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0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040505 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - CNN Sanjay Bupka presented today medical understandings on cause and
040902 - prevention for heart attachs, also, coronary heart disease.
040904 - ..
040905 - Former president Bill Clinton is case study.
040907 - ..
040908 - Problem to solve is avoiding atherosclerosis that builds up into
040909 - calcium plaque when small size LDL cholesterol seeps into the walls
040910 - (lining) of arteries. LDL cholesterol calcium plaque gradually
040911 - increases to eventually create "strictures" that block blood flow in
040912 - the arteries, also called "hardening of the arteries," which causes
040913 - heart attack and stroke.
040915 - ..
040916 - The program presented medical opinion that most LDL cholesterol in the
040917 - blood is comprised of large partricles that do not build up plaque
040918 - that blocks arteries. Therefore blood tests that measure total LDL
040919 - cholesterol do not present a significant threat of blocking arteries,
040920 - and causing heart attack or stroke.
040922 - ..
040923 - This seems to correlate with research a few days ago saying measuring
040924 - LDL cholesterol is fraught with errors, reported on 111117 1415,
040925 - ref SDS 2 148O, and that errors are caused by ambiguity in the
040926 - definition of LDL cholesterol. ref SDS 2 IR6R
040927 -
040928 - [On 111128 0202 letter to medical team cites lab on 111117,
040929 - reporting LDL 200, ref SDS 3 EA4V; asks about increasing
040930 - medication to rosuvastatin 20 mg or trying some other line
040931 - of care to reduce cholesterol LDL < 70, ref SDS 3 EB3U,
040932 - according to the VA work plan on 110817 1030. ref SDS 1
040933 - DG36
040935 - ..
040936 - The CNN broadcast today proposed testing risk of blocked arteries by
040937 - measuring the amount of small LDL particles in the blood, rather than
040938 - total LDL.
040940 - ..
040941 - The broadcast recommends getting...
040942 -
040943 - coronary calcium scan, and...
040944 - ultrasound scan of neck for blockages to brain
040946 - ..
040947 - Doctor Esleson recommends following diet...
040948 -
040949 - avoid...
040950 -
040951 - meat
040952 - fish
040953 - chicken
040955 - ..
040956 - Eat...
040957 -
040958 - broccoli
040959 - asparagus
040960 -
040962 - ..
040963 - Research on the Internet shows...
040964 -
040965 - 1. Heart Health on MSNBC.Com
040966 - Men's Health
040967 -
040968 - Small LDL particles pose biggest risk
040969 - A low cholesterol reading may not mean youre in the clear
040970 -
040971 - http://www.msnbc.msn.com/id/35058886/ns/health-heart_health/t/small-ldl-particles-pose-biggest-risk/#.TtBxO2Flvtw
040973 - ..
040974 - By Laura Roberson
040975 - updated 2/14/2010 1:57:01 PM ET
040976 -
040977 - 1. Not all LDL cholesterol is created equal. Some particles of
040978 - this blood fat are large and buoyant and breeze easily through
040979 - your circulatory system. But other particles are small and
040980 - dense and four times as likely to cause heart disease. "In
040981 - order for cholesterol to cause disease, it has to embed in the
040982 - wall of the artery," says Paul Ziajka, M.D., Ph.D., a clinical
040983 - lipidologist with the Southeast Lipid Association. "And the
040984 - smaller the particle, the easier it can do that."
040986 - ..
040987 - 2. But before you swallow what your doctor prescribes, we suggest
040988 - you read this article .
040990 - ..
040991 - 3. That means even a low cholesterol reading may not be an
040992 - all-clear if you have predominantly small, dense LDL particles
040993 - known as pattern B. For a quick indication, have your doctor
040994 - check your triglycerides using a standard blood test. If your
040995 - reading is over 200, you're probably pattern B, says Dr.
040996 - Ziajka, which means you should lower your LDL cholesterol
040997 - target another 30 points. (Calculate your recommended baseline
040998 - LDL at
040999 -
041000 - http://aristos.com/ldl-target.php
041002 - ..
