Warfarin and systemic calcification?

[Agian]

I don’t think anyone knows for sure the causes of Coronary Heart Disease. Currently two doctors in the UK are writing good blogs about it. First one, Dr Malcolm Kendrick is on the 19th ‘episode’ https://drmalcolmkendrick.org you’ll have a lot of reading to read them all And second one, Dr David Grimes, who writes a little less often than Dr Kendrick, has a very interesting point of view (microbial/infection): http://www.drdavidgrimes.com

Great I'll read their blogs and educate myself on the world's biggest killer.

 

[Agian]

I have read up on it, maybe not to the extent of some but hey. Some believe the fatty deposits cause calcification theory is pushed by pharmaceutical companies who want everyone on a statin from birth to death. I'm not saying they've set the hook on me with that one but it's out there.

Of course theories are pushed by pharmaceutical companies. Then there are the people that make a mint putting in stents, and the multimillion-dollar industry pushing psychostimulants on rowdy children, who grow up with holes in their brains. Just imagine no evil pharmaceutical capitalists touting their wares. Or the latest money-spinner the CAC scores. Nocturne still hasn't told us what advice they offered him after they told him he's at higher risk of having a heart attack. They didn't even offer him an elective angiogram, like they did me... And caused a 'trivial heart attack'. It's all about the money, my friend. Get used to it. The same company that made my valve touts its wares on the top of this forum... whether it does it for free is not for me to decide.

Don't believe the hype, but don't create your own either.

 

[Nocturne]

I'll explain some math.

I'm 42, with a CAC score of 156. At my age, this puts me in the worst 1% category. It SHOULD be 0. I would hazard a guess that my situation came about for a variety of reasons -- overweight/obesity, sedentary lifestyle, low HDL, high LDL, family history, and likely a phenomenally low testosterone level. I only recently became aware of most of these (no one in the family talked about the last generation, for example, dropping of heart disease in their 50s).

Over 100 CAC at any age is considered "coronary artery disease" and grounds for being put on statins. It's about average for a 65 year old man, so I'm over 20 years "ahead of the game".

For people with a score over 0, CAC progresses at an average rate of about 15% per year. Lifestyle factors appear to be able to affect this, but statins do NOT, which has caused some confusion in the medical community, because everyone expected that they would. Even at a modest progression of 10% per year, I hit 400 CAC (high risk) at age 50, and 1000 (say your prayers and put your affairs in order risk) by the time I am 60. If I can keep it to 7% per year progression or below, I can stave off hitting 1000 until I am 70.

So you see, for me, a slight affect on CAC progression is a very big deal. I recognize that this is not the case for everyone. But FOR ME, it is.

I know that the effects of vitamin K2 on slowing CAC progression are not thoroughly researched or accepted by the medical community yet. But if there's even just a fair chance that they may be significant, and given the knowledge that lifespan after AVR is roughly the same for bioprosthetic vs mechanical, I just don't feel comfortable going with mechanical at this time.

Fortunately for me, there is still time for medical science to remove the need for me to make a decision before I actually need my surgery. And in the meantime, I'll be taking my K2 supplement, even though doing so is not currently endorsed by the AHA, because from the data I have seen there is a FAIR CHANCE that it slows down plaque progression, and my life is on the line.

 

[cldlhd]

I don’t think anyone knows for sure the causes of Coronary Heart Disease. Currently two doctors in the UK are writing good blogs about it. First one, Dr Malcolm Kendrick is on the 19th ‘episode’ https://drmalcolmkendrick.org you’ll have a lot of reading to read them all And second one, Dr David Grimes, who writes a little less often than Dr Kendrick, has a very interesting point of view (microbial/infection): http://www.drdavidgrimes.com

Yes that is a lot of reading but from the but I was able to peruse until I decided lighter reading would go better with my morning coffee it seemed to suggest that "enhanced blood clotting " could be responsible for CVD. So would a higher intake of vitamin k exacerbate blood clotting and therefore cvd?

