Re: Re: BMI and IHD

[Guest guest]

http://ije.oxfordjournals.org/cgi/content/abstract/35/1/141

"Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6–19%, 2P = 0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. "

But the real question is why would we want to worry about < 20?

Regards

[ ] Re: BMI and IHD

Hi folks:What would be REALLY instructive (and perhaps very relevant for people on CRON?) about the subjects in this study would be to know what the CVD risk factor numbers look like for those who had a BMI below 21. Is their increased IHD risk reflected in higher numbers for things like BP; LDL; TG; etc.? Or do they still get more IHD despite having apparently good lipids numbers, as low-BMI people on CRON have?Rodney.

[Guest guest]

http://ije.oxfordjournals.org/cgi/content/abstract/35/1/141

"Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6–19%, 2P = 0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. "

But the real question is why would we want to worry about < 20?

Regards

[ ] Re: BMI and IHD

Hi folks:What would be REALLY instructive (and perhaps very relevant for people on CRON?) about the subjects in this study would be to know what the CVD risk factor numbers look like for those who had a BMI below 21. Is their increased IHD risk reflected in higher numbers for things like BP; LDL; TG; etc.? Or do they still get more IHD despite having apparently good lipids numbers, as low-BMI people on CRON have?Rodney.

[Guest guest]

I like the way these data are stated:http://content.nejm.org/cgi/content/full/338/1/1?ijkey=d89df84a7c6e7a65c722bccc127b8920c1e0cc30

The curves are instructive, however, I can't get that 0.5% (455 per 100,000) difference out of my head.

Regards.

Re: [ ] Re: BMI and IHD

http://ije.oxfordjournals.org/cgi/content/abstract/35/1/141

"Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6–19%, 2P = 0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. "

But the real question is why would we want to worry about < 20?

Regards

[Guest guest]

I like the way these data are stated:http://content.nejm.org/cgi/content/full/338/1/1?ijkey=d89df84a7c6e7a65c722bccc127b8920c1e0cc30

The curves are instructive, however, I can't get that 0.5% (455 per 100,000) difference out of my head.

Regards.

Re: [ ] Re: BMI and IHD

http://ije.oxfordjournals.org/cgi/content/abstract/35/1/141

"Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6–19%, 2P = 0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. "

But the real question is why would we want to worry about < 20?

Regards

[Guest guest]

Hi All,

From http://tinyurl.com/48x2u is:

" Potential mechanisms for excess risk at BMI < 20 kg/m2 ... The higher IHD

risk

associated with low BMI could represent a combination of various other factors.

For

example, a very low BMI in the absence of chronic illness may be a consequence

of

consuming a very restricted diet for a prolonged period of time, resulting not

only

in diminished fat stores but also in an inadequate supply of some important

cardioprotective nutrients. In Western populations, individuals with extremely

low

body weight (such as patients with anorexia nervosa and bulimia, or those

undergoing

strict diet restriction) are at increased risk of several cardiovascular

abnormalities, including reduction of ventricular mass, valvular dysfunction,36

electrocardiographic changes,37 and damage of the myocardial fibres.38 Some

chronic

infections may also contribute to the development of IHD,39–43 and individuals

with

extremely low body weight may have reduced immune function,44,45 which might

predispose them to increased risk of chronic infection. Moreover, severe loss of

adipose tissue and its triglyceride storage capacity (as in lipodystrophy) can

lead

to insulin resistance, diabetes, hyperlipidaemia and fatty liver, which have the

effects that are similar to some of those caused by obesity.46 Finally, in

Western

studies of acute MI, patients with very low BMI have worse survival in hospital

than

those with a higher BMI.47,48 If this was also the case in Chinese MI patients,

then

this might help explain the higher IHD mortality associated with very low BMI in

this prospective study.

Implications ... The present study involves large numbers of IHD deaths, so

its

findings are statistically reliable. The positive association between BMI and

IHD

death at BMI levels >20 kg/m2 can largely or wholly be explained by the

association

of BMI with blood pressure and, most probably, blood lipids. But, although the

association between BMI and blood pressure continues downwards at lower levels

of

BMI, the risk of IHD death does not continue down linearly—indeed, after

adjustment

for blood pressure, the risk is somewhat greater for those with BMI < 20 than

for

those with BMI = 20–21.9 kg/m2. Further epidemiological studies with collection

of

blood samples, perhaps using additional measures of adiposity (such as waist

circumference and bioelectrical impedance49–51), in low BMI populations may help

elucidate mechanisms by which extremely low BMI increases the risk of IHD at

given

levels of blood pressure and blood lipids.

The present findings among those with BMI levels >20 kg/m2 cannot be

translated

directly into public health conclusions about the relevance of elevated BMI to

overall mortality in China, as IHD accounted for only 6.5% of all the deaths in

this

study, and some non-IHD causes of death are inversely related to BMI. The BMI

values

associated with minimum overall mortality may vary from population to

population,

depending on the particular BMI distributions and the background rates of

mortality

from IHD and other diseases.52 "

--- Rodney <perspect1111@...> wrote:

> Hi JW:

>

> Because my impression is that there are quite a few CRONers whose

> BMIs are below 20. Especially over at 'the other place'.

>

> Also, because the very much better lipids values these people have

> may, possibly, be misleading them about their chances of suffering

> IHD, if that study is correct.

>

http://tinyurl.com/48x2u

> > But the real question is why would we want to worry about < 20?

