to become more stable, and less likely to rupture… and kill you. Which means that reversal of calcification may look good on a scan, and your doctor may smile with pleasure at your reduced CAC. But… it is all good? I have seen an argument used (by the pro-statin camp) that statins accelerate calcification – but this might be a good thing, because the plaque is less likely to rupture. Is this true? [It would by a nice irony].

Perhaps, here, you can see why I struggle a bit with the whole calcification thing. Is it a natural progression of the plaque? It is a way that the body closes down further damage, and stops further plaque progression. Does calcification help to strengthen the artery wall to prevent it rupturing? Should we be trying to reverse calcification… would we simple be turning a calcified plaque back into a vulnerable plaque?

Calcification is certainly not a new thing. CT scans of mummies – from a number of different cultures – have demonstrated that many/most mummified bodies have large areas of arterial calcification. Ergo, CVD is most certainly not a disease of modern humanity. The mummies from Egypt are well over two thousand years old.

As you can probably tell I am not sure exactly what to make of calcification. However, I think you can probably make the following statements:
• If you do a CT scan and have no demonstrable calcification – after the age of about forty to fifty – you are at very low risk of dying of CVD
• If you have a high CAC score this means that you have been developing plaques for quite a while, and therefore (unless you change something) you are at high risk of dying of CVD. [However, bear in mind that CAC represents your history, not necessarily your future].
• Calcification can reverse. Vitamin K2s (Menaquinones) seem to be more protective/able to reverse calcification than Vitamin K1. Menaquinones are primarily found in meat and dairy-based foods and fermented soybeans (known as natto, commonly consumed in Japan)
• Calcification is not a cause of CVD, it is (or seems to be) the final stage of plaque development. It may be a protective mechanism to stabilise plaques.
• There is no evidence, that I am aware of, that if you reverse calcification you improve CVD risk. But it seems likely there would be benefit.
Sorry, I am not sure if that is very helpful, but I thought I had to discuss calcification in this series.

1: http://www.ncbi.nlm.nih.gov/books/NBK2015/

 

[Nocturne]

That's interesting, Paleogirl. What I have read is that calcium score goes steadily upward at 10%-30% per year, a thing that would be especially damning for me if it were true. I have seen several studies illustrating this as fact.

My original question was whether or not having a replacement valve would make the likely outcome of having a heart attack even worse than it would otherwise be. For example, are people with normal, undiseased valves more likely to avoid or survive heart attacks than people with replacement valves? I'm worried because I'll eventually need a new valve, and looking at my CAC score, I'll probably have a heart attack at some point in the future as well (even if I am very good about diet and exercise, once my calcium score hits 1000 sometime in my early sixties, things get very ugly).

And yes, everything I have read to date indicates that a CAC increase of "just" 10% per year is quite optimistic. That's the rate that puts me at 1000 by my early 60s.

 

[cldlhd]

My calcium score was zero on both CT angiograms I've had - but I'm not male or American ;-) Mind you, my husband's calcium score on CT scan was also zero (age 52 then) - cardiologist had it done on him due to hubby's large family history of heart disease - and hubby is male, but not American !

The ct angio showed some calcified plaque in my one artery-supposedly with 50% stenosis- but the cardiac cath showed them to be free and clear. A year later the ct angio said 30 % stenosis so I guess that's probably down to interpretation.

 

[cldlhd]

My calcium score was zero on both CT angiograms I've had - but I'm not male or American ;-) Mind you, my husband's calcium score on CT scan was also zero (age 52 then) - cardiologist had it done on him due to hubby's large family history of heart disease - and hubby is male, but not American !

Also I have to imagine at this point the typical English diet isn't that far removed from the American.

 

[Paleowoman]

Also I have to imagine at this point the typical English diet isn't that far removed from the American.

It's probably not much different…….perhaps a bit less fast food in England….I was kind of joking about not being American, hence the ;-)

Interesting that your CT angio showed some calcified plaque but that the cardiac cath was clear.

 

[cldlhd]

It's probably not much different…….perhaps a bit less fast food in England….I was kind of joking about not being American, hence the ;-)

Interesting that your CT angio showed some calcified plaque but that the cardiac cath was clear.

I know you were joking. I usually avoid the fast food, celebrating my birthday now with the family out having a nice dinner and a few craft beers ( that's a weakness in the diet I guess). It was explained to me that the plaque is in the arterial wall but not blocking any flow. Large and clear the doc said. Taking my k2 daily in case it helps....

 

[Paleowoman]

Taking the K2 too Dr Malcolm Kendrick has been doing a whole series of blog posts the past few weeks on cardiovascular disease which concentrates on plaque development which is fascinating (even though I don't have any plaque I still want to prevent it): http://drmalcolmkendrick.org

 

[cldlhd]

My surgeon told me what I have isn't a threat and the cardiac cath results were great and in his opinion that's the gold standard. So I'm just trying to keep it from getting worse, if it's possible to reduce it then great. Had a grass fed free range (at least they say it was) burger last night and I hear that's better for you. I can't speak to the science of that but I can attest that it was delicious......

 

[Paleowoman]

Grass fed meat tastes tons better than factory farmed meat, that's for sure. I only eat grass fed meat, partly because of the flavour but also because I can't stand the conditions factory farmed animals are kept in. Factory farmed animals also are full of hormones and antibiotics, grass fed not unless they're ill. Also the fats in grass fed meat are superior and contain omega 3's. And the lean is better since the animals are roaming around which makes good muscle, rather than standing around in a 'factory farm' being fed corn to fatten them up.

 

[cldlhd]

I agree with all that, I told my son the meat tastes better when the cow was happier in life but he just told me it's not doing them a lot of good now. It was nice to see the option on the menu- one of those gastro pubs- a little heavy on the forced hipster vibe but great food and 100 different beers so even though I don't wear a wool hat in the summer or have an arm full of interesting ink I like it.