 

[Nocturne]

Agian, I had to peck at my docs several times before they would sign off on giving me a CT scan to look for CAC. About a year ago, I presented with symptoms typical to hypogonadism -- symptoms so awful I honestly fear a return to them more than I fear dying early of heart disease. I learned that my testosterone level, 135 ng/dl, was far below the normal range and approached that of a castrated male. Since that time, treatments have brought it into normal range and symptoms have abated, but along the way I learned of recent studies looking at the connection between low T and heart disease, and got worried enough to ask about getting a CT scan.

Both docs (GP and hormone specialist) "pooh-poohed" the idea of the scan, insisting that "at YOUR age" the scan would be useless as I'd most likely have a zero score, or at worst something in the teens. Then a few months later a routine physical revealed a heart murmur, which turned out to be AS with calcification on the valve, and I again asked about getting a CT scan to check calcification in the rest of the heart. One doc "pooh-poohed" again, the other agreed to write an order for a scan (just to put my mind at ease, I gathered), and bam -- whopping score of 156. My GP, who had been "pooh-poohing" all this time, called me at home and sounded nervous over the phone, ordering statin and aspirin therapy and telling me that the only reason he wasn't ordering something to lower my BP was because I'd lowered it enough through weight loss and diet that he was afraid it would push my BP too low.

Laughably, insurance still wants me to pay for the scan, for the specific reason that according to their data, it will not result in any changes of treatment. Despite the fact that it did in fact do exactly that! Still arguing that one.

 

[Agian]

Nocturne, don't just talk about it act!
Lose weight, get your HDL up with exercise, stop eating ****, Niacin is great for lowering Lp (a), see if you can get on Ezetimibe, or even Evolocumab. Get your carotid arteries monitored, so you can monitor you progress. To do a 'CAC' on someone, tell them they're at high risk and the not offer them advice is unethical.

Why do I know so much? I had a stent put in last year for something that was probably reflux and now the cardiologist refuses to even let me look at the angiogram. **** em! Take control of your own health, no one else will.

 

[cldlhd]

Of course theories are pushed by pharmaceutical companies. Then there are the people that make a mint putting in stents, and the multimillion-dollar industry pushing psychostimulants on rowdy children, who grow up with holes in their brains. Just imagine no evil pharmaceutical capitalists touting their wares. Or the latest money-spinner the CAC scores. Nocturne still hasn't told us what advice they offered him after they told him he's at higher risk of having a heart attack. They didn't even offer him an elective angiogram, like they did me... And caused a 'trivial heart attack'. It's all about the money, my friend. Get used to it. The same company that made my valve touts its wares on the top of this forum... whether it does it for free is not for me to decide.

Don't believe the hype, but don't create your own either.

I would think I've expressed enough skepticism out here to prove I don't "believe the hype". You could argue the money angle a million ways. The pharmaceutical companies want you in a new , unproven much more expensive anticoagulant or you could say the ones who pay for it ( various government agencies, insurance companies etc..) want you in the cheaper more proven product and they wouldn't care if there's the POSSIBILITY that it'll give some a higher chance of a fatal heart attack at 71 vs 84. I'm not saying this is a belief of mine so don't accuse me of manufacturing my own 'hype'. I'm just pointing out that the old follow the money theory can go in lots of directions.The connection between warfarin and calcification is unproven and it does what needs doing now cheaply so case closed as far as they're concerned .
I freely admit I don't know for sure but unlike some I have an open mind to the subject. I'm waiting to be shown conclusive evidence but in a subject like this I expect that the vast majority of us out here will be taking the long dirt nap before it comes in.

 

[Paleowoman]

Yes that is a lot of reading but from the but I was able to peruse until I decided lighter reading would go better with my morning coffee it seemed to suggest that "enhanced blood clotting " could be responsible for CVD. So would a higher intake of vitamin k exacerbate blood clotting and therefore cvd?