-- Al Pater, PhD; email: old542000@...

__________________________________________________

[Guest guest]

Hi All,

From http://tinyurl.com/48x2u is:

" Potential mechanisms for excess risk at BMI < 20 kg/m2 ... The higher IHD

risk

associated with low BMI could represent a combination of various other factors.

For

example, a very low BMI in the absence of chronic illness may be a consequence

of

consuming a very restricted diet for a prolonged period of time, resulting not

only

in diminished fat stores but also in an inadequate supply of some important

cardioprotective nutrients. In Western populations, individuals with extremely

low

body weight (such as patients with anorexia nervosa and bulimia, or those

undergoing

strict diet restriction) are at increased risk of several cardiovascular

abnormalities, including reduction of ventricular mass, valvular dysfunction,36

electrocardiographic changes,37 and damage of the myocardial fibres.38 Some

chronic

infections may also contribute to the development of IHD,39–43 and individuals

with

extremely low body weight may have reduced immune function,44,45 which might

predispose them to increased risk of chronic infection. Moreover, severe loss of

adipose tissue and its triglyceride storage capacity (as in lipodystrophy) can

lead

to insulin resistance, diabetes, hyperlipidaemia and fatty liver, which have the

effects that are similar to some of those caused by obesity.46 Finally, in

Western

studies of acute MI, patients with very low BMI have worse survival in hospital

than

those with a higher BMI.47,48 If this was also the case in Chinese MI patients,

then

this might help explain the higher IHD mortality associated with very low BMI in

this prospective study.

Implications ... The present study involves large numbers of IHD deaths, so

its

findings are statistically reliable. The positive association between BMI and

IHD

death at BMI levels >20 kg/m2 can largely or wholly be explained by the

association

of BMI with blood pressure and, most probably, blood lipids. But, although the

association between BMI and blood pressure continues downwards at lower levels

of

BMI, the risk of IHD death does not continue down linearly—indeed, after

adjustment

for blood pressure, the risk is somewhat greater for those with BMI < 20 than

for

those with BMI = 20–21.9 kg/m2. Further epidemiological studies with collection

of

blood samples, perhaps using additional measures of adiposity (such as waist

circumference and bioelectrical impedance49–51), in low BMI populations may help

elucidate mechanisms by which extremely low BMI increases the risk of IHD at

given

levels of blood pressure and blood lipids.

The present findings among those with BMI levels >20 kg/m2 cannot be

translated

directly into public health conclusions about the relevance of elevated BMI to

overall mortality in China, as IHD accounted for only 6.5% of all the deaths in

this

study, and some non-IHD causes of death are inversely related to BMI. The BMI

values

associated with minimum overall mortality may vary from population to

population,

depending on the particular BMI distributions and the background rates of

mortality

from IHD and other diseases.52 "

--- Rodney <perspect1111@...> wrote:

> Hi JW:

>

> Because my impression is that there are quite a few CRONers whose

> BMIs are below 20. Especially over at 'the other place'.

>

> Also, because the very much better lipids values these people have

> may, possibly, be misleading them about their chances of suffering

> IHD, if that study is correct.

>

http://tinyurl.com/48x2u

> > But the real question is why would we want to worry about < 20?

-- Al Pater, PhD; email: old542000@...

__________________________________________________

[Guest guest]

Remember, there are overweight people without HTN, with normal lipids and no type two. A high BMI doesn't "require" bad blood test data.

That's what left out of the data.

With all the bad SAD, the U. S. population is living longer.

Do we have to get to ANY BMI to live longer on CR?

Surely, we could generalize that anyone of any weight will live longer if they merely eat the least calories?

Regards.

[ ] Re: BMI and IHD> > > Hi folks:> > What would be REALLY instructive (and perhaps very relevant for > people on CRON?) about the subjects in this study would be to know > what the CVD risk factor numbers look like for those who had a BMI > below 21. Is their increased IHD risk reflected in higher numbers > for things like BP; LDL; TG; etc.? Or do they still get more IHD > despite having apparently good lipids numbers, as low-BMI people on > CRON have?> > Rodney.>

[Guest guest]

Remember, there are overweight people without HTN, with normal lipids and no type two. A high BMI doesn't "require" bad blood test data.

That's what left out of the data.

With all the bad SAD, the U. S. population is living longer.

Do we have to get to ANY BMI to live longer on CR?

Surely, we could generalize that anyone of any weight will live longer if they merely eat the least calories?

Regards.

[ ] Re: BMI and IHD> > > Hi folks:> > What would be REALLY instructive (and perhaps very relevant for > people on CRON?) about the subjects in this study would be to know > what the CVD risk factor numbers look like for those who had a BMI > below 21. Is their increased IHD risk reflected in higher numbers > for things like BP; LDL; TG; etc.? Or do they still get more IHD > despite having apparently good lipids numbers, as low-BMI people on > CRON have?> > Rodney.>

[Guest guest]

I must point out it's similar to the risk at 25 to 26.9.

Regards.

[ ] Re: BMI and IHD

Okay, there's a little bit of risk unexpected risk-- 1.15. Hardly astronomical, and even when including blood pressure it doubles the risk to what, 1.3? This is a single study, after all.IMO, there are dozens of stronger reasons, many of which we have exhaustively examined here, to maintain a BMI no lower than 19 or 20.Mike"...the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2.

[Guest guest]

I must point out it's similar to the risk at 25 to 26.9.

