Carotid IMT

March 11, 2007

Hi folks:

On another topic altogether. I was invited to a sort of annual

reunion yesterday, with people I rarely see throughout the year. I

arrived early and others sauntered in over the next couple of hours.

Around 7 pm Len arrived. I hadn't seen Len since the same time last

year, and was surprised to see the others greet him as if he was

Livingston returning from Africa. Obviously they knew something I

didn't.

After the hubbub had died down a bit and the crowd around him had

dissipated, I asked him where he had been. He replied: " Hospital.

Had a heart attack shovelling snow three weeks ago. They put in a

stent and I am on blood thinners. Still not feeling quite back to

normal. "

This is remarkable. He is eight years older than I am. But he is

slim. For a guess BMI ~22? Retired on a pension so has no financial

worries. Wife doesn't seem like the nagging type. And he has a

notably easy-going, relaxed disposition.

So I asked him if he was going to be changing the things he

eats. " No " he said. " They gave me instructions about diet, but I

have been eating that way for years. Rarely eat meat. Fish

occasionally. A little wine most days. Mostly fruit and vegetables. "

So I asked him if he knew what his blood pressure had been before the

attack. 130/70 he said. And lipids? " LDL 54, I don't remember the

others " .

-------------------------

This gives pause, imo. It seems to me the inescapable conclusion

that has to be drawn from the above is that we all need to check so

that we know for sure whether our arteries are clogged or not. And

if they are clogged, by how much. The only radiation-free non-

invasive way to do that that I know of is carotid IMT.

I am going to be quite insistent about this at my next checkup. It

will be interesting to see the reaction, and find out what the health

system policy is on this kind of thing.

If anyone has a alternative view on this I would certainly want to

hear it.

Rodney.

March 11, 2007

Rodney,

I thought about your friend Len's story: Having a heart attack while

shoveling snow, and having a normal BMI and eating " right " for years.

(Rarely meat, Fish occasionally. A little wine most days. Mostly

fruit and vegetables.)

This is somewhat reminiscent of the stories of runners who are very

fit and die after a strenuous race. The cardiovascular system tends

to fail at its weakest point. Once the blood starts clotting, there

can be obstructions that cause either strokes or heart attacks.

I think the critical factor was that your friend was not used to

vigorous exercise and he overexerted himself beyond the capacity of

one of the subcomponents (heart muscles, heart capillaries, etc).

Also, we tend to assume that a more vegetarian diet is healthier than

one that includes meats, fish, and dairy. This may not be necessarily

so. The cell walls consist of bilipid layers of which fatty acids are

a principal constituent. The right ratio of saturated to unsaturated

fatty acids may be very important for properties of the cell walls

such as flexibility, permeability, strength, etc.

I see several things that can be learned from this:

- Exercise moderately and regularly to keep the cardiovascular and

pulmonary systems in good shape, and the muscles strong.

- Don't strain much beyond the level of fitness at which you train

because something is more likely to break.

- Eat a balanced diet that includes a variety of natural fats.

Your comment about Len having a diet consisting of mostly " fruits and

vegetables " makes me think that Len may have a nutritionally deficient

diet. We all may learn a lot if you can coax your friend to tell you

exactly what he eats, and any supplements that he takes, so that a

week's diet can be crunched on CRON-o-Meter or DWIDP. This analysis

might reveal whether his diet has any deficiencies (magnesium, EFAs,

etc) that we should guard against.

Tony

March 11, 2007

Tony,

>I think the critical factor was that your friend was not used to

>vigorous exercise and he overexerted himself beyond the capacity of

>one of the subcomponents (heart muscles, heart capillaries, etc).

People don't suffer heart attacks just because they overextend themselves.

In the absence of underlying CVD, no one suffers a heart attack regardless

how hard they push themselves. They get tired, they get prematurely winded -

that's it. Heart attacks *always* indicate an underlying pathological

process.

Al

March 12, 2007

At 01:43 PM 3/11/2007, Rodney wrote:

> I asked him if he knew what his blood pressure had been before the

>

>attack. 130/70 he said. And lipids? " LDL 54, I don't remember the

>others " .

Are you sure his memory was accurate? An LDL of 54 is very

low. For the most part such a low LDL is only found in people who

are either: A) on a very strict diet such as CR or an Ornish diet

(and even then 54 is very low) or people who are on a high dose of

a statin, C) some combination of statin or diet or D) people who have

low cholesterol due to genetics or other illness.

It's not impossible to have a heart attack at any cholesterol level,

but the probability is very low with such a low LDL. (Unless perhaps

he had a history of high LDL and only got it low recntly.)

Fadden

March 12, 2007

Hi folks:

Yes, there certainly is a well known correlation between snow

shovelling and heart attack. I believe the effects of breathing in

plenty of cold air is a major contributing factor, and the unusual

exertion no doubt plays a part in dislodging plaque.

