Heart Attack

From Out of Nowhere, a Heart Attack at Age 56

My husband, Jim, suffered an unexpected heart attack last week. I am writing this blog to detail and chronical what happened. Here is this blog's home page and navigation guide. Except for this post, which will remain at the top of this blog, the posts are in reverse chronological order-so the most recent posts are at the top, immediately below this post. Most of this blog's readers will want to navigate around here using the categories which are listed in the far right column, and also on this blog's home page. Jim's heart attack occured on January 8, 2008. I started this blog the same month. You can find the first posts of this blog, including the telling of how the heart attack happened, on the January 2008 archive page here. The following month, February 2008, posts are here - these posts include a post describing the follow-up visit with our primary care physician.

It is our hope that the information here helps others.

vadkins

Excellent Heart Attack Prevention Book

My husband and I started reading Hidden Causes of Heart Attack and Stroke, Inflammation, Cardiology's New Frontier, a book by Christian Wilde, and we highly recommend it. Since my husband's heart attack on January 8, 2008, we have been confounded as to why it happened. Jim's cholesterol at the time of the heart attack was 169, and he has never smoked or drunk alcohol. He was not, and is not, diabetic. He did have a waist measurement, at that time, of 42" and he was 35 pounds overweight. Regardless, our primary care physician was shocked that Jim had had a heart attack.

Reading through t his book by Christian Wilde is answering a lot of our questions as to why Jim had the heart attack. We haven't yet finished reading the book, but from what we have read, it appears that there are many hidden risk factors for heart attack that we did not know about. And it looks like what modern medicine has decided are healthy upper limits for cholesterol, triglycerides, etc. are actually too high. For example, I learned from reading this book that physicians very often consider an overall cholesterol level of 200-220 healthy. But the upper limit for overall cholesterol should probably be more like 150-160. According to the Framingham study, that's cited in this book, of people with cholesterol levels under 150-NONE of these people suffered any heart attacks or cardiac episodes over many years! And this is only a sample of what we are learning by reading this book.

I will be charting/analyzing my husband's medical tests in the next week or two. I will then post those results.

vadkins

Heart Attack: Trans Fats, the Dirty Little Secret

This post expands on my previous post which summarized the advice that a dietician gave us during one of my husband's cardiac rehab sessions.

During my husband's recovery from a heart attack in January, one of the facts that was repeatedly pounded into our heads by the cardiology staff at the Boston Medical Center, was that trans fats are really really bad for us. Eating trans fats is like injecting plaque plugs directly into our arteries. I've often wondered since then, why the medical staff made such a point of it though, because I have yet to find one food for sale that lists any trans fat content.

Well the dietician told us that a food manufacturer can put trans fats in a food product, but not be required to list it in the nutritional labeling. If a food has less than .5 grams in a serving, then that item does not have to be listed on the nutritional labeling list. That means that a food can contain .4 grams of trans fats, can say on the label Trans Fats: 0.

The rub in this is that, according to the dietician, people should not consume more than 2 grams of trans fats per day. The limit is so low because it is so dangerous for us. So, if we eat 6 servings a day of foods that each contain .4 grams of trans fats, then we are exceeding the amount of trans fats that we can safely ingest.

So the dietician recommends that we do what she does: always read the list of ingredients in a food. If the list contains anything that says "hydrogenated", don't eat it.

Here's what the FDA has on their web site about trans fats:

Q: Is it possible for a food product to list the amount of trans fat as 0 g on the Nutrition Facts panel if the ingredient list indicates that it contains "partially hydrogenated vegetable oil?"

A: Yes. Food manufacturers are allowed to list amounts of trans fat with less than 0.5 gram (1/2 g) as 0 (zero) on the Nutrition Facts panel. As a result, consumers may see a few products that list 0 gram trans fat on the label, while the ingredient list will have "shortening" or "partially hydrogenated vegetable oil" on it. This means the food contains very small amounts (less than 0.5 g) of trans fat per serving.

vadkins

Heart Attack: Dietician's Recommendation

My husband has been in cardiac rehabilitation for about 7 weeks now. He goes to cardiac rehab to exercise 3 mornings a week. During one of his rehab sessions, a dietician came by to answer questions about how they, cardiac patients, should be eating. The foods that cardiac patients eat is vitally important to survival after a heart attack, because heart disease is a life style disease.

