The Skinny on CAD.....
It’s What You Don’t See that’s Gonna Git’cher
Jim Fixx was the guru of jogging. Back in the 70’s he wrote the book that got America on the move. He jogged 60 miles a week and had run 20 marathons. He was as fit as a fiddle and apparently twice as healthy. In 1984 at the age of 52, a few minutes into his morning jog, he keeled over and died of a massive heart attack.
Jim Fixx was a health icon, and jogging would make all Americans healthy. That was the promise. You don’t see many fat joggers now do you? So how come he died? Wasn’t exercise and fitness supposed to stop heart attacks? Come to think of it, why do almost as many thin people die of heart attacks as fat ones?
The millions of Americans who are obese and eat junk food didn’t miss a heartbeat and went right on stuffing their faces. They’d never heard of Jim Fixx anyway and any exercise, let alone jogging, just wasn’t on their radar. For the millions more who exercised periodically, occasionally foreswore a Haagendaz or went on a diet once in a while, or sorta tried to eat healthy..... this was great news! They were off the hook!
If a guy like Jim Fixx got a heart attack, why in hell deny yourself? Sure, let’s eat sensibly and exercise a bit. All the docs say that’s good for you, but let’s also enjoy life. A little bit of what you fancy makes life worth living and can hardly do you any harm, can it? And if Jim Fixx kicks the bucket at 52 you might as well live 20 years longer than him and enjoy life, right.....?
That’s all very nice in theory, but it just isn’t how it works. Half of us will probably die of heart disease in one form or another. The question is, which form? Being fit and not overweight can keep your heart healthy long into old age, to be sure. But if your heart is starved of life-giving blood, it doesn’t matter how strong it is. It will pack it in and die within minutes, and so will you. Jim Fixx’s autopsy showed he had a heart as strong as a lion, but his arteries were almost completely blocked.
You’ll Never Know....
Coronary artery disease (CAD) is the most insidious and deadly of all heart conditions. It has many causes and can creep up on you and strike you down whether you are fat or thin, rich or poor. As physicians like to tell us, for one third of all heart attacks victims, the first symptom is death. Blocked arteries to the heart are invariably the cause. A degree of arterial plaque, the oily gunge that clogs the arterial walls and causes the blockages, is common to almost everyone. Our doctors really only begin to worry when we have over 70% blockage. Kids of 19 killed while serving in Vietnam were shown on autopsy to have 90% blockages to their coronary arteries. These boys, had they lived, would probably have gone on to their mid-40’s and 50’s before getting their first cardiac “event”. But the foundation of their heart disease was already right there as teenagers.
The reason why CAD is so dangerous is that often as not it’s symptomless. You can have 90% blockage or occlusion of your coronary arteries and not feel a thing. You can even have 99% blockage, but enough blood seeps through to keep you happily chugging along. It’s only when a piece of arterial plaque breaks free from the vein to block an already narrowed artery completely that a cardiac event occurs. Within minutes sections of your healthy heart start to die and pretty soon you follow too unless treated immediately.
If I Knew Then What I Know Now....
In an ideal world we would all be aware from an early age how our life style can keep us healthy or make us sick and would lead our lives accordingly. Life is not like that and nor is youth. It is in the nature of things for us to come by any wisdom the hard way, usually via bitter experience. Some of us are just lucky and get by whatever we do, others of us don’t make it and flame out early. The majority of us start to get intimations of mortality in our early middle age and start to clean up the act a little. It is incremental and almost always never enough to prevent some serious health challenge in our 50’s and 60’s. For most of us thatmeans some degree of heart disease.
So this is mainly directed at men and women over 40. If you are not already doing so you need to take certain steps to protect yourself from heart disease. If you do not look after your heart your life can change overnight. Even if you survive a heart attack, as nowadays the majority do, you will find yourself in the grip of forces over which you have little control. The cardio-medico juggernaut is the most amazing structure yet devised by man. It will sweep you into its maw, chew you up and spit you out, still living if sheer human ingenuity can manage it. Truly it is a wondrous thing and ever-evolving. But very few people who have been through it are ever quite the same. Open heart surgery is a fearsome thing and perhaps we would all do well to think of what such a colossal assault upon the body means in terms of sheer physical and psychic trauma. You are sawn open like a side of beef.
Speaking for myself I would go to almost any lengths to avoid open heart surgery.
Life’s Little Pleasures
However that is a lot easier said than done. It is human nature not to want to reflect on the grisly details of such unpleasant matters, just as it is to give in to our “little pleasures of life”. And if that just happens to be a jeroboam of Chateau Lafite a day or Big Macs for breakfast, lunch and tea, we can usually make the necessary rationalisations to make it OK. As usual I’m overstating it, and our little pleasures are seldom as gross as this, but you get the picture.....
There are a lot of chronic diseases that whack us by the time we reach middle age, and it is hard to know which will be the one to get us. I mean, it’s not really fair if you give up smoking and junk food to avoid lung cancer and heart disease but end up getting adult onset diabetes, is it? If you’d have known diabetes was going to kill you slowly, you could’ve gone right on smoking and eating what you wanted since you were going to die from something else anyway. However f-witted such thinking is, you gotta admit that is rather how our minds work.