Regards.

[ ] Re: BMI and IHD

Okay, there's a little bit of risk unexpected risk-- 1.15. Hardly astronomical, and even when including blood pressure it doubles the risk to what, 1.3? This is a single study, after all.IMO, there are dozens of stronger reasons, many of which we have exhaustively examined here, to maintain a BMI no lower than 19 or 20.Mike"...the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20–21.9, 18–19.9, and <18 kg/m2.

[Guest guest]

At 02:40 PM 4/26/2006, you wrote:

>Hi Mike:

>

>There are a couple of things that are interesting about this.

>

>First, lipids seem to drop with BMI, but if IHD doesn't also then it

>shows a divergence in the relationship between the two, which is

>odd. Why on earth would people with even lower BMIs/lipids get more

>ISCHEMIC heart disease? One could understand other types of heart

>problems, perhaps. But more ischemic seems really weird to me. Do

>the arteries start clogging up again as BMI drops?

>

>Second, didn't the PROCAM study show no elevation of risk at the very

>lowest LDL levels? EXCEPT AMONG SMOKERS, many of whom may be quite

>slim? Perhaps that is the confounder here? Perhaps the overall risk

>at lower BMIs is accounted for purely by the smokers?

My mom was as thin as a rail: she died suddenly when she was

sitting on the toilet all alone in her house at the age of 52. Everybody

assumed it was some kind of cardiovascular problem, but there was no

autopsy and we really don't know.

My dad died seven years earlier in an accident and my mom never

really recovered. One of my mom's friends moved in to live with her for a

year or so soon after my dad died. Her friend had a job working for a

tobacco company: she'd go around to convenience stores and put up

promotional signs. It seems like Sue got my mom into smoking -- she hid it

from all of us, but we found a pack of cigs in a kitchen cabinet after she

died. She also quit taking her blood pressure medicine (Beta

blockers) My mom was a definite 'type A' person with insecure

attachment... Her mom died of cancer when she was 2 years old and she

spent a couple of years in an orphanage.

[Guest guest]

At 02:40 PM 4/26/2006, you wrote:

>Hi Mike:

>

>There are a couple of things that are interesting about this.

>

>First, lipids seem to drop with BMI, but if IHD doesn't also then it

>shows a divergence in the relationship between the two, which is

>odd. Why on earth would people with even lower BMIs/lipids get more

>ISCHEMIC heart disease? One could understand other types of heart

>problems, perhaps. But more ischemic seems really weird to me. Do

>the arteries start clogging up again as BMI drops?

>

>Second, didn't the PROCAM study show no elevation of risk at the very

>lowest LDL levels? EXCEPT AMONG SMOKERS, many of whom may be quite

>slim? Perhaps that is the confounder here? Perhaps the overall risk

>at lower BMIs is accounted for purely by the smokers?

My mom was as thin as a rail: she died suddenly when she was

sitting on the toilet all alone in her house at the age of 52. Everybody

assumed it was some kind of cardiovascular problem, but there was no

autopsy and we really don't know.

My dad died seven years earlier in an accident and my mom never

really recovered. One of my mom's friends moved in to live with her for a

year or so soon after my dad died. Her friend had a job working for a

tobacco company: she'd go around to convenience stores and put up

promotional signs. It seems like Sue got my mom into smoking -- she hid it

from all of us, but we found a pack of cigs in a kitchen cabinet after she

died. She also quit taking her blood pressure medicine (Beta

blockers) My mom was a definite 'type A' person with insecure

attachment... Her mom died of cancer when she was 2 years old and she

spent a couple of years in an orphanage.

[Guest guest]

Sudden cardiac death is not unusual, and I'm not entirely sure we know how to protect against it.

Regards.

Re: [ ] Re: BMI and IHD

My mom was as thin as a rail: she died suddenly when she was sitting on the toilet all alone in her house at the age of 52. Everybody assumed it was some kind of cardiovascular problem, but there was no autopsy and we really don't know. My dad died seven years earlier in an accident and my mom never really recovered. One of my mom's friends moved in to live with her for a year or so soon after my dad died. Her friend had a job working for a tobacco company: she'd go around to convenience stores and put up promotional signs. It seems like Sue got my mom into smoking -- she hid it from all of us, but we found a pack of cigs in a kitchen cabinet after she died. She also quit taking her blood pressure medicine (Beta blockers) My mom was a definite 'type A' person with insecure attachment... Her mom died of cancer when she was 2 years old and she spent a couple of years in an orphanage.

[Guest guest]

Sudden cardiac death is not unusual, and I'm not entirely sure we know how to protect against it.

Regards.

Re: [ ] Re: BMI and IHD

My mom was as thin as a rail: she died suddenly when she was sitting on the toilet all alone in her house at the age of 52. Everybody assumed it was some kind of cardiovascular problem, but there was no autopsy and we really don't know. My dad died seven years earlier in an accident and my mom never really recovered. One of my mom's friends moved in to live with her for a year or so soon after my dad died. Her friend had a job working for a tobacco company: she'd go around to convenience stores and put up promotional signs. It seems like Sue got my mom into smoking -- she hid it from all of us, but we found a pack of cigs in a kitchen cabinet after she died. She also quit taking her blood pressure medicine (Beta blockers) My mom was a definite 'type A' person with insecure attachment... Her mom died of cancer when she was 2 years old and she spent a couple of years in an orphanage.

