X-Message-Number: 17879
Date: Fri, 9 Nov 2001 18:53:27 EST
Subject: Heart attack; and what you can do about it


Several people have written about heart attack risk and the unpredictability 
of the disease. It is true that even people with no family risk and optimum 
HDL/LDL (cholesterol) levels can and do have lethal heart attacks. Why? The 
short answer is that we don't know. It has been demonstrated that the 
following previously under-appreciated factors may be culprits, but no 
definitive studies exist:

* Particulate pollution inhalation. This is the kind of pollution generated 
by rubber tires on road surfaces, diesel engines, smokestacks, pine trees, 
and many other sources. India has experienced an explosion of heart disease 
and one reason may be its unbelievably bad particulate pollution. LA and 
Phoenix are examples of two US hotspots.

* Infection with Epstein-Barr virus (EBV) and/or cytomegalavirus (CMV). CMV 
in particular has been found in atherosclerotic plaque and has been suggested 
as culprit in atypical heart disease since DeBakey first publicized it over a 
decade ago. 

* Infection with Chlamydia. This VD is asymptomatic in a large number of 
males infected with it, perhaps as many as 60%. It was thought to be confined 
to the reproductive system but recent research has shown it in the brain, and 
in atheromas on vessels of patients with atherosclerosis. Chlamydia is 
incredibly common and even one stray encounter can cause infection.

*High homocysteine levels which may be influenced by dietary inadequacy (lack 
of adequate folate and other B-vitamins). 

* Higher average blood sugars due to overfeeding which our heart disease free 
relatives didn't have the luxury of. Fat and complex carbohydrate consumption 
are the worse causes of this increase in average blood sugar and concomitant 
increase in obesity and high blood insulin levels (unlike rice, potatoes are 
very good at causing a hyperglycemic spike). 

In part we are becoming more sensitive to these causes because we are 
decreasing the main cause of mortality; hypercholestremia largely through 
nutrition, and drugs like the statins. As the big causes disappear the 
smaller ones show up more and come to the attention of treating physicians 
and researchers alike.


There are lots of things that can be done to address the specific risks 
above, and this is the kind of article I used to love to write for CRYONICS 
magazine (or solicit to be written) when I was editing it. The reason is that 
it can save and improve the quality of a lot of lives right now, and that's 
gratifying and gives cryonicists some of the value of what they are paying 
for today, as opposed to 100 years from now.

Alas, I haven't the space here, so I'll give just one really good piece of 
advice, one I gave over 12 years ago in CRYONICS when the technology first 
became available at a few centers:


This technology has recently become widely available and is being heavily 
advertised on television. It has been marketed by General Electric and is 
called Electron Beam CT or EBCT for short. It allows for incredibly precise 
and fine resolution scans of moving objects such as the heart. It can detect 
heart disease when vessel occlusion is only 15% to 25% complete. That's as 
compared to 60% to 70% occlusion by treadmill or other non-invasive 
techniques. The cost is about $500 and you do not need a prescription from 
your doctor. You just make an appointment at an imaging center near you and 
pay your money. (Insurance won't cover it.)

Whole body scans are also available and I highly recommend one starting at 
age 40 (for a baseline) and then again at 45 (if clean at 40) and every 2 
years after 45 till age 55. After that, I recommend yearly scans if you can 
afford them. These cost about $1,000, but cost is likely to come down. These 
also are not covered by insurance.

The scans are painless, done in an "open coil" (so claustrophobia is not an 
issue) and you do not even have to remove your street clothes; you just lay 
down and get passed through the machine. 

You just have to have the money. I am at high risk (family history) for heart 
disease but can't afford at EBCT. For those of you who can, I recommend it 
strongly. I can't think of how many people I've seen die from cancer who 
would have been saved by this technique, let alone heart disease.


With every powerful new diagnostic tool comes the problem of information 
misuse. This happened terribly when continuous EKG monitoring became 
available. Physicians found a large subgroup of people with heart rhythm 
irregularities which, when seen in the ICU or acutely after heart attack, 
were very ominous. Drug companies then generated a whole class of drugs to 
treat these irregularities in otherwise asymptomatic people. The result was 
tens of thousands of deaths from the drugs; deaths in excess of any deaths 
from the heart irregularities. 

The point here is that EBCT is likely to show a lot of "abnormalities" that 
are benign but will not be appreciated as such until physicians get a lot of 
experience and realize how common they were all along and how to deal with 
them. Fortunately, this is not the case with heart disease and most cancers. 
If these things show up on EBCT you need treatment quickly. If it indicates 
the presence of heart disease, the existing approaches are pretty sound. So, 
if they say you need a cardiac catheterization to refine the diagnosis it is 
probably the right thing to do next.

With possible malignancies the smart thing would probably be to have PET-CT 
scan done; especially if the suspected growth is in your brain or a deep 
organ (liver, kidney). These scans show the metabolism of the tumor and if it 
is significantly higher than normal it is almost certainly cancer.

EBCT coupled with PET-CT offers the possibility of curing many, many cases of 
cancer that would otherwise be hopeless. Why? Because tumors as small as a 
few millimeters could be detected. Almost all cases of pancreatic cancer 
could be cured in this way and probably many cases of lung, lymphatic and 
colon cancer.

The only trouble is paying for it. 

As I predicted here the Abiocor total artificial heat is surpassing every 
public and most medical expectations. Robert Toole (the first patient) is on 
TV frequently ambling about with a machine pumping his blood for over 130 
days now. Easily 50,000 lives could be vastly prolonged with good quality if 
this heart comes into wide use. But again, the issue is who will pay for it? 
That is increasingly going to be the question in healthcare and the answers 
are not encouraging.

Mike Darwin

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