But, taking Len's case specifically, they put in a stent and put him

on blood thinners. You don't put stents in if the arteries are

clear. And my impression is that blood clots cause heart attacks by

moving downstream until they become wedged in a constricted part of

the coronary artery. So in his case ......... slim, 'normal' BP,

low LDL, mostly vegetarian diet, it seems blood flow in his coronary

artery is appreciably constricted.

Which surprises me, and may not only apply to Len.

Rodney.

> >

> > Tony,

> >

> > >I think the critical factor was that your friend was not used to

> > >vigorous exercise and he overexerted himself beyond the capacity

of

> > >one of the subcomponents (heart muscles, heart capillaries, etc).

> >

> > People don't suffer heart attacks just because they overextend

> themselves.

> > In the absence of underlying CVD, no one suffers a heart attack

> regardless

> > how hard they push themselves. They get tired, they get

prematurely

> winded -

> > that's it. Heart attacks *always* indicate an underlying

pathological

> > process.

> >

> > Al

> >

>

> Al,

>

> Just Googling " snow shoveling heart attack " gets over half a million

> hits. Apparently shoveling snow can cause death rates from heart

> attacks to triple among men 35 to 49 years old, and the American

Heart

> Association recognizes the significant correlation. I would not

> dismiss overexertion, rather than pathology, as a cause of heart

> attacks. Strenuous activity causes the heart to pump harder and

> increases blood pressure. Couldn't this increased pressure burst

some

> capillaries? I think that the statistics say yes. Does this

> constitute pathology? Not necessarily. Everything including

tendons,

> muscles, and bones will break when stressed enough. They will

always

> break at its weakest point.

>

> Tony

>

> ==

> http://www.americanheart.org/presenter.jhtml?identifier=3027990

> Don't Let a Snow Forecast Also Forecast Your Heart Attack:

> Heart-Health Tips from the American Heart Association

>

> ALBANY - Cardiac deaths rise during the holiday season, and the

> American Heart Association recommends the following tips to help

> prevent sudden cardiac arrest:

>

> Avoid Sudden Cold Weather Exertion:

>

> Snowstorms present challenges for everyone, primarily because

getting

> rid of snow usually means sudden exertion in cold weather. Snow

> shoveling can be healthy, good exercise, but not if you are normally

> sedentary, are in poor physical condition, or have risk factors that

> make snow shoveling inadvisable for your health. Everyone who must

be

> outdoors in cold weather should avoid sudden exertion, like lifting

a

> heavy shovel full of snow. Even walking through heavy, wet snow or

> snowdrifts can strain a person's heart.

> ==

>

http://www.cbsnews.com/stories/2005/01/24/earlyshow/contributors/emily

senay/main668725.shtml

> If you shovel for 30 minutes, you'll clear away 200 calories along

> with the snow. Snow shoveling is very demanding on the body. Typical

> winter conditions (a little more than an inch of snowfall and

> temperatures that dip below 20 degrees) cause death rates from heart

> attacks to triple among men 35 to 49 years old. Shoveling snow can

be

> very dangerous if the right precautions aren't taken.

>

> What makes shoveling more dangerous than other average tasks around

> the house is the temperature. Your heart rate and blood pressure

> increase during strenuous activity. That, coupled with the body's

> natural reflex to constrict arteries and blood vessels when exposed

to

> the cold, is a recipe for a heart attack.

>

March 12, 2007

Hi :

Well I don't know what you have in mind for me to provide as a

satisfactory answer to your question. Are you expecting me to demand

he produce a signed certificate from his doctor?

His appearance - younger than his chronological age, slim, sensible

diet, and in all other respects *apparently* fit and healthy - looked

to me to fit a profile for low LDL. It was his heart attack that

seemed like the aberration.

And that, of course, was the reason for my original post about this.

It was *because* it was surprising to me that anyone would have a

heart attack, and require a stent and blood thinning medication with

an LDL that low that I posted about it. If he had told me his BP was

180/120 and his LDL was 300 I would never have mentioned it here,

since it would have contributed nothing new to the knowledge base of

this group.

If someone knows of any papers that reported on studies that looked

at the relationship between LDL and occlusion in coronary and/or

carotid arteries we would be much better able to assess this

information. Is he a 5 sigma event that it would be reasonable to

ignore? Or is his case not especially unusual? If the latter then

we all need to have carotid IMTs done, imo.

Rodney.

> > I asked him if he knew what his blood pressure had been before

the

> >

> >attack. 130/70 he said. And lipids? " LDL 54, I don't remember the

> >others " .

>

> Are you sure his memory was accurate? An LDL of 54 is very

> low. For the most part such a low LDL is only found in people who

> are either: A) on a very strict diet such as CR or an Ornish diet

> (and even then 54 is very low) or people who are on a high dose

of

> a statin, C) some combination of statin or diet or D) people who

have

> low cholesterol due to genetics or other illness.

>

> It's not impossible to have a heart attack at any cholesterol

level,

> but the probability is very low with such a low LDL. (Unless

perhaps

> he had a history of high LDL and only got it low recntly.)

>

> Fadden

>

March 12, 2007

Yes, of course; but the IMT suggestion is, I think, a sound one. Good

bang for small bucks.