[Guest guest]

I recall for some of the CRed rats at autopsy, the cause of death not determined.

You don't have to smoke, or be old, or sedentary, or obese.

http://www.findarticles.com/p/articles/mi_m0NHG/is_2_17/ai_n6210223

"Of the one million Americans who develop coronary artery disease (CAD) each year, between 25 and 50% will suffer sudden cardiac death (SCD). Frustratingly, the majority of these CAD cases are asymptomatic. Indeed, the Framingham study data show that, for some 60% of men and 45% of women, the first symptom of CAD is either SCD or myocardial infarction (MI). ...

To be sure, sudden death from cardiac causes occurs with unusually high frequency during or shortly after vigorous physical exertion. "

Maybe better testing?

Regards.

Re: [ ] Re: BMI and IHD> > > > My mom was as thin as a rail: she died suddenly when she was > sitting on the toilet all alone in her house at the age of 52. Everybody > assumed it was some kind of cardiovascular problem, but there was no > autopsy and we really don't know.> > My dad died seven years earlier in an accident and my mom never > really recovered. One of my mom's friends moved in to live with her for a > year or so soon after my dad died. Her friend had a job working for a > tobacco company: she'd go around to convenience stores and put up > promotional signs. It seems like Sue got my mom into smoking -- she hid it > from all of us, but we found a pack of cigs in a kitchen cabinet after she > died. She also quit taking her blood pressure medicine (Beta > blockers) My mom was a definite 'type A' person with insecure > attachment... Her mom died of cancer when she was 2 years old and she > spent a couple of years in an orphanage.>

[Guest guest]

I recall for some of the CRed rats at autopsy, the cause of death not determined.

You don't have to smoke, or be old, or sedentary, or obese.

http://www.findarticles.com/p/articles/mi_m0NHG/is_2_17/ai_n6210223

"Of the one million Americans who develop coronary artery disease (CAD) each year, between 25 and 50% will suffer sudden cardiac death (SCD). Frustratingly, the majority of these CAD cases are asymptomatic. Indeed, the Framingham study data show that, for some 60% of men and 45% of women, the first symptom of CAD is either SCD or myocardial infarction (MI). ...

To be sure, sudden death from cardiac causes occurs with unusually high frequency during or shortly after vigorous physical exertion. "

Maybe better testing?

Regards.

Re: [ ] Re: BMI and IHD> > > > My mom was as thin as a rail: she died suddenly when she was > sitting on the toilet all alone in her house at the age of 52. Everybody > assumed it was some kind of cardiovascular problem, but there was no > autopsy and we really don't know.> > My dad died seven years earlier in an accident and my mom never > really recovered. One of my mom's friends moved in to live with her for a > year or so soon after my dad died. Her friend had a job working for a > tobacco company: she'd go around to convenience stores and put up > promotional signs. It seems like Sue got my mom into smoking -- she hid it > from all of us, but we found a pack of cigs in a kitchen cabinet after she > died. She also quit taking her blood pressure medicine (Beta > blockers) My mom was a definite 'type A' person with insecure > attachment... Her mom died of cancer when she was 2 years old and she > spent a couple of years in an orphanage.>

[Guest guest]

Hi Rodney. Fwiw, fish oil has been purported to reduce risk of sudden

cardiac death by reducing incidence of heart tissue conduction defects,

IIRC. I don't recall if or not the conduction defect episodes are most

likely to occur during vigorous exercise, but it does seem that would be the

most dangerous time for them to occur, the most likely time to result in

death.

Al

> Yes. Certainly better testing would be a very good idea. We know

> what kind of tests will reveal those most likely to suffer from the

> occluded-artery, plaque-rupture, type of heart disease. But what

> sort of test will yield a number that represents the probability an

> individual will have an electrically-precipitated heart stoppage and

> drop dead in the street?

>

> If there is such a test I will go and have it done tomorrow, if not

> this afternoon. Are we to suppose that Dr. Smaha, a cardiologist and

> one-time president of the American Heart Association, never bothered

> to have such a test done on himself? Or is there no such test? Or

> did it not reveal Dr. Smaha's problem?

>

> If I were to come out positive on such a test then for sure I would

> avoid vigorous exercise like the plague (or perhaps I should say the

> Avian Flu?). If this kind of problem truly accounts for half the

> sudden deaths from heart disease, as is claimed, then that represents

> a huge proportion of the population that should be going nowhere near

> vigorous exercise. I wonder if Smaha would have died of this problem

> if he didn't exercise.

>

> Questions, questions, and not enough answers!

>

> Rodney.

>

>

>> >

>> > Sudden cardiac death is not unusual, and I'm not entirely sure

> we

>> know how to protect against it.

>> >

>> > Regards.

>> >

>> > Re: [ ] Re: BMI and IHD

>> >

>> >

>> >

>> > My mom was as thin as a rail: she died suddenly

> when

>> she was

>> > sitting on the toilet all alone in her house at the age of

> 52.

>> Everybody

>> > assumed it was some kind of cardiovascular problem, but

> there

>> was no

>> > autopsy and we really don't know.

>> >

>> > My dad died seven years earlier in an accident and

> my

>> mom never

>> > really recovered. One of my mom's friends moved in to live

> with

>> her for a

>> > year or so soon after my dad died. Her friend had a job

> working

>> for a

>> > tobacco company: she'd go around to convenience stores and

> put

>> up

>> > promotional signs. It seems like Sue got my mom into

> smoking --

>> she hid it

>> > from all of us, but we found a pack of cigs in a kitchen

> cabinet

>> after she

>> > died. She also quit taking her blood pressure medicine

> (Beta

>> > blockers) My mom was a definite 'type A' person with

> insecure

>> > attachment... Her mom died of cancer when she was 2 years

> old

>> and she

>> > spent a couple of years in an orphanage.

