Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. --- In , " Rodney " <perspect1111@...> wrote: > > Hi folks: > > From Al's post, one of the studies examines the relationship between > BMI and ischemic heart disease among a chinese population. It found > a BMI of 20 was associated with the lowest rates of IHD, with > increasing rates both below and above these levels. It should be > noted that only 6.5% of all deaths in this group were from IHD - much > lower than in North America - so these results may, or may not, apply > to people in economically more advanced countries. > > October 2005. PMID: 16258057. > > Here is the abstract: > > " Body mass index and mortality from ischaemic heart disease in a lean > population: 10 year prospective study of 220 000 adult men. > > Zhengming Chen1,*, Gonghuan Yang2,3, Maigeng Zhou2, Margaret 1, > Alison Offer1, Jieming Ma2,3, Lijun Wang2,3, Hongchao Pan1, > Whitlock1, Rory 1, Shiru Niu2 and Peto1 > 1 Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), > Radcliffe Infirmary, University of Oxford, UK > 2 Disease Surveillance Points, Chinese Center for Disease Control, > Beijing, PRC > 3 Centre for Chronic Disease and Behaviour Risk Factors Surveillance, > Institute of Basic Medical Sciences, Chinese Academy of Medical > Sciences, Beijing, PRC > > * Corresponding author. Clinical Trial Service Unit & Epidemiological > Studies Unit, Doll Building, Old Road Campus, Roosevelt > Drive, Oxford OX3 7LF, UK. E-mail: zhengming.chen@... > > Background: Increased body mass index (BMI) is known to be related > to ischaemic heart disease (IHD) in populations where many are > overweight (BMI 25 kg/m2) or obese (BMI 30). Substantial > uncertainty remains, however, about the relationship between BMI and > IHD in populations with lower BMI levels. > > Methods: We examined the data from a population-based, prospective > cohort study of 222 000 Chinese men aged 40–79. Relative and absolute > risks of death from IHD by baseline BMI were calculated, standardized > for age, smoking, and other potential confounding factors. > > Results: The mean baseline BMI was 21.7 kg/m2, and 1942 IHD deaths > were recorded during 10 years of follow-up (6.5% of all such deaths). > Among men without prior vascular diseases at baseline, there was a J- > shaped association between BMI and IHD mortality. 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. > > Conclusions: Lower BMI is associated with lower IHD risk among > people in the so-called normal range of BMI values (20–25 kg/m2), but > below that range the association may well be reversed. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. --- In , " Rodney " <perspect1111@...> wrote: > > Hi folks: > > From Al's post, one of the studies examines the relationship between > BMI and ischemic heart disease among a chinese population. It found > a BMI of 20 was associated with the lowest rates of IHD, with > increasing rates both below and above these levels. It should be > noted that only 6.5% of all deaths in this group were from IHD - much > lower than in North America - so these results may, or may not, apply > to people in economically more advanced countries. > > October 2005. PMID: 16258057. > > Here is the abstract: > > " Body mass index and mortality from ischaemic heart disease in a lean > population: 10 year prospective study of 220 000 adult men. > > Zhengming Chen1,*, Gonghuan Yang2,3, Maigeng Zhou2, Margaret 1, > Alison Offer1, Jieming Ma2,3, Lijun Wang2,3, Hongchao Pan1, > Whitlock1, Rory 1, Shiru Niu2 and Peto1 > 1 Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), > Radcliffe Infirmary, University of Oxford, UK > 2 Disease Surveillance Points, Chinese Center for Disease Control, > Beijing, PRC > 3 Centre for Chronic Disease and Behaviour Risk Factors Surveillance, > Institute of Basic Medical Sciences, Chinese Academy of Medical > Sciences, Beijing, PRC > > * Corresponding author. Clinical Trial Service Unit & Epidemiological > Studies Unit, Doll Building, Old Road Campus, Roosevelt > Drive, Oxford OX3 7LF, UK. E-mail: zhengming.chen@... > > Background: Increased body mass index (BMI) is known to be related > to ischaemic heart disease (IHD) in populations where many are > overweight (BMI 25 kg/m2) or obese (BMI 30). Substantial > uncertainty remains, however, about the relationship between BMI and > IHD in populations with lower BMI levels. > > Methods: We examined the data from a population-based, prospective > cohort study of 222 000 Chinese men aged 40–79. Relative and absolute > risks of death from IHD by baseline BMI were calculated, standardized > for age, smoking, and other potential confounding factors. > > Results: The mean baseline BMI was 21.7 kg/m2, and 1942 IHD deaths > were recorded during 10 years of follow-up (6.5% of all such deaths). > Among men without prior vascular diseases at baseline, there was a J- > shaped association between BMI and IHD mortality. 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. > > Conclusions: Lower BMI is associated with lower IHD risk among > people in the so-called normal range of BMI values (20–25 kg/m2), but > below that range the association may well be reversed. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. Rodney. --- In , " jwwright " <jwwright@...> wrote: > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. Rodney. --- In , " jwwright " <jwwright@...> wrote: > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. > > > > 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. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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. > > > > 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. