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.

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