>> >

>>

>>

>>

>>

>>

>>

>>

>> --------------------------------------------------------------------

> ----------

>> ! GROUPS LINKS

>>

>> a.. Visit your group " " on the web.

>>

>> b..

[Guest guest]

Hi Rodney. Fwiw, fish oil has been purported to reduce risk of sudden

cardiac death by reducing incidence of heart tissue conduction defects,

IIRC. I don't recall if or not the conduction defect episodes are most

likely to occur during vigorous exercise, but it does seem that would be the

most dangerous time for them to occur, the most likely time to result in

death.

Al

> Yes. Certainly better testing would be a very good idea. We know

> what kind of tests will reveal those most likely to suffer from the

> occluded-artery, plaque-rupture, type of heart disease. But what

> sort of test will yield a number that represents the probability an

> individual will have an electrically-precipitated heart stoppage and

> drop dead in the street?

>

> If there is such a test I will go and have it done tomorrow, if not

> this afternoon. Are we to suppose that Dr. Smaha, a cardiologist and

> one-time president of the American Heart Association, never bothered

> to have such a test done on himself? Or is there no such test? Or

> did it not reveal Dr. Smaha's problem?

>

> If I were to come out positive on such a test then for sure I would

> avoid vigorous exercise like the plague (or perhaps I should say the

> Avian Flu?). If this kind of problem truly accounts for half the

> sudden deaths from heart disease, as is claimed, then that represents

> a huge proportion of the population that should be going nowhere near

> vigorous exercise. I wonder if Smaha would have died of this problem

> if he didn't exercise.

>

> Questions, questions, and not enough answers!

>

> Rodney.

>

>

>> >

>> > Sudden cardiac death is not unusual, and I'm not entirely sure

> we

>> know how to protect against it.

>> >

>> > Regards.

>> >

>> > Re: [ ] Re: BMI and IHD

>> >

>> >

>> >

>> > My mom was as thin as a rail: she died suddenly

> when

>> she was

>> > sitting on the toilet all alone in her house at the age of

> 52.

>> Everybody

>> > assumed it was some kind of cardiovascular problem, but

> there

>> was no

>> > autopsy and we really don't know.

>> >

>> > My dad died seven years earlier in an accident and

> my

>> mom never

>> > really recovered. One of my mom's friends moved in to live

> with

>> her for a

>> > year or so soon after my dad died. Her friend had a job

> working

>> for a

>> > tobacco company: she'd go around to convenience stores and

> put

>> up

>> > promotional signs. It seems like Sue got my mom into

> smoking --

>> she hid it

>> > from all of us, but we found a pack of cigs in a kitchen

> cabinet

>> after she

>> > died. She also quit taking her blood pressure medicine

> (Beta

>> > blockers) My mom was a definite 'type A' person with

> insecure

>> > attachment... Her mom died of cancer when she was 2 years

> old

>> and she

>> > spent a couple of years in an orphanage.

>> >

>>

>>

>>

>>

>>

>>

>>

>> --------------------------------------------------------------------

> ----------

>> ! GROUPS LINKS

>>

>> a.. Visit your group " " on the web.

>>

>> b..

[Guest guest]

I appreciate your anxiety, Rodney, and as JW implies, it's been with us for

some time and is pretty common. The archtypical example is the late (very

late) runner Jim Fixx that died in (I think) the 70s. He was a well-educated

runner and fitness guru that was in tremendous shape, ~late 30s early 40s.

He simply dropped dead during a routine training run.

I join you in desiring a far more complete clinical picture of what happened

to Dr Smaha. But then I'm always frustrated by the lack of clinical detail

that attends news accounts of people's illnesses/deaths.

Al

> Thanks, I had forgotten about the fish oil >>> SCD connection.

>

> In the very recent discussions about Dr. Smaha I have seen it

> mentioned more than once that SCD most often occurs during, or

> immediately following (as in Dr. Smaha's case), vigorous exercise.

> It has been a major revelation to me that this is such an apparently

> huge cause of death in 'supposedly healthy' people.

>

> And I am far from confident in my knowledge about how to avoid it.

>

> Rodney.

>

>

>> >> >

>> >> > Sudden cardiac death is not unusual, and I'm not entirely

> sure

>> > we

>> >> know how to protect against it.

>> >> >

>> >> > Regards.

>> >> >

>> >> > Re: [ ] Re: BMI and IHD

>> >> >

>> >> >

>> >> >

>> >> > My mom was as thin as a rail: she died suddenly

>> > when

>> >> she was

>> >> > sitting on the toilet all alone in her house at the age of

>> > 52.

>> >> Everybody

>> >> > assumed it was some kind of cardiovascular problem, but

>> > there

>> >> was no

>> >> > autopsy and we really don't know.