Here is summary of what we were told by the dietician:

• Can HDL (the good cholesterol) levels be raised by diet alone?

No. The only way to raise HDL levels is by regular, aerobic exercise.

• It is best to eat all kinds of heart healthy foods. Eat the fruits and vegetables that are in season.
• How much salt can a heart attack survivor eat daily, if they do not have high blood pressure?

  If a heart attack survivor does not have high blood pressure, then they can consume up to 4000 mg/day. Heart attack survivors who do have high blood pressure issues need to limit their salt/sodium consumption to 2400 mg/day.

• Trans fats are really bad for us-don't eat them.

We learned that it's very easy to be eating trans fats and not know it, because of the FDA's labeling regulations. I've expanded on this in this post.

vadkins

Heart Attack: Blood Pressure Still Normal

Last month, my husband who is a heart attack survivor, had a few dizzy spells one evening. We went to the Emergency Room to make sure that he wasn't having a stroke or another heart attack. He was kept in the hospital for about 12 hours so they could measure his blood troponin levels, and make sure that he hadn't had another heart attack. The blood tests confirmed that he had not had another heart attack, and that they did not find anything to explain the dizziness. I mentioned that all of the prescription medicines he is taking list dizziness as a side effect, and that his blood pressure had been running pretty low-around 110/60.

Jim has never had high blood pressure, but after the heart attack he had been given Lisinopril to take every day for high blood pressure. It's standard medical precedure to prescribe blood pressure medicine to patients after a heart attack. So I asked the cardiologist if Jim could take less Lisinopril or stop taking it all together. The cardiologist agreed, and told Jim to stop taking Lisinopril.

That was about a month ago, and happily Jim's blood pressure remains normal or below normal-and he's not taking any blood pressure medication.

vadkins

Heart Attack - Benign Dizziness and a Short Detour to the Hospital

On Wednesday evening my husband, Jim, had a few dizzy spells beginning at about 10:15 PM. He had about 4 dizzy spells that lasted only about 30 seconds each. The spells were about 10 minutes apart. One time he got dizzy when he stood up from a chair. During the other dizzy spells he was sitting in the living room and using his laptop computer.

This was the first time that Jim has felt dizzy since his heart attack on January 8, 2008. We had no idea why this was happening. He called his cardiologist's office and the doctor who was on-call for his cardiologist said that the dizziness might be caused by one of the heart medications that he is taking. Jim's pulse was running between 55 and 85 that evening, which is normal for him. His blood pressure was the usual 100/60. That's what his blood pressure has been running since the heart attack when he was put on a 5 mg dose of Lisinopril to lower his blood pressure. (Before the heart attack Jim's blood pressure had been running about 120/80, so high blood pressure has not really been one of his problems.) The doctor said that the dizziness could be caused by his medications. That was probably the case since his pulse was normal and steady. He said that a low pulse was about 40 bpm. The doctor told Jim that he could go to the Emergency Room and have his heart checked, but that it probably wasn't necessary, and that he should call his cardiologist the next day. If Jim felt anymore dizziness that night, he should go to the ER.

About an hour later, Jim felt dizzy again for about 30 seconds. At that point we decided that he'd better go to the ER to get checked out. The hospital is only about 5 miles from our house, so we drove there.

Within only about 30 minutes after arriving, Jim had been admitted and was in an examining room. The hospital had none of Jim's medical records since his heart attack occurred while he was traveling on business in Massachusetts, and he was treated at Boston Medical Center. So we verbally gave the ER doctor Jim's heart attack history and how that had been treated. The doctor ordered blood work for Jim, a chest x-ray and an EKG. All were normal. But the doctor told us that he would probably admit Jim so that they could measure the troponin levels in his blood for the next 12 to 18 hours. (Troponin is an enzyme in the blood that, if elevated, indicates that the patient has had heart damage, usually from a heart attack.)

After about 2 hours in the ER, one of our primary care physician's partners came by to examine Jim. He was especially checking to see if Jim had any signs of having had a mini-stroke. Thankfully, Jim did not. And Jim had not had any more dizzy spells in about 4 hours.

At 4 AM I went home, confident that Jim was really OK and in very good hands. By about 1 PM the next afternoon, all of Jim's blood tests had normal troponin levels, so he had not had another heart attack. Jim's cardiologist came by and said that all of Jim's tests were fine. He said that the dizziness could have been caused by the blood pressure lowering medicine, Lisinopril. He told Jim to stop taking that medication, and to keep an eye on his blood pressure. If Jim's blood pressure rises above 120/80, then he should call his cardiologist.

