Got another stent in 15 months - why and what should I do next. Anxious?

[michellefisherm]

Hi,

I am 61 year old living in San Francisco Bay Area and in Jan 2023, I got 4 stents (2 in LAD, 1 each in LCx and RCA). Had 50-60% blockage in distal RCA and D2 of LAD. Before the stents:

LDL-C was in 70s, ApoB and LP(a) were never measured. A1C was 5.6, Blood pressure 130/80. Active - Biking 3 to 4 days a week.

Meds were Metoprolol 50mg and Atorvastatin 40mg

After the stents:

LDL-C has been around 53, ApoB 64

A1C 5.4

Blood Pressure 110/70 (around this)

Meds were Metoprolol 50mg Extended Release, Rosuvastatin 20mg, Losartan 12.5mg, Aspirin 81mg, Effient was given for a year

Exercise - strength training 3 days a week, 50 minute run on treadmill (zone 2 for 40 min and 10 min zone 5)

Diet - mostly vegetarian, except chicken and fish

I got tested for LP(a) and got into Olpasiran double blind study. LP(a) dropped from 285 to 179 but not below 75

So on April 3, felt having a heart attack, went to hospital and distal RCA blockage was 99% and got another stent. The 4 stents were clear and did not show any plaque build up.

Now medicine is Metoprolol 50mg Extended Release, Rosuvastatin 20mg, Ezetimibe 10mg, Aspirin 81mg and Brilinta 90mg (twice a day for year).

The questions I have is:

1. Why did plaque grow from 60% to 99% when my Medicine, Exercise, Diet was all on track? Any theories?

2. What tests can I do to catch the progress of plaque proactively?

3. What else should I be considering?

Thank you

[pasigal]

What does your cardiologist think?

I have had a similar experience, although my LAD was 90+% blocked before the stents. I had no symptoms. 8 months later, had cardiac arrest while running. I also have high LpA.'

I did all the right things, and yet, I nearly died from a blockage in my circumflex. Anxiety through the roof. I still struggle with it, nearly 3 years later.

I guess I would say that there are still a lot of things we don't know about coronary artery diesease. What I do know is that the treatment options look across populations, not individuals, Remember that a 25% reduction in your chances of having another HA doesn't mean you WON'T have another!

My pet theory about my problems is that the initial stents disrupted a very delicate blood flow balance, leading to issues with an unstented artery. But who knows?

Two other points on your case: I'm surprised you had stents with such low levels of blockage. The latest protocol is not to stent. And, wow, lowering LpA is amazing. Hope that drug gets approved...

[michellefisherm in reply to pasigal]

Thank you for sharing your thoughts and experience. The cardiologist does not have a good explanation for it. When they took me in to do the Cath Angio, the theories were either blockage of the stents or plaque had broken. Since the only thing they found was 99% blockage of distal RCA, the Cardiologist thinks it could be Lp(a), unknown/body is mysterious. Also they estimate the blockage and it could have been 70-80% instead of 50-60%. From my perspective irrespectively it progressed in spite of medicine, exercise, diet, stress reduction and that bothers me. He is pointing that my stents are clear and that is good news. Now only D2 (Diagonal 2) of LAD is 80% blocked and they don't do anything with distributaries. But it does make me anxious of when something could go wrong as there is no strong theory.

[devonian186]

In answer to 1), presumably some people are just genetically predisposed to creating plaque.

Still on 1) perhaps the diet is not as clean as might be thought. Scientists are always changing their minds as to what foods are good for us and it may be that something commonly eaten in your diet is not as good as you thought it was.

In general, perhaps HA's are not always caused by any deficiency in our diet or exercise but just "one of those things." Perhaps stress, anxiety, excessive exercise, exposure to Electro Magnetic Fields, Traffic pollution etc etc are also more responsible than we currently think

[michellefisherm in reply to devonian186]

Yes, thank you. There is no current concrete theory.

[Happyrosie]

you mention your diet being “on track”.

When I first had high blood pressure I was asked to follow what’s called the NHS EatWell Plate (the NHS being our health service here in the UK). Google it for yourself.

The Eatwell plate hasn’t ,as far as I can see, been updated in the twenty years since and one of the things it says is that you should choose “low fat options”. We now know that “low fat foods” generally speaking contain all sorts of things to make them palatable when the manufacturer has taken the fat away. And I was told to have eggs and prawns at most weekly, not more often.

So,what I’m saying to you is that you might want to look at your diet again and ensure, as far as you can, that your food is freshly prepared from “real” ingredients with some, but not much, salt. This includes drinks too - no fizzy drinks. And make sure you are hydrated well.

This doesn’t answer your questions but might give you some thoughts.

[michellefisherm in reply to Happyrosie]

Thank you Happyrosie. no sodas for a long time. only 2 cups of green tea in a day. Mostly vegetarian home cooked diet - beans, legumes, minimal carbs, chicken and fish 3 to 4 times a week to gain muscle mass.

[Cchhabra]

Get on plant based no oil and no dairy diet. Read dr Esselstyn book. You will see a difference

[michellefisherm in reply to Cchhabra]

I gave up dairy while ago. The only exception to plant based diet is chicken which I eat three times a week to help with muscle growth

[Cchhabra in reply to michellefisherm]

I would certainly give up chicken or any kind of meat. That is saturated fat which can contribute to plaque. Get your ldl under 50. Hope you are on statins

[michellefisherm in reply to Cchhabra]

Thank you. Ezetimibe 10mg was added to lower LDL below 30 and I got tested yesterday. So i will find out how much has it been lowered.

[Western1234]

Hi michellefisherm,

It looks like you have done everything possible to minimise any aspect of your lifestyle (exercise and diet etc) from contributing to your heart disease.

I agreed with devonian186: some people are predisposed to creating plague.

There is a overwhelming evidence that the genetic component is the main factor in heart disease/cardiac problems.

I think that there can sometimes be an element of guilt with heart disease/failure "what did I do, or not do, to cause this?" There are things in life, getting sick is one of them, where sometimes there is not a lot we can do.

Best wishes