>> >> >

>> >> > My dad died seven years earlier in an accident and

>> > my

>> >> mom never

>> >> > really recovered. One of my mom's friends moved in to live

>> > with

>> >> her for a

>> >> > year or so soon after my dad died. Her friend had a job

>> > working

>> >> for a

>> >> > tobacco company: she'd go around to convenience stores and

>> > put

>> >> up

>> >> > promotional signs. It seems like Sue got my mom into

>> > smoking --

>> >> she hid it

>> >> > from all of us, but we found a pack of cigs in a kitchen

>> > cabinet

>> >> after she

>> >> > died. She also quit taking her blood pressure medicine

>> > (Beta

>> >> > blockers) My mom was a definite 'type A' person with

>> > insecure

>> >> > attachment... Her mom died of cancer when she was 2 years

>> > old

>> >> and she

>> >> > spent a couple of years in an orphanage.

>> >> >

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >> -----------------------------------------------------------------

> ---

>> > ----------

>> >> ! GROUPS LINKS

>> >>

>> >> a.. Visit your group " " on the web.

>> >>

>> >> b..

[Guest guest]

I appreciate your anxiety, Rodney, and as JW implies, it's been with us for

some time and is pretty common. The archtypical example is the late (very

late) runner Jim Fixx that died in (I think) the 70s. He was a well-educated

runner and fitness guru that was in tremendous shape, ~late 30s early 40s.

He simply dropped dead during a routine training run.

I join you in desiring a far more complete clinical picture of what happened

to Dr Smaha. But then I'm always frustrated by the lack of clinical detail

that attends news accounts of people's illnesses/deaths.

Al

> Thanks, I had forgotten about the fish oil >>> SCD connection.

>

> In the very recent discussions about Dr. Smaha I have seen it

> mentioned more than once that SCD most often occurs during, or

> immediately following (as in Dr. Smaha's case), vigorous exercise.

> It has been a major revelation to me that this is such an apparently

> huge cause of death in 'supposedly healthy' people.

>

> And I am far from confident in my knowledge about how to avoid it.

>

> Rodney.

>

>

>> >> >

>> >> > Sudden cardiac death is not unusual, and I'm not entirely

> sure

>> > we

>> >> know how to protect against it.

>> >> >

>> >> > Regards.

>> >> >

>> >> > Re: [ ] Re: BMI and IHD

>> >> >

>> >> >

>> >> >

>> >> > My mom was as thin as a rail: she died suddenly

>> > when

>> >> she was

>> >> > sitting on the toilet all alone in her house at the age of

>> > 52.

>> >> Everybody

>> >> > assumed it was some kind of cardiovascular problem, but

>> > there

>> >> was no

>> >> > autopsy and we really don't know.

>> >> >

>> >> > My dad died seven years earlier in an accident and

>> > my

>> >> mom never

>> >> > really recovered. One of my mom's friends moved in to live

>> > with

>> >> her for a

>> >> > year or so soon after my dad died. Her friend had a job

>> > working

>> >> for a

>> >> > tobacco company: she'd go around to convenience stores and

>> > put

>> >> up

>> >> > promotional signs. It seems like Sue got my mom into

>> > smoking --

>> >> she hid it

>> >> > from all of us, but we found a pack of cigs in a kitchen

>> > cabinet

>> >> after she

>> >> > died. She also quit taking her blood pressure medicine

>> > (Beta

>> >> > blockers) My mom was a definite 'type A' person with

>> > insecure

>> >> > attachment... Her mom died of cancer when she was 2 years

>> > old

>> >> and she

>> >> > spent a couple of years in an orphanage.

>> >> >

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >> -----------------------------------------------------------------

> ---

>> > ----------

>> >> ! GROUPS LINKS

>> >>

>> >> a.. Visit your group " " on the web.

>> >>

>> >> b..

[Guest guest]

You sold me, Mike. Thanks for the ref.

The next question is what do I tell the dr in order to justify the test?

Especially after we've done the cath.

It always comes down to the practical alternatives.

Regards.

[ ] Re: BMI and IHD

Absolutely, we need better biomarkers and better testing. There are a group of cardiologist who are enthusiasts of PET (positive electron tomography) for cardiac imaging. Key among them is K. Lance Gould. Check out his most recent pub at:PMID: 16391188Recently, so-called 64-slice (better resolution) PET has been introduced and the adherents of this technique seen even more exicited:Check here:PMID: 16636804If you come down to Gould's lab in Houston next week, be sure to say hello.I agree, it is amazing that Smaha, a cardiologist preaching and practicing (?)the "lifestyle." should drop in this fashion, but it does happen.Ironically, the article sent along by JW, i.e.:http://www.findarticles.com/p/articles/mi_m0NHG/is_2_17/ai_n6210223contained the story of another cardiologist, a Dr. Nequin:Nequin, the "aura of invincibility" that too often surrounds athletes is a source of great frustration and needs immediate debunking.He should know. In 1982, Nequin completed the first 50 miles of the Western States 100 without symptoms. The next month, he completed the entire 100 miles. Again, he showed no symptoms. The following month, a stress test showed marked ischemia--"only when my heart rate was 150 beats per minute [bpm] and higher"--but still, no chest pain. An angiogram revealed that his proximal right coronary artery had a 90% blockage, which was later found with PTCA (PET) scanning to be in actuality 99% blocked. Nequin concludes, "The ability to do hard work, run a marathon, et cetera, does not guarantee the coronary arteries are clean. People run with silent ischemia all the time."Notice, they did the scanning after! his ischemic espisode.As I see it, then, there are two issues. 1. It's possible to have extensive blockage (90-90%), and still exercise. 2. People with lower levels of blockage, say (20-60%) may still be at risk if the mechanism of failure, as some now believe, is more than just the narrowing of arteries; it involves the breakaway of soft athersclerotic material, and as result the formation of myocardial-causing clotFinally, I'm neither a patient of, nor shill for, Dr. Gould, but he has written a very interesting book, "Heal Your Heart":http://tinyurl.com/l9q6kHis prescription is Ornish-like, and he loves statins. He also loves PET as a diagnostic and clinical tool and makes, seemingly, some very credible arguments against the value of arteriography (cardiac catherization)Mike

[Guest guest]

You sold me, Mike. Thanks for the ref.