Today was Jim's first day since the heart attack when he did not take the Lisinopril. Tonight his blood pressure is 115/65, so it is a little higher than it had been when he was taking Lisinopril. But Jim has had no more dizziness either.

vadkins

Heart Attack - Cardiologist Appointment

Last week Jim had his second appointment with his cardiologist since his heart attack on 1/8/2008. The appointment began, as most doctor appointments do, with the nurse checking his weight, blood pressure, pulse and a review of the medicines Jim is now taking.

The cardiologist came in to the examining room after only about a 5 minute wait. He spent about 15 minutes with us. After he listened to Jim's heart, he reviewed the blood test results. Jim's test results showed that Jim has a low relative risk for a future cardiovascular event. This is measured as the C-Reactive Cardiac Protein. Jim's result for this is 0.18 (less than 1.00 is low, 1.00-3.00 is average, greater than 3.00 is high). The A1C lab test (see the Heart Attack: Tests and Diagnosis category of this blog for a definition) for diabetes, which was ordered by our primary care physician, shows that Jim is not diabetic (good news!). The A1C result is 5.5 (normal range is 4.8-5.9). The lipoprotein result is 3 mg/dL (desirable range is less than 20, borderline high risk is 20-30, high risk is 31-50 and very high risk is more than 50; values greater than 30 may indicate independent risk factor for CHD (coronary heart disease)).

So far, so good-all of the blood test results are excellent and in normal range. But Jim's homocysteine (plasma homocysteine, P) result is 18.9 umol/L. This is high as the normal range is 0.0-15.0. The cardiologist tells us that, fortunately, it's not difficult to lower the homocysteine level. It's treated with over-the-counter vitamin supplements. Jim needs to take a vitamin supplement each day. The supplement must contain 1 mg of folic acid plus vitamin B6 and vitamin B12. The doctor told us that eating a handful of almonds and 2 tablespoons of olive oil per day will help to decrease the homocysteine level.

Then the cardiologist reviewed the lipid panel test results that our primary care physician had reviewed with us a few weeks ago. The test shows an overall cholesterol level of 96 mg/dL (100-199 is the normal range), triglycerides level of 109 mg/dL (1-149 is the normal range), HDL cholesterol level is 27 mg/dL (40-59 is the normal range), VLDL cholesterol cal level of  22 mg/dL (5-40 is the normal range), LDL cholesterol calc level is 47 mg/dL (1-99 is the normal range, for cardiac patients this needs to be under 70), and the LDL/HDL ratio is 1.7 (ratio units is 0.0-3.6). Here's a summary post of the daily medication regime.

The cardiologist says that Jim's HDL cholesterol level is very low (27) and it needs to be above 40! To do that, he changed Jim's medications. He told us to cut the dosage of Crestor (a cholesterol lowering, statin drug) in half (or to 20 mg/day), and that Jim needs to begin taking Niaspan 500 mg, once a day in the evening. Niaspan is difficult for many people to take because it, not infrequently, causes flushing. The nurse told Jim to take his daily aspirin 1/2 hour before taking Niaspan. And he is to eat applesauce just before taking the Niaspan pill. The pectin in the applesauce helps to reduce or prevent completely the flushing. And the doctor will be doubling the Niaspan dosage after 30 days.

The cardiologist and the professionals at the cardiac rehab center tell us that Jim's very low HDL cholesterol level may well be caused by heredity. The doctor says that vitamin B3 can help raise the HDL level.

vadkins

Heart Attack - Cardiologist Prescription to Raise HDL Cholesterol

One of the most important action items from my husband's cardiologist appointment last week, was to follow the doctor's prescriptions for getting Jim's HDL levels up. Here's what cardiologist says to do to get the HDL cholesterol level increased:

• Decrease the Crestor (cholesterol reduction medicine) dosage in half, to 20 mg
• Take 400 mg daily of Niaspan. Niaspan is said to be very effective in raising HDL cholesterol levels. But many people have had problems taking Niaspan because it often causes flushing. The doctor's nurse told Jim that he should take the Niaspan at night, and with applesauce. She said that something about the pectin in the applesauce helps prevent the flushing. And it's very important that Jim take his daily aspirin 1/2 hour before he takes the Niaspan. Jim took the Niaspan as the nurse directed, and he has had no flushing at all-except for the one night that he decided to take Niaspan without eating the applesauce. Sure enough, a couple hours later he flushed-and he described the flushing as fairly obnoxious.

