Say what? APoB

 Listening to Dr. Peter Attia on a podcast today (he has a new book so he's been on several), he was discussing the 3 most important things for preventing heart disease--the #1 cause of death.  1.  Blood pressure (he recommends 120/80)--check.  2.  No smoking--check.  and 3. APoB.  Say what? Had to look that one up.  I don't see it on my lab reports.  Apparently, neither have most people--even doctors.  Here's what I found on a website called Levels.   https://www.levelshealth.com/blog/why-apob-may-be-a-better-cholesterol-marker

What is the ApoB Test?

"The ApoB test measures your body’s level of Apolipoprotein B-100 (also simply known as ApoB). ApoB is a protein that helps carry cholesterol and other important compounds through your bloodstream to the tissues that need them. Testing for this protein helps doctors quantify the number of potentially dangerous cholesterol-carrying particles in your body, thus giving insight into your risk of heart disease. . . 

"To understand how ApoB predicts heart disease risk, we first need to step back and understand cholesterol. Cholesterol is a waxy substance, a type of fat (lipid) that’s essential for human life. It’s used by cells as a structural material (to build cell membranes and insulate nerve cells) and as a building block for important hormones (e.g. cortisol, estrogen, and testosterone). Every cell can make its own cholesterol, but it’s produced in the largest quantities by the intestines (which absorb and repackage some cholesterol from dietary sources) and the liver. These organs then export cholesterol to other cells and tissues via the bloodstream. But this step presents the body with a challenge: Cholesterol is hydrophobic. It does not disperse easily in the blood but instead clumps together like oil in water. The solution is a particle called a lipoprotein—a molecule that encases cholesterol in a hydrophilic shell so that it can travel through the blood in small, discrete parcels.

There are many different types of lipoproteins that sequentially change into each other as triglycerides are offloaded. At the beginning of this chain is the Very Low-Density Lipoprotein (VLDL) molecule. VLDLs are formed when your liver bundles cholesterol along with triglycerides (another fatty substance that stores energy) into a large, protein-wrapped molecule. This molecule is “low-density” in the sense that it floats in blood—it is buoyant. The VLDL is then sent out into your bloodstream, where it circulates until it encounters a cell with an open receptor (typically a smooth muscle cell or fat cell). The VLDL then deposits its triglycerides into the cell, which can store them or use them for immediate energy." continues at web site. Important to read.

. . . "ApoB can give you critical information about your long-term heart health. This may be especially important for people with a personal or family history of heart disease, as well as people with a current heart disease diagnosis who are monitoring their condition."

Health equity?

Demands for "health equity" for racial and ethnic groups is a push for more government control. The CDC reported in 2014 that the 5 top causes of death were diseases primarily of personal behavior, 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. These are most often a result of obesity, smoking, drinking, drugs, lack of exercise and other risky behavior. HIV rates are still very high among young black men who have sex with men, and CDC says risk factors are poverty, high rates of unemployment, and cultural stigmas. Doesn't mention risky sex. I'm no doctor or researcher, but any poor, unemployed man who doesn't have sex with men will not be at risk for HIV.  The costs of unintentional injuries are huge--motor vehicle, drugs, suicide,  work, falls. The burden on employers and society in general runs in the billions of dollars annually. . . $1,097.9 billion 

Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010 (cdc.gov)

How Many People Die From HIV/AIDS Each Year? (verywellhealth.com)

Health Risks of Overweight & Obesity | NIDDK (nih.gov)

Societal Costs - Injury Facts (nsc.org)

Toledo isn’t very healthy

Holy Toledo!  It’s at the bottom of 100 cities for heart health. 100.  It’s about what we eat, and how much we exercise, and our smoking and drinking habits. It's lifestyle, and we have control over that.

https://www.13abc.com/video?vid=571489272

Detroit is Number 99.

In the summer, we’re close by in Lakeside and our TV local news comes from Toledo.

Ejection fraction—what is measured and what does it mean?

Bob had an echocardiogram on Friday and the LV ejection fraction was below 50%.  What does that mean?  According to Mayo clinic web page, https://www.mayoclinic.org/ejection-fraction/expert-answers/faq-20058286

“Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts.

The heart contracts and relaxes. When your heart contracts, it ejects blood from the two pumping chambers (ventricles). When your heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, the heart can never pump all blood out of a ventricle. The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat.

The ejection fraction is usually measured only in the left ventricle (LV). The left ventricle is the heart's main pumping chamber. It pumps oxygen-rich blood up into the upward (ascending) aorta to the rest of the body.

