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tovli

I need to choose: heart attack or diabetes or maybe both?

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tovli

I am not asking for medical advice - I am writing this because I am overwhelmed by the uncertainty of too much medical information.

 

I think I remember someone saying "The only thing certain in life is death", but it seems even death has a debate these days.

 

1) My cardiologist just upped my dose of Rosuvastatin which might:

  • lower risk of coronary event by 50%
  • extend all cause mortality by 5 to 27 days
  • raise risk of diabetes by 256%

2) I have been "treating" pre-diabetes with carb restriction which might reduce the risk of diabetes by 30-50%

3) I feel like I need to decide if I want

  • a possible heart attack, (by ignoring my current cardiologist's medical advice)
  • or
  • possibly diabetes, or possibly diabetes and a heart attack (by following the most current medical guidance)

 

Facts about me:  (Sure TMI - or maybe this is "data".)

  • 68 years old,
  • "Normal BMI" (23.7)
  • BP 123/75 at home, 130/85 when I see a doctor, 
  • Resting Heart Rate: 42-45, Max Heart Rate seen during exercise 172, Average during exercise 143, 
  • Diet: Eat <100g net carbs/day and only meals that keep 1hr BG <140
  • BG: 
    • A1C: 5.6  Fasting: 109 
    • (Cannot eat pasta, ordinary bread, french fries, or OJ.  BG peaks at 217 and drops to 179 at 2 hrs.)
  • Cholesterol (on 10mg Rosuvastatin): Total: 147  HDL: 47 TriG: 58
  • Exercise: Run/walk 5k in 38 minutes twice a week, bike 12 miles in 1 hour once a week, and walk in nature 2-4 miles three to five times a week.
  • Heart Stress Test technician ran off screaming for his attending cardiologist during the test (I made it to 10 MET after promising not to sue them.)
  • Coronary Calcium Score of 76: "Mild heart disease.  Moderate chance of heart attack (12% ten-year risk). 
  • My heart is "abnormal" according to cardiologist but he is "not worried since you are able to run 5k without pain"

 

I'm not asking "what would you do?" - I just feel overwhelmed by the uncertainty of life.

 

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meyery2k

Thank you for sharing.  Yes, I agree, there is so much advice out there it can be overwhelming.  Based on past posts, I am certain you will make an informed decision.  So far, your decisions have got you to 68 and in great shape.

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Hammer

Tovli, have you asked your doctor about a cardiac catheter procedure?  That's where they give a slight sedative, and they cut your wrist or groin area, and insert a small catheter (tube) into the incision and move it up next to your heart, then they release a dye and watch on a monitor, how the dye flows through your heart and blood  vessels.  This shows them if there are any blockages in your blood vessels.  I've had this procedure done twice and it's painless.

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Dowling
55 minutes ago, tovli said:

I am not asking for medical advice - I am writing this because I am overwhelmed by the uncertainty of too much medical information.

 

I think I remember someone saying "The only thing certain in life is death", but it seems even death has a debate these days.

 

1) My cardiologist just upped my dose of Rosuvastatin which might:

  • lower risk of coronary event by 50%
  • extend all cause mortality by 5 to 27 days
  • raise risk of diabetes by 256%

2) I have been "treating" pre-diabetes with carb restriction which might reduce the risk of diabetes by 30-50%

3) I feel like I need to decide if I want

  • a possible heart attack, (by ignoring my current cardiologist's medical advice)
  • or
  • possibly diabetes, or possibly diabetes and a heart attack (by following the most current medical guidance)

 

Facts about me:  (Sure TMI - or maybe this is "data".)

  • 68 years old,
  • "Normal BMI" (23.7)
  • BP 123/75 at home, 130/85 when I see a doctor, 
  • Resting Heart Rate: 42-45, Max Heart Rate seen during exercise 172, Average during exercise 143, 
  • Diet: Eat <100g net carbs/day and only meals that keep 1hr BG <140
  • BG: 
    • A1C: 5.6  Fasting: 109 
    • (Cannot eat pasta, ordinary bread, french fries, or OJ.  BG peaks at 217 and drops to 179 at 2 hrs.)
  • Cholesterol (on 10mg Rosuvastatin): Total: 147  HDL: 47 TriG: 58
  • Exercise: Run/walk 5k in 38 minutes twice a week, bike 12 miles in 1 hour once a week, and walk in nature 2-4 miles three to five times a week.
  • Heart Stress Test technician ran off screaming for his attending cardiologist during the test (I made it to 10 MET after promising not to sue them.)
  • Coronary Calcium Score of 76: "Mild heart disease.  Moderate chance of heart attack (12% ten-year risk). 
  • My heart is "abnormal" according to cardiologist but he is "not worried since you are able to run 5k without pain"

 

I'm not asking "what would you do?" - I just feel overwhelmed by the uncertainty of life.