Vitamin K as in K1 is the coagulant vitamin, but it's very well controlled by the body so that even if you eat a lot of K1 rich foods such as leafy green veggies etc, you won't find you have an increased CVD. Vitamin K2, as I know you know, helps put calcium in the bones intead of the arteries and some studies are showing that it helps reverse CAD: http://www.ncbi.nlm.nih.gov/pubmed/25694037 (The study was done on postmenopausal women so if we were to be pedantic we could say that we don't know if men get the same benefit).

 

[cldlhd]

I'll explain some math.

I'm 42, with a CAC score of 156. At my age, this puts me in the worst 1% category. It SHOULD be 0. I would hazard a guess that my situation came about for a variety of reasons -- overweight/obesity, sedentary lifestyle, low HDL, high LDL, family history, and likely a phenomenally low testosterone level. I only recently became aware of most of these (no one in the family talked about the last generation, for example, dropping of heart disease in their 50s).

Over 100 CAC at any age is considered "coronary artery disease" and grounds for being put on statins. It's about average for a 65 year old man, so I'm over 20 years "ahead of the game".

For people with a score over 0, CAC progresses at an average rate of about 15% per year. Lifestyle factors appear to be able to affect this, but statins do NOT, which has caused some confusion in the medical community, because everyone expected that they would. Even at a modest progression of 10% per year, I hit 400 CAC (high risk) at age 50, and 1000 (say your prayers and put your affairs in order risk) by the time I am 60. If I can keep it to 7% per year progression or below, I can stave off hitting 1000 until I am 70.

So you see, for me, a slight affect on CAC progression is a very big deal. I recognize that this is not the case for everyone. But FOR ME, it is.

I know that the effects of vitamin K2 on slowing CAC progression are not thoroughly researched or accepted by the medical community yet. But if there's even just a fair chance that they may be significant, and given the knowledge that lifespan after AVR is roughly the same for bioprosthetic vs mechanical, I just don't feel comfortable going with mechanical at this time.

Fortunately for me, there is still time for medical science to remove the need for me to make a decision before I actually need my surgery. And in the meantime, I'll be taking my K2 supplement, even though doing so is not currently endorsed by the AHA, because from the data I have seen there is a FAIR CHANCE that it slows down plaque progression, and my life is on the line.

So if my score is 1 then a year later it'll be 1.15 which is how I would calculate a 15% progression or are you saying it would 16?

 

[Agian]

so don't accuse me of manufacturing my own 'hype'.

So if I'd said 'Don't put all your eggs in one basket.', would you have thought I was accusing you of being a chicken farmer?

 

[Nocturne]

Nocturne, don't just talk about it act!
Lose weight, get your HDL up with exercise, stop eating ****, Niacin is great for lowering Lp (a), see if you can get on Ezetimibe, or even Evolocumab. Get your carotid arteries monitored, so you can monitor you progress. To do a 'CAC' on someone, tell them they're at high risk and the not offer them advice is unethical.

Why do I know so much? I had a stent put in last year for something that was probably reflux and now the cardiologist refuses to even let me look at the angiogram. **** em! Take control of your own health, no one else will.

Agian, over the last year I have lost between 55 and 60 pounds -- I'm now within less than five pounds of "ideal weight range" and I recently took one of those newfangled barefoot scale scans that found everything else to be "in the green" and gave me a "metabolic age" of 37, five years lower than my actual age. I haven't gone Esselstyn yet, but I am eating worlds better than I was (no soda, no fast food, lots of whole foods and plants, limiting sat fats). Just yesterday I FINALLY got to go shopping and buy myself a new wardrobe that FITS! Waist size went from a 38 to a 32. Mind you, pretty much all of this happened BEFORE I learned that ANYTHING was wrong with my heart. HDL is frustratingly gene-dependent, but regular exercise seems to have raised it from 35 to 40. LDL went from 185 to 135 from diet, weight loss, and exercise alone, and the statins brought it down into the eighties. My trigs have never been a problem -- 95 or so at their worst -- but are now in the 40s-50s. So I think I've earned the right to say that I'm not "just talking about it".