041003 - 4. But even a healthy triglyceride number isn't a free pass
041004 - exempting you from coronary artery disease. The blood tests
041005 - described below measure not only the amount of LDL coursing
041006 - through your veins, but also its average particle size. Have
041007 - your doc refer you to an area lab offering advanced
041008 - lipid-profile testing; the referral often means a cheaper
041009 - rate. And check out these seven ways to prevent heart disease.
041010 -
041011 - 1. LDL-S3 GGE test
041012 -
041013 - Proteins from your blood are spread across a gel palette.
041014 - As the molecules move from one end to the other, the gel
041015 - becomes progressively denser. Large particles of LDL
041016 - cholesterol can't travel as far as the small, dense
041017 - particles can, Dr. Ziajka says. After staining the gel,
041018 - scientists determine the average size of your LDL
041019 - cholesterol particles. (Berkeley HeartLab, bhlinc.com,
041020 - about $15 with insurance)
041022 - ..
041023 - 2. The VAP test
041024 -
041025 - Your sample is mixed into a solution designed to separate
041026 - lipoproteins by density. "The proteins in your blood have
041027 - to find their equilibrium," says Dr. Ziajka. "Small, dense
041028 - particles sink, and large, fluffy particles stay at the
041029 - top." The liquid is stained and then analyzed to reveal 21
041030 - different lipoprotein subfractions, including dominant LDL
041031 - size. (Atherotech, thevaptest.com, direct cost $40)
041033 - ..
041034 - 3. NMR lipoprofile test
041035 -
041036 - Inside a magnetic field, radio waves charge the lipids in
041037 - your blood. When the magnetic field is turned off, the
041038 - protons give off energy, and that energy can be captured.
041039 - Because energy emissions vary by particle size, this can
041040 - be used to determine the type of LDL coursing through your
041041 - veins. (LipoScience, lipoprofile.com, $100)
041042 -
041044 - ..
041045 - Another article says...
041046 -
041047 - 2. New York Times
041048 - Health Guide
041050 - ..
041051 - Hardening of the Arteries
041052 -
041053 - Review Date: 5/5/2011
041054 - Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate
041055 - Professor of Medicine, Harvard Medical School; Physician,
041056 - Massachusetts General Hospital. Also reviewed by David Zieve,
041057 - MD, MHA, Medical Director, A.D.A.M., Inc.
041058 -
041059 - 1. Hardening of the arteries, also called atherosclerosis, is
041060 - a common disorder. It occurs when fat, cholesterol, and
041061 - other substances build up in the walls of arteries and
041062 - form hard structures called plaques.
041064 - ..
041065 - 2. Over time, these plaques can block the arteries and cause
041066 - symptoms and problems throughout the body.
041068 - ..
041069 - 3. Causes
041071 - ..
041072 - Over the course of years and decades, plaque buildup
041073 - narrows your arteries and makes them stiffer. These
041074 - changes make it harder for blood to flow through them.
041076 - ..
041077 - 4. Clots may form in these narrowed arteries and block blood
041078 - flow. Pieces of plaque can also break off and move to
041079 - smaller blood vessels, blocking them.
041081 - ..
041082 - 5. Either way, the blockage starves tissues of blood and
041083 - oxygen, which can result in damage or tissue death
041084 - (necrosis).This is a common cause of heart attack and
041085 - stroke. If a clot moves into an artery in the lungs, it can
041086 - cause a pulmonary embolism.
041088 - ..
041089 - 6. In some cases, the plaque is part of a process that causes
041090 - a weakening of the wall of an artery. This can lead to an
041091 - aneurysm. Aneurysms can break open (rupture), and cause
041092 - bleeding that can be life threatening.
041094 - ..
041095 - 7. Hardening of the arteries is a process that often occurs
041096 - with aging. However, high blood cholesterol levels can
041097 - make this process happen at a younger age.
041099 - ..
041100 - 8. For most people, high cholesterol levels are the result of
041101 - an unhealthy lifestyle -- most commonly, eating a diet that
041102 - is high in fat. Other lifestyle factors are heavy alcohol
041103 - use, lack of exercise, and being overweight.
041105 - ..
