Biological vs Mechanical -- what does the ACC think?

[Agian]

It depends where you're at. I just looked it up and for an American male it's now 78 on average. Places like the northeast are around 80. West Virginia, Alabama, Mississippi its more like 72.
Ya I'm aware of the Generals warning but without wanting to get too political that guy would have been called a communist by the loudest wing of his party today.A highly progressive tax policy, against the 'military industrial complex', might as well come out agaisnt fellatio with that one.

Now, I'm confused.

 

[cldlhd]

Now, I'm confused.

It's ok to be confused occasionally, you don't want to wake up knowing there will never be any surprises do you?

 

[LondonAndy]

The ACC report does indeed make interesting reading, but does anyone here know how widespread home self-testing of INRs is? The ACC report quotes a study ( Effect of Home Testing of International Normalized Ratio on Clinical Events) but this study is from 2010 and also does not specify what home testing devices were used. Here in England, home testing only became recommended as the best practice way of managing INRs in 2014, and then only specifically for CoaguCheck XS devices, and I have seen reports in the media here that only 1% of those on Warfarin currently self-test, though I am not sure how long home testing has been common practice in other countries. (In the US it became approved in 2002, according to the study).

So I would be concerned that

1. there was not a large home-testing patient cohort to draw from at the time of the study (2008 - 2010 I think),
2. they may not have been doing this for long to provide meaningful stats, and
3. has technology for home devices improved since 2008 - 2010? ​

I guess that I am curious as to how much of the (surprising) lack of difference in major events for those with mechanical valves and home testing for anti-coagulation management compared with clinic management is down to poor self testing, with patients actually being out of INR range more than they are today, or if the bleeding events etc occurred whilst people were genuinely within their therapeutic range, which of course is possible.

Personally I am still glad that I went with mechanical.

 

[Agian]

I'm reading a book called 'Track Your Plaque' by a cardiologist called William Davis. He talks about how hospital bureaucrats sit around talking about how to encourage people to have 'procedures' because it's big business. We're talking about competing multibillion dollar industries: From evil Big Pharma, to the unregulated Vitamin industry; the companies that make stents and the interventionalists who use sub-optimal stress tests to justify angiography. There's a vegan girl in a bikini who runs a You Tube channel. Her boyfriend refers to himself as her pimp. The 'couple' make $10K a month just from her touting bananas online. The food industry, the dairy industry; the experts that recommend the various diets don't really give a **** whether you live or die. The man who made Type A Personality popular (the anxious, driven people who get heart attacks) had his research funded by the tobacco industry. I've said this before, and I insist this is just my opinion. We have to become experts in our own health. It's the ONLY way we'll survive. It's great to have people upload the latest research, but we need to read it carefully.

 

[Paleowoman]

I'm reading a book called 'Track Your Plaque' by a cardiologist called William Davis. He talks about how hospital bureaucrats sit around talking about how to encourage people to have 'procedures' because it's big business.....<snip>....We have to become experts in our own health. It's the ONLY way we'll survive. It's great to have people upload the latest research, but we need to read it carefully.

Hi Aglan - I read &#145;Track Your Plaque&#146; by Dr Davis back in 2007 when I was following his blog of the same name. It&#146;'s there I first learned about the importance of vitamin D3 and Vitamin K2 in heart health ! He&#146;'s actually changed some of his advice since &#145;Track Your Plaque&#146; was written - his latest book is &#145;Wheat Belly&#146; - you could tell he was building up to that in the 'Track Your Plaque blog&#146;. Here&#146;'s a link to his current blog: http://www.wheatbellyblog.com

Here&#146;'s a very thought provoking article by another cardiologist, Dr Aseem Malhotra: &#147;'Good Health Doesn&#146;t Come Out of a Medicine Bottle&#146;': http://doctoraseem.com/good-health-d...dicine-bottle/

 

[Agian]

I'm reading various opinions, but not treating any as sacred knowledge. He makes some valid points.

 

[Agian]

$$$$$$$$$$$$$$$ ;-)

 

[Paleowoman]

$$$$$$$$$$$$$$$ ;-)

They're all selling something, a book, a film, but at least it's not as much as big pharma and doesn't harm if we also read carefully and become experts in our own health !

 

[neil]

always hated the tissue v mech thing, to me its not a contest, its two great ways of staying alive, both have good and bad points hence the sometimes heated debates, hopefully in time there will be a valve what lasts a lifetime and does not need warfarin,

 

[dick0236]

always hated the tissue v mech thing, to me its not a contest, its two great ways of staying alive, both have good and bad points hence the sometimes heated debates, hopefully in time there will be a valve what lasts a lifetime and does not need warfarin,

Amen!........and this will happen someday.

 

[Nocturne]

I'm reading various opinions, but not treating any as sacred knowledge. He makes some valid points.

I have been reading Davis' book as well. As Paleogirl mentions, he seems to have gotten out of the CAC regression biz and into grain exclusion. Not sure what to make of that but it is too bad as the only docs left in CAC regression are people like Esselstyn who advocate vegetarian, if not vegan, diets and eschew even things like nuts and olive oil. A true "low fun" diet.