The next question is what do I tell the dr in order to justify the test?

Especially after we've done the cath.

It always comes down to the practical alternatives.

Regards.

[ ] Re: BMI and IHD

Absolutely, we need better biomarkers and better testing. There are a group of cardiologist who are enthusiasts of PET (positive electron tomography) for cardiac imaging. Key among them is K. Lance Gould. Check out his most recent pub at:PMID: 16391188Recently, so-called 64-slice (better resolution) PET has been introduced and the adherents of this technique seen even more exicited:Check here:PMID: 16636804If you come down to Gould's lab in Houston next week, be sure to say hello.I agree, it is amazing that Smaha, a cardiologist preaching and practicing (?)the "lifestyle." should drop in this fashion, but it does happen.Ironically, the article sent along by JW, i.e.:http://www.findarticles.com/p/articles/mi_m0NHG/is_2_17/ai_n6210223contained the story of another cardiologist, a Dr. Nequin:Nequin, the "aura of invincibility" that too often surrounds athletes is a source of great frustration and needs immediate debunking.He should know. In 1982, Nequin completed the first 50 miles of the Western States 100 without symptoms. The next month, he completed the entire 100 miles. Again, he showed no symptoms. The following month, a stress test showed marked ischemia--"only when my heart rate was 150 beats per minute [bpm] and higher"--but still, no chest pain. An angiogram revealed that his proximal right coronary artery had a 90% blockage, which was later found with PTCA (PET) scanning to be in actuality 99% blocked. Nequin concludes, "The ability to do hard work, run a marathon, et cetera, does not guarantee the coronary arteries are clean. People run with silent ischemia all the time."Notice, they did the scanning after! his ischemic espisode.As I see it, then, there are two issues. 1. It's possible to have extensive blockage (90-90%), and still exercise. 2. People with lower levels of blockage, say (20-60%) may still be at risk if the mechanism of failure, as some now believe, is more than just the narrowing of arteries; it involves the breakaway of soft athersclerotic material, and as result the formation of myocardial-causing clotFinally, I'm neither a patient of, nor shill for, Dr. Gould, but he has written a very interesting book, "Heal Your Heart":http://tinyurl.com/l9q6kHis prescription is Ornish-like, and he loves statins. He also loves PET as a diagnostic and clinical tool and makes, seemingly, some very credible arguments against the value of arteriography (cardiac catherization)Mike

[Guest guest]

I've had 2 catheterizations, one in 1986, another in 2002, both were "clear".

Here, if that weren't the case, the dr would have done a stent or something, (while the patient is prepped). The second one they woke me up to show me the display which was a computer diagram which told me naught. The first was an actual x-ray type screen.

My 82 yo bro has CHF, which I take to be fat in the cells or small capillaries, that can't be fixed anyway. The electrical problem in his case is skipped beats (erratic heart beat).

I can understand not giving an expensive test to everyone, but I also think I can err on the side of moderation and not take up running, eg.

Obviously something causes my HTN, which is why I keep trying to learn as much as possible. But I don't think I have athero, at least it's not obvious in my legs or circ.

If they can get a test down to say 100$, they might sell enough of them to justify the cost (without a prescription) and the patient could pay for it.

Reading list is a great idea, thanks.

Regards.

[ ] Re: BMI and IHD

>> You sold me, Mike. Thanks for the ref.> The next question is what do I tell the dr in order to justify the test?> Especially after we've done the cath.> It always comes down to the practical alternatives.> > Regards.Have you actually had a cath? According to Gould (there I go again), "...coronary arteriograms may appear normal in the presence of diffuse atherosclerosis without significant segmental narrowing. This unidentified diffuse disease may result in plaque rupture and heart attack despite the normal-appearing coronary arteriograms." Incidentally, I was at www.alibris.com(my favorie used book site) and noticed used copies of Gould's book are $2.95. Plus postage, of course.The problem with getting a PET scanning is that insurance companies may balk. The gold standard may be dross , but it's still the gold standard. PET is expensive. I don't now if this new 64-slice machine is any cheaper but the images it produces are fantastic and seem to unambiguosly show CAD. Check out some of them here:http://images.google.com/images?q=64+slice & hl=en & btnG=Search+ImagesHere's a suggestion. This is an interesting topic for many of us, but maybe not to others. How about if we agree on a reading list and really delve into the topic offline? This would include material on, say, the value a carotid artery sonogram, as a predictor of CAD, and thus, IHD and SCD. I agree with Rodney's points in an earler post. It seems astonishing that as a nation, we haven't pursued CHD diagnostics more vigorously, especially given the huge costs we incur due to IHD. As usual, we are left to fend for ourselves. Mike

[Guest guest]

I've had 2 catheterizations, one in 1986, another in 2002, both were "clear".