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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? Third, I was looking at the data yesterday of a male CRONer with a BMI of 17.3; and another with a similar BMI who was saying they planned to lose another twenty pounds - which would put them at a BMI of 14.x. For people like that, getting this information straight would be important. also has a very low BMI I seem to remember. And others. It will be a long time before I get my BMI below 20, if ever. Rodney. > > > > > > 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. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 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? Third, I was looking at the data yesterday of a male CRONer with a BMI of 17.3; and another with a similar BMI who was saying they planned to lose another twenty pounds - which would put them at a BMI of 14.x. For people like that, getting this information straight would be important. also has a very low BMI I seem to remember. And others. It will be a long time before I get my BMI below 20, if ever. Rodney. > > > > > > 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. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 Rodney: I think you may be trying to tease too much out of these numbers, although I fully agree that some of questions the data raise are intriguing. One reason I'm being so cavalier is that, besides the fact that the added risk isn't that huge, a lot of the more recent thinking on ichemia is that while it's definitely not good to have clogged arteries, " clogging " is not the primary mechanism of ischemia. Soft plaque can break off at arterial flow that's only reduced, say, 20%, and kill you. On the other hand, you can get by at 80% reduced flow, albeit with dimished cardiac reserve, and longer-term danger of heart failure and other undesirable CVD outcomes. This is what's behind some of the controversy about the value of stenting: http://tinyurl.com/mbd22 I'm having enough trouble getting below 25 BMI (and believe me, I'm not ripped like Tony). I don't understand people who aim for 15, or below! Mike > > > > > > > > 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. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2006 Report Share Posted April 26, 2006 Rodney: I think you may be trying to tease too much out of these numbers, although I fully agree that some of questions the data raise are intriguing. One reason I'm being so cavalier is that, besides the fact that the added risk isn't that huge, a lot of the more recent thinking on ichemia is that while it's definitely not good to have clogged arteries, " clogging " is not the primary mechanism of ischemia. Soft plaque can break off at arterial flow that's only reduced, say, 20%, and kill you. On the other hand, you can get by at 80% reduced flow, albeit with dimished cardiac reserve, and longer-term danger of heart failure and other undesirable CVD outcomes. This is what's behind some of the controversy about the value of stenting: http://tinyurl.com/mbd22 I'm having enough trouble getting below 25 BMI (and believe me, I'm not ripped like Tony). I don't understand people who aim for 15, or below! Mike > > > > > > > > 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. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2006 Report Share Posted April 27, 2006 Hi JW/: It seems there are two types of very sudden heart death. Artery blockage causing ischemia, the result directly or indirectly of plaque in the artery. Carotid IMT should be a good measure of that. The other seems to be the 'electrical disturbance' type of incident where, following a brief onset of symptoms, the heart simply stops pumping blood. This does not require any blockage anywhere. (If the MDs here would like to correct the above, or add additional types of sudden heart death, PLEASE do.) I think (hope) that CRON greatly diminishes the incidence of the former. But the latter, although the risk factors for it seem to be very similar, may or may not be beneficially affected by CRON. Do we have reason to believe that CRON improves the electrical performance of the heart? Some internet sources appear to claim that this latter problem accounts for fully half the very sudden deaths from heart disease. This issue has been highlighted by the very recent, very sudden, death of a well known, 63 year old exercising cardiologist, Dr. Smaha, who had a reputation for exhorting his patients to live healthy lifestyles. He lived just down the road from Cornell, in Penn Yan, and was a visiting lecturer at Cornell, the same place the well known obese exerciser Dr. advocates pretty much that it doesn't matter how obese you are so long as you exercise. But Dr. Smaha does not appear to be anywhere close to being obese. More input on Dr. Smaha's health issue would be very helpful here, I think, if anyone comes across it. I.E. what, very specifically, did he regard as a healthy lifestyle, and what, exactly, was the heart problem he had? Rodney. --- In , " jwwright " <jwwright@...