Maco

At 07:41 AM 3/12/2007, you wrote:

Rodney wrote:

>

> His appearance - younger than his chronological age, slim, sensible

> diet, and in all other respects *apparently* fit and healthy -

looked

> to me to fit a profile for low LDL. It was his heart attack that

> seemed like the aberration.

>

I think we may be missing the point. When would this first heart attack

have occurred if the person ate a lot of meat and had a large BMI? The

point of CR and ON is to move your own personal longevity chart to to

right.

We can not know what this person's natural tendencies would be in a

different situation. One person is one person and one can not

extrapolate from them.

Positive Dennis

March 12, 2007

A definite link between shoveling snow and heart attacks has been shown. Shoveling snow can result in exertion equivalent to a maximal stress test. However, we dont see the increase in heart attacks with maximal stress tests. Perhaps this is because they are being monitored by an MD who can notice changes and stop the test before a serious fatal event can occur. I know we have stopped many and in a few, have even rushed the patient to the emergency room. In all cases, there was some evidence of existing underlying disease. So, I would guess that this increase in heart attacks during snow shoveling occurs in those with exisiting underlying disease. And this may not be causing problems in other areas, at that point As has been pointed out, the exertion during the shoveling may cause exertion that the person is not accustomed to in their day to day activities and can

"expose" an existing weakness. This weakness may not be exposed in day to day activities as none may be pushed to that extreme. Can it occur in someone with out any pre existing disease? I dont know, but would highly doubt it. I would also have some concern about the accuracy of the persons "lifestyle" including their dietary intake. Sometimes there is a lot more to the picture than we hear, when we look really closely. Also, if there was a stent placed than we could assume there was some pre existing underyling disease. Improvements in their lifestyle over time, may not have been enough to reverse the disease to a point where it wouldnt cause harm under great exertions. I do agree that the IMT is a worthwhile inexpensive (and non invasive) test worth getting. Just my 2 cents Jeff

March 12, 2007

>

> I believe that his height and weight can be estimated

> accurately by you. What his diet was is something

> that presents questions? People are incorrect in

> their eating habits. Those who have suffered ill

> health are often reticent to admitting that the cause

> of their misfortune is their fork and knife. My

> brother had a heart attack and claimed that it had

> blocked completely his main artery, and that he had

> survived because his heart had bypassed the block.

> When I read his actual doctor's report, however, it

> was a branch from his main artery that was blocked.

> Anecdotes should be treated as such. Also, Al Young

> has said in a separate message that snow shoveling

> could lead to a burst artery,

Please show me - I have no idea what you may be talking about.

Al

March 12, 2007

I too was quite surprised when I read Rod’s description and anecodote of what happened to this apparently healthy man.

But we don’t know all the facts. Did he ever smoke? Did he have any warning signs? It would be quite unusual not to have any warning at all. Usually chest pains or discomfort (or “heartburn”), pain in the left arm, shortness of breath, dizziness, etc precede such an event. At least in all the anecdotal stories that I’ve heard. Was he sedentary or did he exercise previous to the snow shoveling? I don’t expect Rod to have these answers, but perhaps those would be factors that would have played in.

If none of the above, then it would sure be unusual. But as Al Pater said: we only have this heart attack victim’s word for it that he led a “clean’ life. And most people are way off in their estimations of what they ingest.

>

> Tony,

>

> >I think the critical factor was that your friend was not used to

> >vigorous exercise and he overexerted himself beyond the capacity of

> >one of the subcomponents (heart muscles, heart capillaries, etc).

March 12, 2007

You can have a heart attack with no plaque at all. Totally clear

arteries. Although in this individuals case its not likely he

experienced a Severe Artery Spasm because of the treatment he had.

This is a purely anecdotal case and no one here doing CRON should be

concerned. Keeping your total cholesterol below 150mg/dl with a good

cholesterol ratios will keep you from falling victim to heart attack.

As others have said, we do not know details of this person history,

neither do we know if he has any systemic disease going on which was

the case with my mother (lupus). She has high C-Reactive Protein

levels which is also a predictive factor in heart disease but she

never did have high cholesterol.

Heart disease is multifactoral, as shown in plenty of animal studies.

Many things can be additive and contribute to ones eventual heart attack.

Do not be concerned, CRON lifestyle provides very good protection from

heart attacks.

Matt

> >> >

> >> > Tony,

> >> >

> >>> > >I think the critical factor was that your friend was not used to

> >>> > >vigorous exercise and he overexerted himself beyond the

capacity of

> >>> > >one of the subcomponents (heart muscles, heart capillaries, etc).

>

March 12, 2007

>You can have a heart attack with no plaque at all. Totally clear

arteries.

Diagree. One can suffer an episode, that is almost always fatal, of cardiac

arrest (a phenomenon of interrupted electrical propogation) with clear

arteries, but that's fundamentally different than heart attack (myocardial

infarction). They *both*, however are necessarily the result of underlying

pathology.

Al

>Although in this individuals case its not likely he