I thought about Niacin but learned that Niacin has recently been found to be of no use in preventing heart attacks, despite the fact that it undeniably raises HDL. The AHA recently dropped their recommendation that docs prescribe it because of this. The only people who really look at taking it now are those who believe that in the absence of a statin, it can lower odds of heart attack (everyone in the studies revealing that it didn't do anything to prevent heart attacks was on a statin), but there is no evidence of this and I am already on a statin -- so there is no reason for me to be taking it (believe me, if I thought there was, I would be).

I don't know about Ezetimibe or Evolocumab. I do know that the cardiologist I have been seeing has seemed less than helpful. He seems to see me as a "worry wart" and has insisted that A. I do NOT have AS, despite the fact that I've got a report from the doc who reviewed my echo clearly stating that I do, and B. that lowering my lipids will "freeze" my CAC score where it is, despite that fact that they are only as low as they are because of the statin, and it has been proven that statins has NO effect on slowing down CAC progression. I am looking into finding a new cardiologist.

 

[Nocturne]

So if my score is 1 then a year later it'll be 1.15 which is how I would calculate a 15% progression or are you saying it would 16?

There is a wide margin of progression but the average is about 15% per year, so if you have a 1 then on average (depending on many factors) it would be a 1.15 the following year.

This seems almost insignificant, but as your numbers rise, your score snowballs. Pull out a calculator (there's probably one on your phone these days) and fiddle with the math a bit. The numbers spiral out of control pretty quickly -- and one thing that seems to accelerate the process is higher CAC score.

NOTE: This means that I almost certainly had a score of over 100, indicating CAD, in my thirties, and quite possibly/probably had measurable CAC in my twenties -- when I was overweight, but far from obese, and not athletic, but not sitting in a chair all day either. Yeah, by my thirties I was carrying more weight than I should have been and not exercising at all, but look around -- see one or two other guys here in America like that? Maybe even a small handful? They MIGHT have CAC scores in the thirties if they are unlucky. There are obese diabetic chain smokers my age with better CAC scores than mine.

 

[Agian]

You're doing great Nocturne. There is mounting evidence that CAD is actually reversible. Low Testosterone can contribute so can low DHEA. What they say is that above an LDL of 1.8 (I don't know the units you use over there), CAD progresses, at 1.8 , it is static, below about 1.5, your soft plaques reverse. A newborn has an LDL of about 1. Here's the bonus, get your LDL this low and it will nullify any increase in Lp(a).

Evolocumab is a non-statin (shock horror) used for high risk groups. It will reduce your Lp(a), by 30%, increase your HDL and lower your LDL.

If you take statins and your LDL is ok, then Niacin will not add much. However, if you have other risk factors like low hdl and high Lp(a) it will further minimise your risks.

Did you follow the link I gave you? There's a mechanical valve around the corner that won't need Warfarin.

The reason your cardiologist thinks you're a 'worry wart' is because he probably has no idea. I learned that the hard way. There are lipid experts in your country that are experts in all this. Lose as much weight as you can. I've got 10 kg to go to get below a BMI of 25. I'm essentially vegetarian. Chin up.

 

[Agian]

And don't dismiss statins as a therapeutic agent. Trust me, they save lives. I met a man whose gp told him high cholesterol was good for him (at 11). Triple bypass in his forties. DO NOT believe the bullshiit. I'll say this again: there are families with familial hypercholesterolaemia that would die in their thirties. Statins have normalised the life expectancy of many. Other families have very low LDL. Guess what? They live 15 years longer than the rest of us. So anyone who tells you lipids aren't one of the major causes of heart disease is talking out their arse. And btw, I don't care who I offend.

 

[Paleowoman]

HDL is frustratingly gene-dependent

You might be surprised about that Nocturne ! That's not to say it might not be gene-dependent to a degree, but my HDL used to be a regular 2 (77 in US numbers). Then nine years ago I started to eat extremely low carb Paleo way of eating due to being diagnosed with diabetes (I’m very slim btw, underweight, the diabetes is atypical). Steadily my HDL has risen, first into the upper 2’s, then the 3’s - I even reached 3.9 once - that is 150 in US numbers ! My HDL now holds around 3.5 (135 US). That is eating lots of meat, fish, eggs, non-starchy veggies, nuts, and saturated fats as in coconut oil. No grain foods, starches or sugars, and obviously no foods made with them. I cook everything from scratch, doesn’t take much effort - think steak and sautéed broccoli which we had for dinner yesterday. We eat extremely well Tad expensive. Of course I’m just anecdotal but I’ve read of plenty of others who have done likewise and got similar results. Interesting eh ?