Fortunately the risk factors for most of the top killer diseases are the same. They are bad genes, smoking, lack of exercise, bad diet, being overweight, stress, and/or being a miserable and lonely old sod. Of course bad genes is a bit harder to handle, but the good news is - if you can do something about the rest you stand a good chance of avoiding heart disease, strokes, and diabetes, while substantially reducing your cancer risk.
That’s great news! And we should all be over the moon about it. Ah! But.....and here’s the snag, it only works if we do something about it. The cemetery is full of half measures.
So let’s go back to the No.1 killer heart disease and it’s No.1 cause, coronary artery disease (CAD).
What to Do.....
If you don’t want to die or otherwise be struck down by a heart attack what do you do? First step is blood work to see where you are. If you are in your 40’s, get your cholesterol levels checked. Also your uric acid and homocysteine levels. If elevated, all are risk factors for heart disease and you need to reduce them. The most important of these is cholesterol. Since so many of us are killed by heart attacks, being in what the docs say is the “normal” range isn’t really great a good place to be, is it? So forget normal. What you need is “optimal”. Get your total cholesterol (TC) in the 180 -200 mg/dL range, your LDL (bad cholesterol) below 100 mg/dL and your HDL (good cholesterol) above 50 mg/dL and then you’ll be getting somewhere. Once you’ve hit middle age do blood work twice a year. Things can change almost overnight. You can go from normal cholesterol to dangerously high within a month and have a heart attack before you know it.
Next step is to address your lifestyle. Take a hard look at yourself and the risk factors and see where you are. Then if you have elevated cholesterol, you’re going to have to harden up on yourself. That means really, really losing 20 lbs, it means really really eating healthy food without cheating, and it means getting out of your comfort zone in the gym. It’s not just health baloney, jointly or separately each one of these could save your life. When you’ve got to where you need to be, then you can slacken off, not before.....
Take a multi-nutrient supplement, the best you can find. Most brands on the market are inadequate or useless, so do your research and choose with care. A good formulation containing the full spectrum of vitamins, minerals, amino acids, phyto- and other nutrients is a powerful tool against chronic disease and aging. Make it the basis of any supplementation program.
If you don’t cheat on your lifestyle modification and nothing else works, and your cholesterol still remains high, don’t muck about, start taking the statin drugs. At the moment Lipitor is the best, so take that and don’t be fobbed off with anything else.
Medical Marvels
The next level of prevention are the various non-invasive diagnostic tests designed to see what degree of coronary arterial disease you actually have. These include the treadmill stress test (ECG), and on to the EBT scan for venal calcification and the Sestimibi “nuclear” test. The standby is the ECG, which will ring the warning bells, meaning arterial blockage of over 70%. The point is that all of these tests can miss 20% of arterial blockage and you may get a clean bill of health or false negative but actually have 90% blockage and be a walking cardiac event waiting to happen.
This is when you ascend the cardio-diagnostic ladder to the next stage, which is the angiogram. This is known as the “Gold Standard” and supposed to give you a 100% view of your cardiovascular wellbeing. As a result angiograms have become routine. Nonetheless they are an invasive procedure and can kill you. One in a thousand people die while undergoing it and it can actually precipitate a heart attack or stroke, not to mention kidney damage. So it’s not something you want to do unless you have to. Don’t be rushed into it, but nor should you funk it if the risk factors indicate it.
If they find serious arterial blockages while you’re having your angiogram the surgeon can perform and angioplasty to widen the artery and put in a stent to keep it open. The point to bear in mind about this is that angioplasties don’t last long and may have to be repeated in as little as 3 months. Stents also have significant risk factors of their own, actually causing fatal blockages in a small but significant number of cases. More to the point, blockages causing heart attacks are just as likely to occur in another place which has not been treated.
Finally, if the blockages are just so pervasive or situated in a place where it is too difficult or dangerous to perform these procedures, then there is no option but to schedule open heart surgery. At that stage you are moving into another world altogether.
Extending the Pleasure.....
Simply put, by the time we are 40 almost all of us have some degree of cardiovascular disease. Half of us will go on to develop full-on heart disease, which’ll kill many of us well before our time. Since it is not yet in our nature to take preventative measures right from the start (i.e. puberty, so forget it....) if we are the least bit wise we will at least check ourselves out in early middle age and, if we have significant risk factors, do something about it. The earlier we do this the less drastic the measures we have to take. By the time you have to go into hospital for any procedure, even diagnostic, that is already serious if not drastic. You don’t want that and, more importantly, you can avoid it. Heart disease is a lifestyle disease, it is optional. You don’t have to get it. If you’re at all smart you’ll check into it early and make the minor adjustments necessary. That way you get to hang on to a lot more of life’s little pleasures a whole lot longer.....
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Speaking for myself, I’d do almost anything to avoid open heart surgery. That is, if I really thought about it....But then who wants to dwell on being sawn open like a side of beef?”
ParacelsusAsia
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