041106 - 9. Other risk factors for hardening of the arteries are:
041107 -
041108 - a. diabetes
041109 - b. family history
041110 - c. high blood pressure
041111 - d. smoking
041113 - ..
041114 - 10. Symptoms
041115 -
041116 - Hardening of the arteries does not cause symptoms until
041117 - blood flow to part of the body becomes slowed or blocked.
041119 - ..
041120 - 11. If the arteries to the heart become narrow, blood flow to
041121 - the heart can slow down or stop. This can cause chest pain
041122 - (stable angina), shortness of breath, and other symptoms.
041124 - ..
041125 - 12. Narrowed or blocked arteries may also cause problems and
041126 - symptoms in your intestines, kidneys, legs, and brain.
041128 - ..
041129 - 13. In-Depth Symptoms
041130 -
041131 - Common symptoms of coronary artery disease (CAD) include
041132 - angina, shortness of breath (particularly during physical
041133 - exertion), and rapid heartbeat. Sometimes patients with
041134 - CAD have few or no symptoms until they have heart attack
041135 - or heart failure.
041137 - ..
041138 - 14. Angina
041139 -
041140 - Angina is a symptom, not a disease. It is the primary
041141 - symptom of coronary artery disease and, in severe cases,
041142 - of a heart attack. It is typically felt as chest pain and
041143 - occurs as a consequence of a condition called myocardial
041144 - ischemia. Ischemia results when the heart muscle does not
041145 - get as much blood (and, as a result, as much oxygen) as it
041146 - needs for a given level of work. Angina is usually
041147 - referred to as one of two states:
041148 -
041149 - a. Stable Angina (which is predictable)
041151 - ..
041152 - b. Unstable Angina (which is less predictable and a sign
041153 - of a more serious situation)
041155 - ..
041156 - 15. Angina may be experienced in different ways and can be
041157 - mild, moderate, or severe. The intensity of the pain does
041158 - not always relate to the severity of the medical problem.
041159 - Some people may feel a crushing pain from mild ischemia,
041160 - while others might feel only mild discomfort from severe
041161 - ischemia.
041163 - ..
041164 - 16. Stable Angina and Chest Pain
041166 - ..
041167 - Stable Angina. Stable angina is predictable chest pain.
041168 - Although less serious than unstable angina, it can be
041169 - extremely painful or uncomfortable. It is usually relieved
041170 - by rest and responds well to medical treatment (typically
041171 - nitroglycerin). Any event that increases oxygen demand can
041172 - cause an angina attack. Some typical triggers include:
041173 -
041174 - a. Exercise
041175 - b. Cold weather
041176 - c. Emotional tension
041177 - d. Large meals
041179 - ..
041180 - 17. Angina attacks can happen at any time during the day, but
041181 - most occur between 6 a.m. and noon.
041183 - ..
041184 - 18. Specific symptoms that are more likely to indicate angina
041185 - include:
041186 -
041187 - a. Angina pain or discomfort is typically described by
041188 - patients as fullness or tingling, squeezing, pressure,
041189 - heavy, suffocating, or griplike. It is rarely
041190 - described as stabbing or burning. Changing one's
041191 - position or breathing in and out does not affect the
041192 - pain.
041194 - ..
041195 - b. A typical angina attack lasts minutes. If it is more
041196 - fleeting or lasts for hours, it is probably not angina.
041198 - ..
041199 - c. Pain is usually in the chest under the breast bone. It
041200 - often radiates to the neck, jaw, or left shoulder and
041201 - arm. Less commonly, patients report symptoms that
041202 - radiate to the right arm or back, or even to the upper
041203 - abdomen.
041205 - ..
041206 - d. Stable angina is usually relieved by rest or by taking
041207 - nitroglycerin under the tongue.
041209 - ..
041210 - 19. Other symptoms that may indicate angina or accompany the
041211 - pain or pressure in the chest include:
041213 - ..
041214 - e. Shortness of breath
041216 - ..
041217 - f. Nausea, vomiting, and cold sweats
041219 - ..
041220 - g. A feeling of indigestion or heartburn
041222 - ..
041223 - h. Unexplained fatigue after activity (more common in
041224 - women)
041226 - ..