Here, if that weren't the case, the dr would have done a stent or something, (while the patient is prepped). The second one they woke me up to show me the display which was a computer diagram which told me naught. The first was an actual x-ray type screen.

My 82 yo bro has CHF, which I take to be fat in the cells or small capillaries, that can't be fixed anyway. The electrical problem in his case is skipped beats (erratic heart beat).

I can understand not giving an expensive test to everyone, but I also think I can err on the side of moderation and not take up running, eg.

Obviously something causes my HTN, which is why I keep trying to learn as much as possible. But I don't think I have athero, at least it's not obvious in my legs or circ.

If they can get a test down to say 100$, they might sell enough of them to justify the cost (without a prescription) and the patient could pay for it.

Reading list is a great idea, thanks.

Regards.

[ ] Re: BMI and IHD

>> You sold me, Mike. Thanks for the ref.> The next question is what do I tell the dr in order to justify the test?> Especially after we've done the cath.> It always comes down to the practical alternatives.> > Regards.Have you actually had a cath? According to Gould (there I go again), "...coronary arteriograms may appear normal in the presence of diffuse atherosclerosis without significant segmental narrowing. This unidentified diffuse disease may result in plaque rupture and heart attack despite the normal-appearing coronary arteriograms." Incidentally, I was at www.alibris.com(my favorie used book site) and noticed used copies of Gould's book are $2.95. Plus postage, of course.The problem with getting a PET scanning is that insurance companies may balk. The gold standard may be dross , but it's still the gold standard. PET is expensive. I don't now if this new 64-slice machine is any cheaper but the images it produces are fantastic and seem to unambiguosly show CAD. Check out some of them here:http://images.google.com/images?q=64+slice & hl=en & btnG=Search+ImagesHere's a suggestion. This is an interesting topic for many of us, but maybe not to others. How about if we agree on a reading list and really delve into the topic offline? This would include material on, say, the value a carotid artery sonogram, as a predictor of CAD, and thus, IHD and SCD. I agree with Rodney's points in an earler post. It seems astonishing that as a nation, we haven't pursued CHD diagnostics more vigorously, especially given the huge costs we incur due to IHD. As usual, we are left to fend for ourselves. Mike

[Guest guest]

>PLEASE don't go away from here to have your discussions. I read you

all every day and while I don't understand much of what you are

talking about and or don't have that item as a concern, I would miss

something I'm sure if you talk elsewhere...sincerely,

>

>

>---- Original Message ----

>From: jwwright@...

>

>Subject: Re: [ ] Re: BMI and IHD

>Date: Fri, 28 Apr 2006 15:46:01 -0500

>

>>I've had 2 catheterizations, one in 1986, another in 2002, both were

> " clear " .

>>Here, if that weren't the case, the dr would have done a stent or

>something, (while the patient is prepped). The second one they woke

>me up to show me the display which was a computer diagram which told

>me naught. The first was an actual x-ray type screen.

>>

>>My 82 yo bro has CHF, which I take to be fat in the cells or small

>capillaries, that can't be fixed anyway. The electrical problem in

>his case is skipped beats (erratic heart beat).

>>

>>I can understand not giving an expensive test to everyone, but I

>also think I can err on the side of moderation and not take up

>running, eg.

>>

>>Obviously something causes my HTN, which is why I keep trying to

>learn as much as possible. But I don't think I have athero, at least

>it's not obvious in my legs or circ.

>>

>>If they can get a test down to say 100$, they might sell enough of

>them to justify the cost (without a prescription) and the patient

>could pay for it.

>>

>>Reading list is a great idea, thanks.

>>

>>Regards.

>>

>> [ ] Re: BMI and IHD

>>

>>

>> --- In , " jwwright " <jwwright@...>

>wrote:

>> >

>> > You sold me, Mike. Thanks for the ref.

>> > The next question is what do I tell the dr in order to justify

>the

>> test?

>> > Especially after we've done the cath.

>> > It always comes down to the practical alternatives.

>> >

>> > Regards.

>>

>> Have you actually had a cath? According to Gould (there I go

>> again), " ...coronary arteriograms may appear normal in the

>presence of

>> diffuse atherosclerosis without significant segmental narrowing.

>This

>> unidentified diffuse disease may result in plaque rupture and

>heart

>> attack despite the normal-appearing coronary arteriograms. "

>>

>> Incidentally, I was at www.alibris.com(my favorie used book site)

>and

>> noticed used copies of Gould's book are $2.95. Plus postage, of

>course.

>>

>> The problem with getting a PET scanning is that insurance

>companies

>> may balk. The gold standard may be dross , but it's still the

>gold

>> standard. PET is expensive. I don't now if this new 64-slice

>machine

>> is any cheaper but the images it produces are fantastic and seem

>to

>> unambiguosly show CAD. Check out some of them here:

>>

>>

>http://images.google.com/images?q=64+slice & hl=en & btnG=Search+Images

>>

>> Here's a suggestion. This is an interesting topic for many of us,

>but

>> maybe not to others. How about if we agree on a reading list and

>> really delve into the topic offline? This would include material

>on,

>> say, the value a carotid artery sonogram, as a predictor of CAD,

>and

>> thus, IHD and SCD.

>>

>> I agree with Rodney's points in an earler post. It seems

>astonishing

>> that as a nation, we haven't pursued CHD diagnostics more

>vigorously,

>> especially given the huge costs we incur due to IHD. As usual, we

>are

>> left to fend for ourselves.

>>

>> Mike

>>