No risk factors... So why was my artery 99% closed

[Maradona10]

Just looking for anyone in the same boat as me... Very fit, non smoker, low cholesterol, non drinker, non drug taker. Yet I had the dramatically dubbed "widow maker" five weeks ago. I haven't gotten a very good explanation as to why. I wondered if anyone was in a somewhat similar situation and if yiu have received more of an explanation or information than I have. Thanks in advance for any replies.

[High_fives]

Hello

I may well be in the same boat....

Background, I'm the guy everyone thinks is the fittest of his peers.....

I did annual bloods since 50 years old (now 58) and Dr's never raised an issue I.e. risk of artery disease low. No smoking, good BP, BMI, no diabetes, great health & fitness etc...My cholesterol ratio was good, no family history either. Echo in 2017 passed me as clear too.

Then a chance scan after illness revealed plaques in my neck. Another echo 'just in case'...radiologist says I got to see a cardiologist, somethings not normal. Cardiologist does further tests then tells me I've had a silent HA, heart is damaged, EF is 45% and all arteries moderately blocked (Inc the widowmaker). Still asymptomatic thankfully.

Doesn't know why ( or hasn't told me). Statins will help, plus exercise, aspirin and continue with healthy lifestyle should help prevent progression, so far reacted well to them so all cholesterol & triglycerides dropping, sugar levels & kidney still fine too🙏🏽

I found this out about 6 weeks ago, now just educating myself more.

All tips & advice accepted

[Chappychap]

You ask an important question. I've asked myself the same thing and here's what I've found.

We may have heart disease due to life style or genetic reasons. But it's not actually that clear cut, in practise there's a lot of overlap between life style and genetics . Most genetic explanations operate by leaving us more (or less) susceptible to life style choices. For example, depending on ethnicity up to about 11% of the population carry the E4 variant of the APO gene, with significantly elevated risk of heart attacks and Alzheimer's. However, if one of these people removes virtually all alcohol and all red meat from their diet then their risk falls back down to that of the general population. So is that a life style cause or a genetic cause? I'd suggest it straddles both.

However there are a very small number of genes that pre-dispose the carrier to heart disease no matter what life style is adopted. Most notable in this camp are the genes that cause Familial Hypercholesterolemia. Carriers of these genes have livers that are less able to remove LDL or "bad" cholesterol. Their diet choices have very little influence on their lipid scores. The good news is that there are some extremely effective new medication options, which go far beyond the effectiveness of statins in correcting lipid problems.

Another important consideration is that even though the obvious life style issues (regular exercise, healthy BMI, healthy diet, no smoking, modest alcohol consumption, etc) will manage the risk factors for the great majority of people, there are some people where the life style factors are less obvious.

For example, gum disease may ultimately explain some people's heart disease/atherosclerosis. Another fairly common explanation is any form of sleep disruption, which is why shift workers have a higher incidence of heart attacks and strokes. There's a well established link between sleep apnea or excessive snoring and heart disease.

Another point I'd make is that the trigger point for our GP's to alert us about type 2 diabetes is probably far too high. We aren't considered pre-diabetic until we have an HbA1c score of about 42 or higher. Below this number it's unlikely your GP will raise it, that was certainly the case with me. However, a new GP made it very clear that my steadily increasing HbA1c score was a serious risk factor even though it was technically below the trigger level. Recent research has shown that heart attack and stroke risks start to increase from HbA1c scores that are in the 20's and 30's.

Without very solid family history it's unlikely that you'll qualify for an NHS gene test, but you can pay to have a private test that will look for the fifty or so genes that are known to pre-dispose us towards heart disease. I did this a few years ago and it cost about £500. That may sound a lot but I spend more each year on servicing a car, so maybe it's not that extravagant. However, be aware, in virtually every case the solution to these genes tends to be doubling down on the better known life style issues!

Finally, I've come to the conclusion that simply living in a modern western society actually makes it pretty difficult to adopt a heart healthy lifestyle. For example all processed meats, such as sausages, bacon, or salami, are problematic. But how practical is modern family life without pizzas, frozen meals, or take aways? And when you look at the NHS recommended exercise levels it's clear they go far beyond what most people would describe as an "active lifestyle". Walking the dog and a spot of gardening simply don't come close to the 150 minutes per week of sustained aerobic exercise with a 100 bpm plus heart rate that is recommended. Add on the lengthy warm up and cool down and just meeting the NHS minimum exercise levels would probably mean five gym sessions per week. How achievable is that for most people trying to balance full time employment with family life?

Following bypass surgery I staged a root and branch review of my life style and made all the necessary changes. But the truth is it was pretty tough, and I'm one of the lucky ones with every advantage to implementing these changes.

Anyhow, hope some of that has helped.

Good luck!

[High_fives in reply to Chappychap]

Are you able to share details (say a website) for the genetic tests?

I'm fascinated by that sort of thing, as I was by your longer post on the relationship between blood sugar, cholesterol & arterial disease.

Thank you

[Chappychap in reply to High_fives]

Hello, I'm duel nationality, British and Canadian, and I've had treatment in both countries. Genetic testing as part of heart care is much, much more common in North America. If you want to read more there's an interesting book called Beat The Heart Attack Gene by an American cardiologist called Dr Bale. It's a bit long winded but there's a lot of information between the covers.

The head of research at the BHF laments the fact that the NHS doesn't do more to embrace genetic testing. However, gene testing gets cheaper every year, so perhaps it's not too far away.

One way of getting some limited gene testing at a lower price is to look out for the occasional promotions run by "23andMe". They do a small health check package that includes an APO E4 test, and I seem to recall that on promotion it's only about £20. You won't get to know if you're APO E2 or APO E3, just yes or no, are you a carrier of the APOE4 variant. However, that in itself could be critical information. You can read more about APO E4 here,

gbhealthwatch.com/GND-High-...

And here's what the BHF has to say about gene testing for heart disease,

bhf.org.uk/informationsuppo....

Hope that's useful.

Good luck!

[High_fives in reply to Chappychap]

Hi again, and just to follow-up on this in case others are interested:

Randox Health offer a genetic test in the UK as follows "Inherited Cardiac Conditions genetic test covers 174 different genes related to 17 inherited cardiac conditions including cardiomyopathies, arrhythmias, arteriopathies and lipid disorders"

It's not cheap but it's available, along with a consultation to discuss if its suitable before moving forward. I'm going to find out if I'm a candidate.

Thanks for your original post