vadkins

Heart Attack - Cardiologist Changes Medication Regimen Again

Jim met with his cardiologist last week , and because of blood test results (the HDL cholesterol level is way too low and the homocysteine level is too high) the doctor changed some of Jim's medications. This is what Jim is now taking each day to treat the coronary heart disease:

Prescription medicines taken daily:

• Niaspan 500 mg (to increase to 1000 mg after 30 days)
• Crestor 20 mg
• Coreg 10 mg
• Lisinopril 5 mg
• Plavix 75 mg

Over-the-counter medicines/supplements taken daily as advised by cardiologist

• Aspirin 325 mg
• Co (enzyme) Q-10 150 mg
• Vital Remedy MD's Daily Multiple Dietary Supplement (3 pills/day); Jim takes this especially for the folic acid and vitamins B3/B6/B12 (to lower his homocysteine level and raise his HDL cholesterol blood levels)

Jim's previous medication regimens are posted here and here.

vadkins

Heart Attack - The Excess Weight Must Come Off

At the time of my husband's heart attack on January 8, 2008, he weighed 225 pounds. Jim is 6'2" tall and now 57 years old. Last week his cardiologist said that he needs to weigh 190 pounds. But the doctor encouraged Jim to lower his weight to 170 pounds, which is what Jim weighted as a young man. 170-190 pounds is the healthy body weight range for a person of Jim's height, according to the BMI (Body Mass Index) calculation.

Jim has been making great progress with his weight loss by using the Weight Watchers point system to determine food portions, and the cardiac diet to determine what foods he eats. Along these lines, we find that the Heart Association cookbooks is tremendously helpful.

Here's how Jim's weight loss progress is going:

Week 1: 220 pounds
Week 2: 216.5 pounds
Week 3: 215.75 pounds
Week 4: 213.8 pounds
Week 5: 214 pounds
Week 6: 210.5 pounds
Week 7: 210.5 pounds
Week 8: 207.8 pounds
Week 9: 207.8 pounds
Week 10: 206.2 pounds
Week 11: 205.8 pounds
Week 12: 206.4 pounds
Week 13: 206.6 pounds
Week 14: 205.5 pounds

vadkins

Heart Attack - Homocysteine

My husband's cardiologist told Jim that his blood test showed that he has elevated levels of homocysteine in his blood. To lower the homocysteine to a healthy level, he told Jim to take 1 mg of folic acid daily along with vitamins B6 and B12. The American Heart Association website says that there is evidence that elevated levels of homocysteine in the blood may increase the risk of heart attack. But the website also says that no controlled study has yet been done on this. From that website:

Although evidence for the benefit of lowering homocysteine levels is lacking, patients at high risk should be strongly advised to be sure to get enough folic acid and vitamins B-6 and B-12 in their diet. They should eat fruits and green, leafy vegetables daily.

And what is homocysteine exactly?

Homocysteine is an amino acid in the blood. Too much of it is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (fatty deposits in peripheral arteries).

Evidence suggests that homocysteine may promote atherosclerosis (fatty deposits in blood vessels) by damaging the inner lining of arteries and promoting blood clots. However, a causal link hasn't been established.

vadkins

Heart Attack - Folic Acid and Vitamin B Complex

Jim's cardiologist told him that ingesting more folic acid would decrease the level of homocysteine in his blood. Last week the cardiologist ran a lipid panel blood test and the test result indicated that Jim's homocysteine level was high. There is evidence that a high homocysteine level may increase the risk of heart attack. So what is homocystiene:

Folic acid and folate are forms of the water-soluble vitamin B9. These occur naturally in food and can also be taken as supplements. Folate gets its name from the Latin word folium ("leaf").

The cardiologist also told Jim to take a vitamin B6 and B12 supplement to lower his homocysteine level:

Vitamin B6 is a water-soluble vitamin. Pyridoxal phosphate (PLP) is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation. PLP also is necessary for the enzymatic reaction governing the release of glucose from glycogen.