041227 - i. Dizziness or lightheadedness
041229 - ..
041230 - j. Palpitations
041232 - ..
041233 - 20. Unstable Angina and Acute Coronary Syndrome
041234 -
041235 - Unstable angina is a much more serious situation and is
041236 - often an intermediate stage between stable angina and a
041237 - heart attack, in which an artery leading to the heart (a
041238 - coronary artery) becomes completely blocked. A patient is
041239 - usually diagnosed with unstable angina under one or more of
041240 - the following conditions:
041242 - ..
041243 - a. Pain awakens a patient or occurs during rest.
041245 - ..
041246 - b. A patient who has never experienced angina has severe or
041247 - moderate pain during mild exertion (walking two level
041248 - blocks or climbing one flight of stairs).
041250 - ..
041251 - c. Stable angina has progressed in severity and frequency
041252 - within a 2-month period, and medications are less effective
041253 - in relieving its pain.
041255 - ..
041256 - d. Fainting episode.
041258 - ..
041259 - 21. Unstable angina is usually discussed as part of a condition Unstable angina is usually discussed as part of a condition called acute coronary syndrome (ACS). ACS also includes people with a condition called NSTEMI (non ST-segment elevation myocardial infarction) -- also referred to as non-
041260 - treatment. called acute coronary syndrome (ACS). ACS also
041261 - includes people with a condition called NSTEMI (non
041262 - ST-segment elevation myocardial infarction) -- also
041263 - referred to as non-Q wave heart attack. With NSTEMI, blood
041264 - tests suggest a developing heart attack. These conditions
041265 - are less severe than heart attacks but may develop into
041266 - full-blown attacks without aggressive treatment.
041268 - ..
041269 - 22. Other Types of Angina
041270 -
041271 - Prinzmetal's Angina.
041273 - ..
041274 - A third type of angina, called variant or Prinzmetal's
041275 - angina, is caused by a spasm of a coronary artery. It
041276 - almost always occurs when the patient is at rest.
041277 - Irregular heartbeats are common, but the pain is generally
041278 - relieved immediately with standard treatment.
041280 - ..
041281 - 23. Silent Ischemia.
041282 -
041283 - Some people with severe coronary artery disease do not have
041284 - angina pain. This condition is known as silent ischemia,
041285 - which may occur when the brain abnormally processes heart
041286 - pain. This is a dangerous condition because patients have
041287 - no warning signs of heart disease. Some studies suggest
041288 - that people with silent ischemia have higher complication
041289 - and mortality rates than those with angina pain. (Angina
041290 - pain may actually protect the heart by conditioning it
041291 - before a heart attack.)
041293 - ..
041294 - 24. Other Causes of Chest Pain or Discomfort
041295 -
041296 - Chest pain is a very common symptom in the emergency room,
041297 - but heart problems account for only 10 - 33% of all
041298 - episodes. There are many other causes of chest pain or
041299 - discomfort including injured muscles, arthritis,
041300 - heartburn, and asthma.
041302 - ..
041303 - Background....
041304 -
041305 - http://health.nytimes.com/health/guides/disease/atherosclerosis/background.html
041307 - ..
041308 - Risk factors...
041309 -
041310 - http://health.nytimes.com/health/guides/disease/atherosclerosis/risk-factors.html
041312 - ..
041313 - Diagnosis
041314 -
041315 - http://health.nytimes.com/health/guides/disease/atherosclerosis/diagnosis.html
041317 - ..
041318 - Prevention
041319 -
041320 - http://health.nytimes.com/health/guides/disease/atherosclerosis/prevention.html
041322 - ..
041323 - Treatment
041324 -
041325 - http://health.nytimes.com/health/guides/disease/atherosclerosis/treatment.html
041327 - ..
041328 - Medications
041329 -
041330 - http://health.nytimes.com/health/guides/disease/atherosclerosis/medications.html
041332 - ..
041333 - Surgery
041334 -
041335 - http://health.nytimes.com/health/guides/disease/atherosclerosis/surgery.html
041336 -
041337 -
041338 -
041339 -
041340 -
041341 -
041342 -
0414 -