Concerned about my sons' futures after atherosclerosis diagnosis

[deepFreeStone]

H, I'm 58

I had mild chest pain or rather more discomfort a few times last year.

Decided to take it to A&E last October.

ECG, BP were fine, blood test showed high Cholesterol.

Slightly elevated troponin. (10)

Second blood test an hour or so later showed no rise in troponin. (9)

Sent away with something to ease the discomfort which was put down to something gastric.

Also suggested that I start statins, atarvostatin.

Few days later was asked if I wanted to be involved in a study of people that had presented at A&E with chest pain but were not diagnosed with heart failure/disease.

Said yes and when I was phoned got a coin flip in favour of being included which meant a CT scan.

CT scan found "moderate" (50-70%) blockage in distal LAD and mild (under 50%) blockage in other areas of arteries.

-----------------------here's the numbers---------------------

Coronary arteries

Right dominant coronary system

LMS: Normal

LAD: Mild noncalcified plaque in the proximal LAD, less than 50% stenosis. Mild mixed plaque in the mid LAD, less than 50% stenosis. Moderate mixed plaque within the distal LAD, 50-70% stenosis. Small first diagonal. Normal second diagonal branch.

LCX: Mild mixed plaque in the proximal circumflex and AV circumflex, less than 25% stenosis. Mild mixed plaque in the mid / distal circumflex, less than 50% stenosis. Normal OM 1 and OM2 branches.

RCA: Mild mixed plaque in the proximal RCA, less than 50% stenosis. Normal mid and distal RCA. Mild calcified plaque in the PDA, less 25% stenosis.

Cardiac findings

Normal cardiac valves and chambers.

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

Now just looking into it all to try to find out how worried I need to be.

Eating more healthily and losing weight. ( BMI 29 from 30.5 and going down)

Drinking moderately now.

My Dr said that it was better that it be in the distal LAD.

I'm really quite worried as my sons are 15 and 10 and the 10yr old is autistic and I want to see him safe in life.

[Chappychap]

I don't want to minimise the seriousness of the heart disease/atheroschlorosis that you and I both have. It's incurable and progressive, meaning we've got it for life, and left to its own devices it will keep getting worse.

However, the good news is that a combination of medication and life style changes are capable of slowing the progress of our disease to an absolute crawl. Furthermore, get on top of a few key risk factors and metrics, such as blood pressure, lipid levels, BMI, HaB1c scores, exercise, smoking, healthy diet, stress management, healthy sleep patterns, etc, and we can bring our statistical risk of heart attack or stroke right back down to that of the general population of our age and gender.

In other words, with a fair amount of effort and just a little bit of luck, we can enjoy many more decades of active, healthy life.

So take this seriously, but don't be despondent.

You will now have to work at staying healthy, but if you put the effort in then the rewards are there for the taking.

Good luck!

[deepFreeStone in reply to Chappychap]

Thanks for that, that's gotta be my route. You mentioned a few things I'll be back and forth looking into those.So far I'm just monitoring my BP though I have for years, weight as mentioned is falling, alcohol is probably part of the cause but I'm barely drinking now, diet, whilst I have kids is improved from not a bad place pre-diagnosis.

Cholesterol seems way down on where it was according to a monitor I have, need to cross check that against a doctor's reading next time doctor/nurse does it.

Most of all, thanks for the positive pathway and mindset.

[deepFreeStone in reply to Chappychap]

Hi ChappyChap,

Me again.

Thanks again for your reply.

I've been reading quite a bit recently and I'm just wondering how sure you were when you said, "... a combination of medication and life style changes are capable of slowing the progress of our disease to an absolute crawl".

I'm trying to find out nspecifically how much the statins and healthy lifestyle are likely to slow down the build up of plaque.

Are you aware of any studies that show this.

with all good wishes.

[Chappychap in reply to deepFreeStone]

It's a great question.

Let's start by looking at the main three main ways of measuring plaque in the arteries.

The gold standard is an angiogram. But angiograms are not risk free, so they're only conducted sparingly. Most heart patients will only ever have one or two.

Next on the list is a CT angiogram, this is low enough risk that we can elect to have one done privately. But even though it's "lower risk" it''s still not "zero risk", in particular you receive a fairly big hit of radiation with a CT angiogram. Plus the higher your resting pulse the less accurate the results. I think from memory that a pulse above about 60bpm (which really isn't all that high) negates the results. I've been thinking of having a CT angiogram done privately, but at the end of the day I'm unlikely to change my behaviour no matter what the results, so it's a non negligible dose of radiation for no practical purpose beyond satisfying my own curiosity.

Third is an ultra sound scan of the carotid artery. This is zero risk, so can and is used for regular monitoring. The problems however are that it's the least accurate/consistent (different machines and even different operators will give different results), it's measuring an artery in the neck rather than the heart, and it's actually more measuring calcification than plaque. Having said that there are a few studies which have linked life style to progression in carotid artery scans. This is also where it becomes controversial. The NHS and the BHF are clear, we can't remove plaque from our arteries. But some reasonably well qualified and authoritative figures (ie Dr Ford Brewer) have claimed they have seen reductions in carotid scans (CIMT) over time.

All this means that most analysis comes at the question from the other end. Instead of physically measuring plaque it instead measures outcomes, ie by taking certain medication and following certain lifestyles how many of the participants go on to have heart attacks/strokes, and at what age do they die?

Here the evidence is overwhelming. Life style and medication really do work.

I'll point you to just two studies (there are literally hundreds) that you might want to explore.