Vitamin B12 helps maintain healthy nerve cells and red blood cells. It is also needed to help make DNA, te genetic material in all cells. Vitamin B12 is also called cobalamin because it contains the metal cobalt. Vitamin B is bound to the protein in food. Hydrochloric acid in the stomach releases vitamin B12 from proteins in foods during digestion. Once released, vitamin B12 combines with a substance called intrinsic factor (IF). This complex can then be absorbed by the intestinal tract.

vadkins

Heart Attack - C-Reactive Cardiac Protein

There is evidence that inflammation is an important part of the atherosclerosis process:

C-reactive protein (CRP) is one of the acute phase proteins that increase during systemic inflammation. It’s been suggested that testing CRP levels in the blood may be an additional way to assess cardiovascular disease risk. A more sensitive CRP test, called a highly sensitive C-reactive protein (hs-CRP) assay, is available to determine heart disease risk.

My husband is a cardiac patient, and fortunately his CRP level is normal.

vadkins

Heart Attack - What Is VLDL Cholesterol

At the cardiologist appointment last week, the doctor reviewed my husband's blood test results with us. One of the factors tested was VLDL. But what is VLDL?

Very-low-density lipoprotein (VLDL) cholesterol is one of the three major types of blood cholesterol combined with protein. The other two are high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Each type contains a specific combination of cholesterol, protein and triglyceride, a blood fat. VLDL cholesterol contains the highest amount of triglyceride.

Like LDL cholesterol, VLDL cholesterol is considered "bad" cholesterol because elevated levels are associated with an increased risk of coronary artery disease. There is no simple, direct way to measure VLDL cholesterol. So it is usually calculated as a percentage of triglyceride levels.

Fortunately, Jim's VLDL level is normal.

vadkins

Heart Attack - What Is LDL/HDL Ratio?

The LDL/HDL ratio is a better indicator of the risk of having a heart attack than the total cholesterol level. What is the LDL/HDL ratio?

High density lipoprotein (or HDL for short) is also known as "good cholesterol." It picks up extra cholesterol in the blood and returns it to the liver. Low density lipoprotein (or LDL) is also known as "bad cholesterol". It is the main transporter of cholesterol in the body. But too much LDL over many years can result in atherosclerosis (the narrowing and hardening of arteries) and lead to heart disease or a heart attack.

The HDL/LDL ratio looks at the ratio of good cholesterol (HDL) to bad cholesterol (LDL). The ratio is determined by dividing the LDL cholesterol into the HDL cholesterol. For example, if a person has an HDL cholesterol of 50 mg/dL and an LDL cholesterol of 150 mg/dL, the HDL/LDL ratio would be 0.33. The goal is to keep the HDL/LDL ratio above 0.3, with the ideal HDL/LDL ratio being above 0.4.

My husband suffered a heart attack in January 2008. He is doing well and is under the care of an excellent cardiologist. According to his last blood test, his LDL/HDL ratio is normal, but his level of HDL is very low.

vadkins

Heart Attack - What Are Triglycerides?

From the American Heart Association website:

Triglycerides are the chemical form in which most fat exists in food as well as in the body. They're also present in blood plasma and, in association with cholesterol, form the plasma lipids.

Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates. Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals.

vadkins

Heart Attack - Olive Oil

Olive oil is good for heart health. My husband has been told this several times by a variety of health care professionals since his heart attack on January 8, 2008. But why is olive oil so good for the heart?

Virgin olive oil is made from the first pressing of olives and contains higher levels of a class of antioxidants known as polyphenols than more refined olive oils that come from later pressings.

Researchers say these polyphenols may provide another way to reduce the risk of heart disease in addition to the heart-healthy benefits attributed to the monounsaturated fatty acids found in olive oil.

Recent studies have suggested that the bulk of olive oil's heart-healthy benefits comes from good fatty acids (monounsaturated fatty acids), but researchers say polyphenols may also contribute to those benefits and further reduce the risk of heart disease.

vadkins

Heart Attack - Almonds

In addition to eating olive oil each day, my husband's cardiologist recommends eating almonds to reduce the risk of a heart attack. What is it about almonds that helps keep our hearts healthy?

Almonds contain significant stores of antioxidants (35% of the daily recommended value for vitamin E), as well as fiber, arginine—a protein that keeps arteries elastic—and phytochemicals known as plant sterols, which help lower harmful LDL cholesterol levels while maintaining beneficial HDL levels. A three-month study done at Loma Linda University and presented at the Experimental Biology 2000 conference found that when participants added just two ounces of almonds a day to their already low-saturated fat and cholesterol diet, their levels of harmful LDL cholesterol dropped even lower.

vadkins

Heart Attack - Lipoprotein

Lipoprotein is a cholesterol particle. Elevated levels of lipoprotein in the blood results in an increased risk of heart attack, and the lipoprotein level is not associated with a person's LDL level.

