Calcium-answer from Edwards Lifesciences

[nia]

Sometime in late 2004, I posted a question regarding Edwards Lifesciences website?s comment about consulting your doctor before start taking calcium pills. I kept pestering the company last year for their manufacturer?s point of view, and they finally replied. I said before that I?d post the answer if I ever got one, so here goes. Hope this can be of some help to someone.

?This is in response to your question regarding calcium supplements with tissue valve implants.

?In the instructions for use for our valves, it states that we recommend careful consideration of the use of tissue valves in young patients, in patients with conditions affecting calcium metabolism, when calcium containing chronic drug therapies are used, patients on high calcium diets, or patients on maintenance hemodialysis. One reference cited in the instructions for use is regarding a report of early degeneration of a porcine bioprosthesis in an elderly woman on long-term calcium carbonate therapy.

?Additionally, the American College of Cardiology/American Heart Association guideline ?ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease? explains that ?Biological valves have a much higher rate of structural deterioration when implanted in patients with renal failure, those on hemodialysis, or with hypercalcemia. Adolescent patients who are still growing have a high risk for accelerated biological valve calcification. http://www.acc.org/clinical/guidelines/valvular/jac5929fla145.htm#3

?We are not aware of studies conducted on recipients with tissue valves taking specific doses of calcium daily that evaluated the long-term rate of structural valve deterioration or valve calcification. We again urge you to discuss your concerns with your doctor because only he has your full medical history and the training to determine what is best for you.?

 

[Mary]

Thanks Nia, for posting Edwards' reply; I've got one of their valves.

 

[Marguerite53]

Perfect timing, Nia! Thank you!! I'm headed for my second surgeon consultation on friday and I will definitely ask him about this. I'm 52 and take calcium supplements daily because, well, I'm a 52 year old woman! I am leaning heavily toward tissue as my choice, but don't want the calcium depletion to be an issue either.

The link they site is from 1998. Haven't there been a lot of changes since then?

Good job staying on top of that!! Sounds like there's a little pamphlet that comes in the box with each valve, doesnt' it? Maybe I'll scrounge one up at the surgeon's office!!

Again, truly appreciate your sharing this info.

Marguerite

 

[George]

Good job staying on top of that!! Sounds like there's a little pamphlet that comes in the box with each valve, doesnt' it? Maybe I'll scrounge one up at the surgeon's office!!

Again, truly appreciate your sharing this info.

Marguerite

I'll make you a copy of that pamphlet & get it to you ASAP

 

[jax3172]

calcium

calcium

Great post. I have one also (bovine). I don't think we got a good answer from Edwards. I'll send an e-mail to my surgeon. The basic question will be what can be done to make the valve last as long as possible. And what types of conditions, meds, or behaviors will cause it to deteriorate (e.g., I believe drinking soda might be a problem).

Jack

 

[tobagotwo]

You won't get a good answer from them - or any manufacturer - about this. They don't know. The problem is the diversity of metabolisms that people sport. It makes it very difficult to set up a valid study over time.

The FDA won't allow the manufacturers to say outright that calcium will shorten the life of tissue valves, because it hasn't been proven. Further, there is still some mystery about exactly how the deterioration occurs.

One strong theory is that compounds on the surfaces of the valve are chemical tags that mimic damaged or dead tissue, and chemicals from the blood attach as layers of calcific material (actually the mineral apatite) to these receptor areas. New anticalcification techniques are generally aimed at removing or neutralizing those chemically attractive spots.

Apatite in the body is usually impure calcium hydroxyl phosphate, often called hydroxyapatite, biological apatite, or just apatite. One Vr.com minerology-trained oil man liked to refer to it as "cardiolytic apatite." (Okay, you have to have an interest in minerals to think that's funny. I grok rocks, and I thought it was hilarious.) Anyway, teeth are made up mostly of this, as are bones, each with different base impurities which account for the differences in density and appearance. The calcification on valves is made up of deposits of similar apatite mineral.

In practical terms (and by definition), it's unlikely that any normal calcium intake would harm the valve significantly, or the average valve life, which has been studied, would reflect it.