 

[Nocturne]

I call this another case of "figures never lie, but liars often figure." Sure, they can show data indicating that a large percentage of middle-aged or older tissue valve patients never have a re-op, but when they calculate their survival stats, do they eliminate all deaths from non-valve-related causes? (e.g. Do they present a "relative survival rate?") If not, this is not a valid conclusion. If they do, then they may have a case. But then, how many of those seniors who have failing tissue valves have other conditions that preclude another surgery, or they are simply inclined to let things go their course? All of this could distort the statistical relationships the authors are trying to promote.

Good point about relative survival rates. That article doesn't mention them, but they are easy enough to come by. Here's one with a nice graph that even includes some location data for comparison (apparently, Canadians tend to live longer than US citizens):

http://www.sciencedirect.com/science...22522308015729

The whole article is interesting but scroll down a bit and you'll find a graph with information about relative survival rates post-AVR, with regard to age at implant, valve type, and country of origin (Canada, UK, or USA).

Again, not much difference in lifespan post-AVR between mechanical and bioprosthetic valves.

The older you are when you have AVR done, the closer to a normal lifespan you are likely to have. A 50 year old who needs AVR surgery can expect to have about 10 years shaven off of his lifespan (about the equivalent of being a lifetime smoker). For a 60 year old, it's less of a haircut -- closer to 5 years.

Edit: Note that this graph seems to assume an average lifespan of just over 70 years for a US citizen who makes it to the age of 45. That average lifespan has gone up significantly -- it is unclear how that has affected the AVR population.

Now there are other studies I have seen that look at what factors influence average lifespan after AVR. For example, you REALLY want to avoid having a-fib if at all possible if you are an AVR recipient -- I have seen more than one study revealing it to be the single most detrimental factor when it comes to lifespan post-AVR. Meanwhile, if you have a highly functioning heart at the time of AVR, you have much better long term prospects -- in some cases and at some advanced ages, even better than the general population!

 

[cldlhd]

$$$$$$$$$$$$$$$ ;-)

I agree to an extent but then if you take it too far you'll be the Unabomber. Surgeon says you need surgery he's just trying to make a few bucks, cardiologist is pushing a pill as a pimp for big pharma etc....I am going to check out that YouTube channel with the bananas though.,,,

 

[Paleowoman]

I have been reading Davis' book as well. As Paleogirl mentions, he seems to have gotten out of the CAC regression biz and into grain exclusion. Not sure what to make of that but it is too bad as the only docs left in CAC regression are people like Esselstyn who advocate vegetarian, if not vegan, diets and eschew even things like nuts and olive oil. A true "low fun" diet.

I've not read that Nocturne ! Dr Davis is still into CAC regression, very much so - it's with grain exclusion ! Not vegetarian at all.

 

[Paleowoman]

Have a look here Nocturne: http://www.wheatbellyblog.com/?s=coronary+plaque Read some of the blog posts by Dr Davis on that page !

 

[pellicle]

Hi

the tissue v mech thing, to me its not a contest,

Exactly, it's a calculation. In some situations the calculation is simple but because so many can't extract their mindset from the criteria of late middle age / elderly it becomes a contest with people rooting for their own team.

It is also vexing when people do not grasp the true risks of decades of repeat surgeries.

People have one surgery, at 50 and think it's a cake walk, and are happy to set up a 30 year old to have 5.

 

[Nocturne]

Have a look here Nocturne: http://www.wheatbellyblog.com/?s=coronary+plaque Read some of the blog posts by Dr Davis on that page !

Interesting, Paleogirl. Most of the CAC-regression advocates I have contact with online seem to be pushing the work of Esselstyn and others who advocate low-fat, vegetarian/vegan diets. Of course many of them eschew grains as well. Although at some point you realize that the only "safe" things to eat are leaves, sticks, and pure fresh water (not in a plastic bottle, please). And... Honestly, are those 3-5 years of life I might gain from such a diet really worth it? At some point, it does become a serious question.

Thanks for the info, though!

 

[Agian]

I have been reading Davis' book as well. As Paleogirl mentions, he seems to have gotten out of the CAC regression biz and into grain exclusion. Not sure what to make of that but it is too bad as the only docs left in CAC regression are people like Esselstyn who advocate vegetarian, if not vegan, diets and eschew even things like nuts and olive oil. A true "low fun" diet.

I'm a big fan of Dr Esselstyn. I'm essentially vegan (for health reasons), but take fish oil and eat fish sometimes, eat almonds and use some of that cholesterol lowering spread. I'm not convinced a zero-fat diet is necessary.

 

[Agian]

I agree to an extent but then if you take it too far you'll be the Unabomber. Surgeon says you need surgery he's just trying to make a few bucks, cardiologist is pushing a pill as a pimp for big pharma etc....I am going to check out that YouTube channel with the bananas though.,,,

That's exactly the point I'm trying to make. I believe statins save lives, then someone pipes in and says they fund the research that justifies their use. My point is that you could say the same about the guys that make the stents, the vitamins etc. etc. One man's Porsche is another man's coffin.

 

[cldlhd]

That's exactly the point I'm trying to make. I believe statins save lives, then someone pipes in and says they fund the research that justifies their use. My point is that you could say the same about the guys that make the stents, the vitamins etc. etc. One man's Porsche is another man's coffin.

Exactly, it can get to the point where you're average simpleton like me can get a bit bewildered.