Lp(a) was first pinpointed in the blood some 40 years ago, but doctors don't normally screen for this lipoprotein because no standardized screening exists and because even when the Lp(a) is known, very little can now be done to modify it. Unlike other kinds of cholesterol, Lp(a) in the blood is 95 percent determined by genes, so drugs and changes in diet have little effect on it, Danesh said.

Lp(a)'s exact role in the blood also is unknown, Scanu said, although researchers do know it's a fat-carrying particle that includes a protein that mimics the body's natural clot-busting properties.

vadkins

Heart Attack - A1C Test

My husband suffered a heart attack at the age of 56 on January 8, 2008. He is doing well now, and is under the care of our excellent primary care and cardiac doctors. A few weeks ago, Jim reviewed the results of his blood tests with our primary care physician. She noted that his blood sugar level was 109, which is higher than the 100 target. She ordered a A1C test to check for pre-diabetes for Jim's next round of blood tests. But what is the A1C test?

The A1c test is used primarily to monitor the glucose control of diabetics over time. The goal of those with diabetes is to keep their blood glucose levels as close to normal as possible. This helps to minimize the complications caused by chronically elevated glucose levels, such as progressive damage to body organs like the kidneys, eyes, cardiovascular system, and nerves. The A1c test gives a picture of the average amount of glucose in the blood over the last few months. It can help a patient and his doctor know if the measures they are taking to control the patient’s diabetes are successful or need to be adjusted.

vadkins

Heart Risk Calculator

Your Heart Your Life has up a cool Heart Risk Calculator here. To use the calculator you'll need to fill in your age, gender, total cholesterol, HDL cholesterol, if you're a smoker and your systolic blood.

vadkins

Heart Attack: Study Shows How Diabetes Drives Atheroscerosis

This is a good post explaining how diabetes exacerbates atherosclerosis:

Not to hammer on the point too much, but excess body fat held over the years causes chronic inflammation, which enrages your immune system, which leads to atherosclerosis, which tends to kill you abruptly and without warning. All very avoidable. To make matters worse, excess fat - or rather all the food you ate in order to create the excess fat - creates a feedback mechanism that leads to insulin resistance and diabetes, and this makes the atherosclerosis-generation process run faster: "Experts once believed that atherosclerosis, or hardening of the arteries, developed when too much cholesterol clogged arteries with fatty deposits called plaques. When blood vessels became completely blocked, heart attacks and strokes occurred. Today most agree that the reaction of the body's immune system to fatty build-up, more than the build-up itself, creates heart attack risk. Immune cells traveling with the blood mistake fatty deposits for intruders, akin to bacteria, home in on them, and attack. This causes inflammation that makes plaques more likely to swell, rupture and cut off blood flow. ... In part because diabetes increases atherosclerosis-related inflammation, diabetic patients are twice as likely to have a heart attack or stroke. ... Inflammation is blood vessels is one of the main drivers of atherosclerosis, and diabetes makes it much worse."

Below the jump is the text from the original article.

vadkins

Heart Attack Recovery - Salt Intake Limits

Our primary care physician told us today that generally, my husband (a heart attack survivor), should not consume more than 2000 mg of sodium/day. Here's a web page stating that 1 teaspoon of salt contains 2000 mg of sodium:

Sodium levels in salt. The American Heart Association (AHA) recommends that healthy adults reduce their sodium intake to no more than 2,400 milligrams per day. This is about 1 and 1/4 teaspoon of sodium chloride (salt).

They further recommend that if you have heart failure, you reduce your sodium to 2000 mg. Some doctors advise PAH patients to follow the AHA guidelines. Listings of the sodium content of various foods and other guidelines can be found on the AHA’s website (www.americanheart.org).