Best wishes

 

[jax3172]

Bob- love your posts!

Bob- love your posts!

Bob,

I don't know how old you are but did you ever consider becoming a doctor or a medical/biological researcher? If you ever become a cardiologist, sign me up as patient. We all really appreciate your posts.

I was told by my surgeon not to injest too much iron but he didn't mention why and he didn't mention any warnings about calcium. He did say that U of P was researching the process of replacement valve calcification. I'll try to stay on top of that for the group. By the way, I've read on the internet that the balance or ratio of calcium to magnesium can affect heart rate. The theory is that sufficient calcium is needed to start the beat (sinus node) and sufficient magnesium is needed to relax the ventricles. Like everything else, I take it with a grain of salt (make that NaCl, not CaCl).

 

[Ashley]

bicuspid aortic valve stenosis

bicuspid aortic valve stenosis

Hello,
This is probably a silly question - but does anyone think there is any reason for someone with a bicuspid aortic valve (stenotic) NOT to take a calcium supplement. Please excuse my ignorrance, but is there anyway that extra calcium could advance an already calcified valve? Probably no connection...
Thanks
Ashley

 

[tobagotwo]

Ashley,

They have tried to prove it, but have been unable to. What a shame it would be to have your heart fixed, but not be able to enjoy it because your bones are too brittle. Take your calcium, with vitamin D. And don't forget your magnesium to go with it.

Jax,

That's an excellent point you make regarding magnesium. It's one that has surfaced a number of times - sometimes from me - because it is such a worthwhile topic.

A number of our membership have found that magnesium supplements have been helpful in controlling their arrythmias, to the extent that a few have been able to go off of strong medications they had been on for palpitations. Of course, they did this with their doctors' blessings, and it certainly didn't help everyone who tried it. However, it's cheap, easy, and most doctors have no problem with their patients trying it (within reason). If you're on diuretics, you need to watch your mineral levels carefully, so be sure you're clear with your doctor before you take any mineral supplements.

Magnesium is somewhat self-limiting in term of how much you can take at once, as it can have a laxative effect in large doses. A 200mg capsule is tolerated by most everyone without ramifications. If you want to take more, you can try a 400mg to see how it goes, or you can take a second 200mg capsule later in the day, such as with dinner.

Another favorite is salmon oil, full of omega 3 fatty acids that many studies agree seem to smooth out the heartbeat and protect from sudden heart death. This can also be found in certain vegetable oils, such as borage oils, if you're a vegetarian. Again, include your doctor in the plan.

Note that one study exists that found omega 3 was not a positive influence on people who have pacemakers, so that might be a consideration. Another thing to recognize is that fish oils are considered mild anticoagulants, so consult Al Lodwick's site about it if you're on Coumadin, to get his opinion, and to see if you should make any adjustments.

Best wishes,

 

[barbwil]

why?

why?

"Note that one study exists that found omega 3 was not a positive influence on people who have pacemakers, so that might be a consideration."

Bob, that made me take notice as I have had a pacemaker for 3 1/2 years and have been taking fish oil capsules all of that time. Do you have any idea why this statement would be true?

Thanks, Barb

 

[jax3172]

Calcium/Magnesium

Calcium/Magnesium

I would think it would be worthwhile for anyone having fast or irregular heat beats to get a periodic blood test to check the levels of certain electrolytes and minerals, esp calcium and magnesium. I am not one to take supplements by the bunches. Even vitamins and minerals are, in the most general sense, drugs, and need to be approached with caution. I do however, take a good multiple without iron, 1 large Omega-3 gel cap, 1 400 IU E, and one magnesium tab per day - along with my 1 aspirin. By the way, I read you should take the E and Omega-3 together and at a time when there might be limited acid in your stomach (like say 2 hrs after a meal). Of course I've seen only mild improvement in my heart rate issue but it seems to be inching in the right direction. Day by day, some better days and then a worse day (can't seem to correlate it to anything, even stress).

Any thoughts or comments would be appreciated.

Jack