> wrote: > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2006 Report Share Posted April 27, 2006 Hi JW/: It seems there are two types of very sudden heart death. Artery blockage causing ischemia, the result directly or indirectly of plaque in the artery. Carotid IMT should be a good measure of that. The other seems to be the 'electrical disturbance' type of incident where, following a brief onset of symptoms, the heart simply stops pumping blood. This does not require any blockage anywhere. (If the MDs here would like to correct the above, or add additional types of sudden heart death, PLEASE do.) I think (hope) that CRON greatly diminishes the incidence of the former. But the latter, although the risk factors for it seem to be very similar, may or may not be beneficially affected by CRON. Do we have reason to believe that CRON improves the electrical performance of the heart? Some internet sources appear to claim that this latter problem accounts for fully half the very sudden deaths from heart disease. This issue has been highlighted by the very recent, very sudden, death of a well known, 63 year old exercising cardiologist, Dr. Smaha, who had a reputation for exhorting his patients to live healthy lifestyles. He lived just down the road from Cornell, in Penn Yan, and was a visiting lecturer at Cornell, the same place the well known obese exerciser Dr. advocates pretty much that it doesn't matter how obese you are so long as you exercise. But Dr. Smaha does not appear to be anywhere close to being obese. More input on Dr. Smaha's health issue would be very helpful here, I think, if anyone comes across it. I.E. what, very specifically, did he regard as a healthy lifestyle, and what, exactly, was the heart problem he had? Rodney. --- In , " jwwright " <jwwright@...> wrote: > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Hi 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.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Hi 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.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 --- In , " Rodney " <perspect1111@...> wrote: > > Hi JW: > > 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 Rodney: 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: 16391188 Recently, so-called 64-slice (better resolution) PET has been introduced and the adherents of this technique seen even more exicited: Check here: PMID: 16636804 If 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_n6210223 contained 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 clot Finally, 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/l9q6k His 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 --- In , " Rodney " <perspect1111@...> wrote: > > Hi JW: > > 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 Rodney: 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: 16391188 Recently, so-called 64-slice (better resolution) PET has been introduced and the adherents of this technique seen even more exicited: Check here: PMID: 16636804 If 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_n6210223 contained 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 clot Finally, 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/l9q6k His 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 > > 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 > > 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Hi Mike: As I understand it a major disadvantage of CT scans is a substantial radiation dose. I believe there is a big discussion going on in the profession right now as to whether the requirements for justifying CT scans be tightened up for this reason. I don't know about radiation exposure in PET scans. MR (magnetic resonance) scans are radiation-free, but again the equipment is hugely expensive. I hope that soon bone density scans will be done with MR instead of DXA. DXA does involve some radiation and, as previously discussed, is grossly flawed, especially for slim people like many of us. MR, in contrast, truly does measure real volumetric bone density, which is what one wants to know, and which is NOT measured by DXA. I am not greatly concerned as regards arterial occlusion issues, both because it seems CRON takes care of that in almost everyone - as demonstrated in the WUSTL study - and because I suspect carotid IMT does a good enough job of measuring occlusion. But I am greatly curious about the Smaha/electrical circuitry/SCD issue for which I am far from sure we have adequate methods, either to detect risk or to fix it if we have it (apart from fish oil, mentioned earlier, thank you). Rodney. > > > > 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 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Hi Mike: As I understand it a major disadvantage of CT scans is a substantial radiation dose. I believe there is a big discussion going on in the profession right now as to whether the requirements for justifying CT scans be tightened up for this reason. I don't know about radiation exposure in PET scans. MR (magnetic resonance) scans are radiation-free, but again the equipment is hugely expensive. I hope that soon bone density scans will be done with MR instead of DXA. DXA does involve some radiation and, as previously discussed, is grossly flawed, especially for slim people like many of us. MR, in contrast, truly does measure real volumetric bone density, which is what one wants to know, and which is NOT measured by DXA. I am not greatly concerned as regards arterial occlusion issues, both because it seems CRON takes care of that in almost everyone - as demonstrated in the WUSTL study - and because I suspect carotid IMT does a good enough job of measuring occlusion. But I am greatly curious about the Smaha/electrical circuitry/SCD issue for which I am far from sure we have adequate methods, either to detect risk or to fix it if we have it (apart from fish oil, mentioned earlier, thank you). Rodney. > > > > 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 > > > > > > > Quote Link to comment Share on other sites More sharing options...
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