 

[cldlhd]

There is a wide margin of progression but the average is about 15% per year, so if you have a 1 then on average (depending on many factors) it would be a 1.15 the following year.

This seems almost insignificant, but as your numbers rise, your score snowballs. Pull out a calculator (there's probably one on your phone these days) and fiddle with the math a bit. The numbers spiral out of control pretty quickly -- and one thing that seems to accelerate the process is higher CAC score.

NOTE: This means that I almost certainly had a score of over 100, indicating CAD, in my thirties, and quite possibly/probably had measurable CAC in my twenties -- when I was overweight, but far from obese, and not athletic, but not sitting in a chair all day either. Yeah, by my thirties I was carrying more weight than I should have been and not exercising at all, but look around -- see one or two other guys here in America like that? Maybe even a small handful? They MIGHT have CAC scores in the thirties if they are unlucky. There are obese diabetic chain smokers my age with better CAC scores than mine.

Ya I fired up the old phone calculator but then I was called into work.
As for the chicken farmer analogy from Agian maybe it's some form of southern hemisphere humor that escapes me but I don't see where I was creating my hype. That was my point. To dismiss one set of studies as hype while quoting others as having come down from the mountain is fine if you can show even a reasonable amount of suspicion that there is an ulterior motive. Humans aren't generally rational and I figure people on warfarin to prevent stroke or some other life threatening event in the present would be predisposed to, at least subconsciously, to not want to hear it could cause calcification. I assume some people chose tissue because of sensitivity to noise but most did it to avoid warfarin. That doesn't mean I'm saying the warfarin fears are justified. I think most would agree that a tissue valve is much more likely to need replacing compared to mechanical and one of the reasons is due to calcification. So someone with a tissue is likely to be predisposed to want to believe a study that shows vitamin k2 can help prevent it.

 

[Agian]

True Paleogirl, some cardiologist called William Davis claims that high carb diets actually decrease your HDL. Exercise, weight loss and niacin increase it.

 

[LondonAndy]

I'm thinking of taking Q10, because I'm on statins. Interesting to see what it will do to my INR.

Agian: I started taking CoQ10 about a year ago, for the same reason, and if it had any effect on my INR it was a very slight decrease.

 

[Agian]

Ya I fired up the old phone calculator but then I was called into work.
As for the chicken farmer analogy from Agian maybe it's some form of southern hemisphere humor that escapes me but I don't see where I was creating my hype. That was my point. To dismiss one set of studies as hype while quoting others as having come down from the mountain is fine if you can show even a reasonable amount of suspicion that there is an ulterior motive. Humans aren't generally rational and I figure people on warfarin to prevent stroke or some other life threatening event in the present would be predisposed to, at least subconsciously, to not want to hear it could cause calcification. I assume some people chose tissue because of sensitivity to noise but most did it to avoid warfarin. That doesn't mean I'm saying the warfarin fears are justified. I think most would agree that a tissue valve is much more likely to need replacing compared to mechanical and one of the reasons is due to calcification. So someone with a tissue is likely to be predisposed to want to believe a study that shows vitamin k2 can help prevent it.

The chicken analogy is called humour and i, at least, won't be up all night praying that I don't get Calcification because I chose to go on Warfarin. Objective people don't pick and choose studies to suit their own personal needs. And I have read hundreds of studies.

Did you know that over half the people that ever ate tomatoes are dead? Seriously, they're that bad for you. Read it on a blog somewhere.

 

[Agian]

Agian: I started taking CoQ10 about a year ago, for the same reason, and if it had any effect on my INR it was a very slight decrease.

Cool. I've gone back on fishoil as well.