• An LV ejection fraction of 55 percent or higher is considered normal.
• An LV ejection fraction of 50 percent or lower is considered reduced.
• An LV ejection fraction between 50 and 55 percent is usually considered "borderline."

Ejection fraction is just one of many tests your doctor may use to determine how your heart works. But even with a normal ejection fraction, your overall heart function may not be normal. Talk with your doctor if you have concerns about your heart.

Some things that may cause a reduced ejection fraction are:

• Weakness of the heart muscle, such as cardiomyopathy
• Heart attack that damaged the heart muscle
• Heart valve problems
• Long-term, uncontrolled high blood pressure

Ejection fraction can be measured with imaging techniques, including:

• Echocardiogram. This is the most common test used to measure ejection fraction. During an echocardiogram, sound waves are used to produce images of your heart and the blood pumping through your heart.
• Cardiac catheterization. During cardiac catheterization, a thin, plastic tube (catheter) is inserted into an artery in your arm or leg and then gently guided to your heart. Images taken during catheterization can measure the ejection fraction of your heart.
• Magnetic resonance imaging (MRI). An MRI uses magnetic field and radio waves to create cross-sectional images of specific parts of your body. When an MRI is used to study the heart, it's known as a cardiovascular MRI.
• Computerized tomography (CT). During a CT scan, a special X-ray technique is used to create cross-sectional images of specific parts of your body. When a CT scan is used to study the heart, it's known as a cardiac CT.
• Nuclear medicine scan. During a nuclear scan, trace amounts of radioactive material are injected into your bloodstream. Special cameras then detect the radioactive material in your blood as it flows through your heart and lungs.”

More testing today, and we hope he’ll be home soon.

How is it treated? According to Healthline https://www.healthline.com/health/ejection-fraction#treatment

“There are a variety of treatment options for abnormal EF, including:

• Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), or beta-blockers. These medications can reduce the amount of hormones that weaken your heart muscle. They can also slow the progression of heart disease.
• Diuretics. These drugs can help get rid of excess fluid that’s causing swelling and shortness of breath.
• Eplerenone or spironolactone. These agents help you eliminate excess fluid and can help decrease stiffening of your heart.
• Biventricular pacemaker. This pacemaker helps to synchronize the contractions of your left and right ventricles so they’re working to their highest capacity.
• Implantable cardiac defibrillator. This device can be directly implanted into your chest. It sends small electrical triggers to your heart to keep it beating regularly.
• Hydralazine-nitrate. These two drugs have been successful in lowering blood pressure in people who still have symptoms when taking ACE, ARBs, and beta-blockers.”

Healthy heart for life

3 easy steps--eat 5, move 10, sleep 8. I found this nice book at Marc's for $1.99. On the website it's about $30. Copyright is 2012. I get the Mayo Newsletter, and find them interesting. If books could make you healthy or make you an artist, I'd be all set. http://store.mayoclinic.com/products/bookDetails.cfm?mpid=136

https://www.youtube.com/watch?v=TYGsqqzCMSE

Quiz on heart disease—I got about 70%

Heart disease is the No. 1 killer of women in the United States, killing more women than all forms of cancer combined. One in four women die of heart disease, while one in 30 die of breast cancer. Obesity isn’t the biggest risk. According to the Centers for Disease Control and Prevention, 39.5% of Americans are at risk for heart disease because of inactivity. The percentages of U.S. adults with other key risk factors are: obesity, 33.9%; high blood pressure, 30.5%; cigarette smoking, 20.8%; high cholesterol, 15.6%; and diabetes, 10.1%.

http://www.webmd.com/heart-disease/rm-quiz-heart-myths

Maybe it’s your (or my) thyroid

“If you're always cold or tired, you can't lose weight, you have brittle hair and fingernails, or you have other unexplained health issues, the answer may be "Yes."

Untreated, a thyroid disease can make you feel lousy. It can also increase your odds of having high cholesterol, developing atherosclerosis, and having a heart attack. “ Harvard Medical School “Healthbeat,” Dec. 7.

When I was in the hospital for heart rate problems (too fast and irregular), the doctor suggested, based on the blood work, that my thyroid was a bit low and that might be part of the problem with the heart.

My new internist agreed and prescribed Synthroid, very low dose.

What are the Symptoms of Hypothyroidism?