First is a massive UK study into over 7000 middle aged men tracked over more than 15 years. Search for The British Regional Heart Study and Gerald Shaper/Mary Walker/Goya Wannamethee.

Second is the statistical risk analysis tool that British GP's use to evaluate patient's risks of heart attacks and strokes. It's called QRISK3 and it's public domain.

Finally, as my sister and brother in law are both actuaries, I've had access to a number of proprietary risk and mortality studies that are used within the pensions and insurance industries. These have convinced me that someone like myself, heart disease leading to bypass surgery but no heart attacks, can reduce my risk of a heart attack within the next 10 years (I'm 65) to a fraction lower than the risk of the average British 65 year old man. But only if a number of key metrics are managed and maintained into the safe zone. These metrics include, weight/BMI, lipid levels, HbA1c scores, blood pressure scores, exercise levels, nicotine consumption, etc.

Hope that helps!

[deepFreeStone in reply to Chappychap]

Thanks for such a full and enlightening answer.

I will have a look at Gerald Shaper/Mary Walker/Goya Wannamethee and QRISK3 when time allows..

HbA1c scores weren't really on my radar either so I'll look into that.

I've shed 9kg since October and BMI is now 27, and tbh I have rather a broad frame and bones.

TC went from 7.1 to 2.5 (Hdl 1.3 and LDL 1.2) but is up a bit now though TC was at 3.3 just yesterday (results back today) at the Medical centre.

My home chol testing kit gave me 4.1, 4.5 and 3.5 - yes I took 3 readings.

Any recommendations out there for an accurate cholesterol testing kit.

I think my kit tests glucose as well but it's not reliable enough.

The bit about your actuary in laws was very encouraging.

I was getting a bit frustrated and looking at ongoing research for atherosclerosis, have you or anyone heard of

repairbiotechnologies.com

and

Cyclarity

cyclaritytx.com/

Must dash .... take son to tutor.

Big Big thanks again!

[deepFreeStone in reply to Chappychap]

Just checking out the qrisk three calculator and a good bit better --- Thanks!

Quite a good tool!

Now need to to check British Regional Heart Study and Gerald Shaper/Mary Walker/Goya Wannamethee.

[Dadtoalad23]

Almost the same findings I had. Check my old posts and replies as there’s some great information on there. Tbh I wish I’d gotten my diagnoses at 58 rather than 47.

But in the same vein as you i have a ten year old son. And I’m also pretty terrified of not being around for him. And also sad about the impact of having heart disease will have on him.

In saying that though from my short time on here I have seen that the more positive people have the more positive outcomes. I’m not naturally positive. I also have two heart conditions and have just added auto immune issues into the mix. But I still know whatever it is I need to conquer the fear and anxiety. It won’t help me live longer or enjoy the time I am living if I live it in fear. I’m getting counselling to help me and reading about the stoics and other philosophy’s.

I’m by know means there yet and I’m inspired by the positive crew on here who will no doubt offer you some great advice.

BHF helpline nurses helped me greatly, even with practical things like insurances for travel and car etc going forward.

But i totally know where you’re at as I’m there too. Hang in there and good luck. You can live a long life with coronary disease and you’ve just been given a far far better chance than a first symptom being a heart attack.

[deepFreeStone in reply to Dadtoalad23]

Thanks so much, I take on board that you're in a similar boat. I will read your post(again) tomorrow and look at the replies you got. With good wishes

[deepFreeStone]

Oh live those points, the first I wasn't aware of fully, need to research more.The second has been crossing my mind recently and already I hope that some of the things I'm saying are being soaked up albeit not overtly. Older son has a good chance of a career in sports possibly even playing 🏉.

Though he's also a bit wild and would given the choice eat trash a lot. I'm hoping to influence him regarding my bad choices in early adulthood.

Best wishes and thanks!

[LincolnAndy]

Hi … like the others, much as it won’t feel like it, there is good news in there - you found out this way and not by having a HA . You’re in control now … you get to do something about it and the odds against you having a heart related incident just got better 👍🏼

I too got an Atherosclerosis diagnosis a year ago .. I’m 54, fit, healthy, 25 BMI runner, non-smoker, drink small amounts of alcohol (socially) and eat healthily. But there’s family history of heart related death .. both my dad and his dad died in their sleep in their late 50’s of heart related disease, so I’m right in the window so to speak 🙄

Went for proactive cardiology checkups and had the full range … all checked out fine, nothing of concern and my heart is doing all it should be. I also had a CT scan, otherwise known as a calcium scoring scan .. that’s what you had too and what measures the levels of plaque and calcified plaque in your arteries. Despite my overall good health and fitness, it found I had mild plaque and some mild calcified plaque too .. so the early signs I have the same thing they did. Cheers genetics

They should have given you your calcium (or Agatston) score .. do you know what it was ? Mine was 83 …

Shocked me, angered me .. and yeah, I keep worrying. But I got put on 20mg of Atorvostatin straight away and along with some dietary and lifestyle changes, I’m in a good place.

Do the same (I know it’s easier said than done !) and there’s no reason why you shouldn’t go on and have many years left.

Final point .. not something you’d want to worry your kids with now, but definitely suggest you let them know they need to get checked in later life because of the family history that now unfortunately exists.

Good luck 👍🏼

[deepFreeStone in reply to LincolnAndy]

Oh thanks I wish I'd been a bit more proactive 10 years ago. Ta for the tip on calcium score (agatston) I will look into that.Yes both my grand fathers died of heart attacks I think, certainly one did and my dad had a lot of PAD

Best wishes