1/4 teaspoon salt = 500 mg sodium
1/2 teaspoon salt = 1,000 mg sodium
3/4 teaspoon salt = 1,500 mg sodium
1 teaspoon salt = 2,000 mg sodium
1 tsp baking soda = 1,000 mg sodium

vadkins

The Cardiac-Diabetic Diet

Last week, my husband who is a cardiac patient, was told that he is pre-hyperglycemic (pre-diabetic). His glucose blood level is 109 and it should be below 99. So we must undergo another lifestyle/diet change. Jim has been following the cardiac diet. Now it looks like he'll do better with the cardiac-diabetes diet. Here's is the cardiac-diabetes diet that was given to us at the Boston Medical Center:

• The Cardiac-Diabetic Diet is a special diet designed for patients with a history of both heart disease and diabetes. This eating plan is designed to help patients manage their cholesterol, blood pressure and blood sugar. Abiding by the principles of the cardiac-diabetic diet will help in preventing further complications of heart disease and diabetes:

• What is a Cardiac-Diabetic Diet:
  -Low in total fat: limit oils, mayonnaise, salad dressing, margarine
  -Low in saturated fat: limit butter, lard, animal meat, coconut, cheese, ice cream
  -Low in trans fat: avoid packaged snack foods, chips, French fries, donuts
  -Low in sodium: avoid salt, pickles, ketchup, soy sauce, baking soda
  -Low in cholesterol: avoid whole milk, cream, egg yolk, organ meats
  -Low in concentrated sweets: avoid sugar, jelly, candy, syrup, marshmallow

You can still consume many of your favorite foods while following the cardiac-diabetic diet, but it is very important to pay attention to how much you are eating at each meal. Controlling portion sizes will help to limit your intake of fat, cholesterol, sodium and sugar. Following the Diabetic Food Guide Pyramid is an easy way to ensure you are eating a wide variety of food and getting all of the nutrients you need. Below you will find the number of servings you should consume daily from each group with examples of what constitutes a serving size.

Healthy cooking methods: grill, boil, steam, braise, broil, roast, microwave, bake

• What Counts as a Serving?
  Breads, grains & other starches (6-11 servings): 1 slice of bread, 1 oz. unsweetened ready-to-eat cereal, 1/2 cup rice, pasta, cooked cereal
  
  Vegetables (3-5 servings): 1 cup raw leafy vegetables, 1/2 cup other vegetables, cooked or raw, 3/4 cup low sodium vegetable juice
  
  Fruits (2-3 servings): 1 medium apple, orange, banana, pear, 1/2 cup chopped, cooked, canned fruit, 3/4 cup fruit juice
  
  Milk & Dairy (2-3 servings): 1 cup skim or 1% milk, 1 cup low-fat or fat-free, no sugar added yogurt, 1 1/2 oz. natural cheese, part skim milk, 2 oz. processed cheese, low sodium, part skim
  
  Meats & Meat Substitutes (2-3 servings): 2-3 oz. cooked lean meat, poultry or fish, 1/2 cup cooked dry beans, 1 egg counts as 1-oz. of lean mean, 2 tablespoons of peanut butter counts as 1-oz. lean meat, 1/3 cup of unsalted nuts counts as 1-oz. meat
  
  Fats, Oils, Sweets (Use Sparingly)

• Foods Allowed on the Cardiac-Diabetic Diet
  Meats: chicken (without skin, white meat), turkey (without skin, white meat), pork tenderloin or center chops (with visible fat trimmed off), ham (no cured or canned with salt added), duck & pheasant (without skin), venison, lamb (roast, chop, or let), beef (round, sirloin, flank steak, tenderloin, roast (rib, chuck, rump), steak (T-bone, porterhouse), ground round. Select choice grades only, with visible fat trimmed off.
  
  Meat Substitutes: egg whites, egg substitute (Egg Beaters, Scramblers), tofu (no added salt), fresh fish (no smoked or salted), canned tuna (canned in water and rinsed after opening, no salt added), fresh shellfish (**high in cholesterol...limit to less than 6 oz. per day), dry beans, lentils, legumes, canned beans, lentils, legumes (no salt added)
  
  Dairy: skim or 1% milk, low fat or nonfat, no sugar added yogurt, fat free cream cheese, low fat or 2% cheese, fat free sour cream, low fat cottage cheese
  
  Condiments & Seasonings: sugar free jelly or jam, Mrs. Dash, fresh & dried herbs, spices (avoid garlic salt & onion salts), sugar substitutes (Equal, Sweet 'n Low), pepper, hot sauce, Tabasco, lemon juice, light soy sauce
  
  Fruits: all fresh fruits, canned fruit in water or juice (no syrup), no sugar added dried fruits, 100% fruit juice (no sugar added)
  
