Re: America: The world's diet laboratory

Jackie Patti <jpatti@xxxxxxxx> wrote in part:

Jim Chinnis wrote:
dsolo <dalesolomonson@xxxxxxxxx> wrote in part:

Wow... I stood and cheered:

http://heartscanblog.blogspot.com/

I've found some things (in the free parts) to be of interest, but I have
reservations about the general approach. That approach is to undergo CT
scans repeatedly to judge changes in calcification of the coronary arteries.
There's a downside to that, both in radiation exposure and cost. And no one
as yet has shown that the current extent of calcification corresponds to the
current risk of plaque rupture and thus heart attack or stroke.

While plaque buildup isn't a guarantee of a heart attack, you'd be hard
put to have an infraction without plaque.

But the CT-scan can't see plaque. It only sees calcification.

I've undergone (one) CT-scan of coronary arteries. And I can't say that it
added a lot of information to my personal set of risk factors. I think if
you consider abdominal fat (maybe best measured by waist-to-hip ratio at
present), blood pressure, bg control, family and personal history, and lipid
pattern, you won't gain much from a scan, and embarking on a series of scans
to measure progress in controlling coronary calcium just can't be justified.

I disagree. A series of scans would really only be necessary if there
is plaque and you want to monitor your progress; otherwise, if you
"pass", you know not to worry about it.

That's true, at least as far as calcification goes. It's possible to have
dangerous unstable plaque without significant calcification, though.

You're talking about measuring the risk factors rather than measuring
the thing itself - the actual blockages in the coronary arteries. The
risk factors work for measuring risk across populations, but don't give
you a picture of how *you* are doing.

If you could do easy, non-invasive measures of the plaque itself,
particularly the non-calcified unstable plaque that is subject to rupture,
there would be no need to use risk factors. But we can't currently measure
the plaque easily or non-invasively. So we have to rely on risk factors.
Coronary artery calcium score is just a (not that well studied) risk factor.

My lipid panels never really indicated anything; I've never had a doctor
even suggest meds or dietary changes wrt cholesterol prior to the heart
attack. I had sporadic high bp, but since I could get low measurements
when relaxed, it was considered good enough without meds. No one in my
family ever had a heart attack, not even the other diabetics. My only
real high risk factor was being diabetes and a less than optimal
waist-to-hip ratio, but these are hardly big worries with no family
history of heart disease. If I ever thought about my heart risk, it was
way off in the future, cause women don't have heart attacks this young.

I disagree that WHR and diabetes aren't major concerns even in the absense
of bad lipids or family history. That's why I listed them up front:
"abdominal fat ..., blood pressure, bg control, family and personal history,
and lipid pattern." It looks like you failed the first and third and maybe
the second as well.

So I didn't really have any way of knowing until the chest pain began.

When I got home from the hospital and sobered up enough to think about
it, my very first question was to wonder what one can do to reduce
artery blockages. I haven't seen anyone else address this, let alone do
so successfully.

Unfortunately, since I've had a bypass, it's unlikely I could get good
information from a heart scan. But I appreciate that his patients have
them and he therefore has specific clinical experience on what works to
correct various problems. He knows specific stuff like what works for
correcting a high Lp(a) and what reduction of plaque you get for doing
that, etc.

If I'd had a heart scan a year or more ago, and then followed up with
lipoprotein testing and appropriate treatment, I'd likely have avoided
my heart attack entirely.

Possibly. But I think the CT-based heart scan result could have been
predicted by your risk factors.

On the other hand, Davis recommends the first scan for women at age 50,
so he'd have missed me anyway. ;)

There ya go...
--
Jim Chinnis Warrenton, Virginia, USA
.

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