The more commonly known symptoms of hypothyroidism are weight gain, low basal body temperature, brittle fingernails with ridging, cold intolerance and cold extremities, like your hands and/or your feet.

However, the list of symptoms that can be associated with hypothyroidism is actually quite long, varied and can include symptoms that most women might attribute to perimenopause, such as: fatigue, muscle and joint pain, menstrual irregularities, hair loss, loss of libido, infertility, weight gain, decreased mental sharpness (brain fog), fluid retention, depression and/or mood swings. Check the article for 35 symptoms

Maybe big government doesn't know best?

Maybe the USDA and HHS, which revise their guidelines every 5 years, don’t have all the answers?

“. . . ever since the first set of federal guidelines appeared in 1980, Americans heard that they had to reduce their intake of saturated fat by cutting back on meat and dairy products and replacing them with carbohydrates. Americans dutifully complied. Since then, obesity has increased sharply, and the progress that the country has made against heart disease has largely come from medical breakthroughs like statin drugs, which lower cholesterol, and more effective medications to control blood pressure.”

Egg on their faces

Today's new word--Myocardial Infarction

This isn't a new word, but when I see it in print I do slow down--sort of like a "detour ahead" or Big funny words ahead. A myocardial infarction is a heart attack, and ischemia is lack of oxygen to the heart muscle cells, which may have been caused by plaque, a build up of fatty junk, in the arteries which supply the blood to the heart.

Whether or not you listen to Rush Limbaugh, heart attacks (myocardial infarction) have been in the news, either because you heard his confirmation of the excellent care he received from EMTs and at a hospital in Hawaii after experiencing severe chest pain (including aspirin and nitroglycerin tablet before getting to the hospital) or you heard one of the many MSM talkers complaining that he had politicized his emergency by announcing the U.S. has the best health care in the world.



Actually, that's not at all political--although the liberal talkers made it that way. First of all, heart disease is the leading cause of death because our excellent health care and research have pushed it to the top by eliminating so many of the childhood diseases that used to kill or weaken us--scarlet fever, polio, early onset diabetes, measles, etc. Both liberals and conservatives and libertarians should be able to agree that there are many health concerns that only the federal government can tackle--like clean water and air, safe highways, speed limits, and food purity, etc. The political challenge comes in deciding how far can you go in eliminating all risk without destroying people's ability to earn a living so they don't succumb to other health problems--like starvation and freezing for instance.

Secondly, I can't recall ever talking to anyone in the last decade who was rushed to the ER with chest pains who didn't rave about the near miraculous care they received. While Rush was explaining the procedures as he remembered them, a cardiologist from central Illinois called the show (that's called "down state" for those of you not from that area since Chicago overwhelms everything else) and reported that what Rush described was exactly what anyone would receive at his small hospital, regardless of insurance, gender, or celebrity. Rush put his emergency care on his credit card because he's one of the millions of Americans who chooses not to use health insurance, which is his right at this time, but will not be under the new PORK (Pelosi-Obama-Reid-Kennedy) Plan. Liberals continue to quote inaccurate stats--it's not 47 million--and the PORK Plan will not cover all the 10% of our citizens who currently do not have insurance because of choice, neglect to sign up, or being between jobs, or lack of money. Also, no health plan in the world will make Rush exercise more or lose weight or stop smoking cigars--that's the same option we all have regardless of our insurance, lectures from the family doctor, or New Year's Resolutions. He loves his steak, his exercise seems to be limited to golf outings and jaw boning, and he probably doesn't like vegetables. Everyone should know Yo-Yo dieting is unhealthy, but he's a poster child for that method of weight control.

However, he's right about our quality of care. He was treated immediately and didn't need a queue for tests to return when the damage was unrepairable. A free-market economy, whether for heart attacks or building automobiles or publishing on the Internet, is the healthiest way to go for Americans. It is our regulators, unions, creeping socialism in every aspect of life, and our federal bureaucracy that are increasingly plugging up the arteries of our economy with fatty barriers.

BTW, if you google "Myocardial infarction Rush Limbaugh" you get only one hit (now there will be two)--I think it was Money Times (it reports he makes about $50 million a year). You have to use "heart attack" to get all the articles, bizarre comments and smear attacks. That one source linked to over 3,000 that used other language.

Non-obese and non-smokers, but still have clogged arteries

Well! Think of the research grants that will need to be rewritten! Read the story by Ron Winslow in today's Wall Street Journal.

We visited this museum when we were in Egypt in March. An amazing place, and we just scratched the surface. No cameras.