  Vegetables: all fresh vegetables, canned vegetables with no added salt, all frozen vegetables (with no sauces or salt added), low sodium vegetable juice, low sodium salsa
  
  Grains, Cereals, Pastas: whole wheat breads, whole grains (wheat, bulgur, bran, corn, rye, etc.), basmati or long grain rice, whole grain crackers (unsalted tops), wheat pasta, whole grain oats, whole grain, high fiber cereals
  
  Fats: avocado, canola, olive, peanut oil, nuts (almonds, cashews, mixed, peanuts, pecans (unsalted, no salt added)), peanut butter, unsalted, light or fat free margarine

vadkins

Heart Attack - Follow Up Visit with Primary Care Physician

We met with our primary care physician today. For the most part we reviewed Jim's blood test results. The best news is that Jim's LDL (bad cholesterol) level has plunged to 44 from the 109 level that he had on the day of the heart attack. The concerning news is that Jim's HDL cholesterol (the good cholesterol) level is now 27. The HDL level needs to rise to above 40. I'm figuring that the reduction in both the HDL and LDL cholesterol levels is mostly due to Crestor, the cholesterol lowering medication that Jim takes daily. (Here is a post that lists the meds that Jim takes daily.)

Our doctor told us that exercise and eating the good Omega/fish oil fats and flax seeds will usually raise the HDL cholesterol level. She says that Jim can consume these fish oils in pill form - 1000 units/day.

The other surprising and concerning news is that Jim's Glucose fasting blood level is now 109 mg/dL. That is considered pre-hyperglycemic, or pre-diabetic, these days. The glucose blood level should be below 99. So Jim needs to eat lean proteins, and reduce his intake of grains and root plants (i.e. potatoes) - what grains he eats should be whole grain. (I will be posting more about the Cardiac-Diabetes Diet in the next few days.)

We asked the doctor about salt intake. She said that it really isn't possible to eat too little salt - that Jim shouldn't eat more than 2000 units of salt daily.

Our doctor suggested that Jim should reduce his weight to 200 pounds - Jim is 6' 2".

We also had a discussion of the heart attack and what prior indications there might have been that it could happen. On December 21, 2006, Jim had a CTA (cat scan angiogram) of his torso. We did this, just to check if there might be any sign of health problems. A radiologist read the CTA and the scan did show that the LAD (left anterior descending cardiac artery) demonstrates mild mixed plaque in its proximal portion resulting in 20-40% stenosis. The report continues, distal to this, there is a dominant diagonal branch which is patent. The circumflex exhibits approximately 20-40% stenosis in its proximal portion due to noncalcific plaque. Distal to this, there is an obtuse marginal which is patent. The coronary calcium score is 5 by the Agatston method and 10 by the volume method. Mild, nonhemodynamically significant coronary artery disease. (This scan did show that Jim's other 2 coronary arteries are not blocked, which is what the cardiologist saw during the catheterization.) We are encouraged by this finding because it sounds to us like there aren't likely any other plaque deposits in Jim's coronary arteries that can rupture and cause another heart attack. But we sure would like to know what caused the vulnerable plaque to rupture last month, that cause the heart attack.

We asked the doctor if Jim's having had a heart attack at the age of 56, meant that his siblings or adult children should make changes in their own medical care. She told us that family history is usually a medical wild card. Our adult children will probably benefit by improving their diet and living a better heart healthy lifestyle. She said that his siblings should consider discussing this with their doctors, and that their doctors could decide to put his siblings on a cholesterol lowering medicine.

Our doctor recommends that Jim continue walking every day. Jim will begin cardiac rehab in April, when he will be taught how to increase the intensity of his exercise regimen.

Read Jim's complete blood test results below the jump.

vadkins

Heart Attack: Suctioning the Clot Improves Chances for Good Recovery

My husband underwent an angioplasty the day after his heart attack in January. After the successful procedure, the cardiologist told us that he had been able to vacuum out the clot that had been blocking one of my husband's cardiac arteries. He said that it wasn't always possible to remove a clot, and that Jim was fortunate that in his case, it could be done. Here's an article describing a study that indicates that clot removal improves one's chances for a good recovery from a heart attack:

New research suggests that more people survive major heart attacks with fewer problems if doctors use a mini-vacuum to clear out an artery blockage instead of pushing it aside to restore blood flow.

vadkins