 

Does your cardiologist know you are pre-diabetic? Sometimes specialists only go by what they see and not the whole picture. I would inform him of your pre-diabetic situation and then see what happens. I'm sure if he knew he could change your prescription to one that is more diabetic friendly. I'm sure that he has prescribed is not the only medication for your condition.

 

Before you go to the cardiologist talk to your pharmacist. They know more about medications than doctors do. Explain to him what you were prescribed your heart condition and your diabetic condition and ask what he recommends. Don't tell the doctor you got his advice. Just say you are concerned about the med. he prescribed because you are diabetic. Tell him you heard about this medication and it doesn't raise your blood glucose. Then ask him if in his opinion would this be a good option for you. Doctors don't like to be told. They think the rest of us don't have a brain and should just follow them blindly. I have relied on pharmacists often and always run any prescription by them before I have it filled because they know by past prescriptions what you are getting meds. for. and they know just what is in medications and how they interact with each other.

 

Good luck and I hope you get things straightened out.

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tovli
5 hours ago, Hammer said:

Tovli, have you asked your doctor about a cardiac catheter procedure?  

 

Thanks - yes, I discussed cardiac catheterization and other diagnostic and diagnostic with therapeutic options and decided to stick with external tests  - echocardiogram, coronary calcium CT, stress, and 16 lead EKG.  (While doc doesn't think useful, I use Apple Watch while sleeping and chest heart strap while exercising).  Absolutely "nothing unexpected or concerning" has shown up.  

 

My heart response to exercise has been "abnormal" since youth but have never found a doc that could tell me why.  They only ever ask "do you feel pain when you exercise?" (No) and tell me to stop worrying.

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tovli
5 hours ago, Dowling said:

Does your cardiologist know you are pre-diabetic? Sometimes specialists only go by what they see and not the whole picture. I would inform him of your pre-diabetic situation and then see what happens. I'm sure if he knew he could change your prescription to one that is more diabetic friendly. I'm sure that he has prescribed is not the only medication for your condition.

 

Well see that is part of my confusion - as I am pleased with my 10% weight loss and dietary changes to limit BG peaks, I did discuss discovering that I am pre-diabetic and my personally engineered diabetes prevention therapy with him, thinking that it might be applicable information.  I did not know at that time anything about the diabetes-Rosuvastatin side effect.  I was most worried about any tendonitis side effects from increasing the statin dosage.  (Turns out Rosuvastatin also has greater reported achilles tendon and "trigger finger" adverse reactions, that I didn't know during my visit.) 

 

I found the diabetes-Rosuvastatin side effects in a 2019 study, so perhaps he hadn't seen it or who knows.  I'm due to get cholesterol and liver panel check after 6 weeks on the increased dose.  I plan to ask for a phone call after the results. 

Edited by tovli

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tovli
5 hours ago, Dowling said:

Before you go to the cardiologist talk to your pharmacist.

Great idea - I had not thought of that.  Wow - super.

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adiantum

Pharmacists will appreciate you asking them.

Try to be there when theyre not too busy...like 10am or 2pm

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Dowling
5 hours ago, tovli said:

I found the diabetes-Rosuvastatin side effects in a 2019 study, so perhaps he hadn't seen it or who knows.  I'm due to get cholesterol and liver panel check after 6 weeks on the increased dose.  I plan to ask for a phone call after the results. 

Edited 5 hours ago by tovli

I doubt he has seen it or even looked it up. Doctors don't know much about medications. They tend to rely on med. company salesmen. That's where they get those little samples they occasionally hand out.

 

My BIL was on serious antibiotics from a specialist for a chronic ear infection. He went to his own doctor for a checkup and he prescribed a Statin. Since there was a pharmacy in his building they had The script filled there instead of going to their regular pharmacy. BIG MISTAKE. He started taking both. The next day he started having severe chest pain and went to the hospital. They ran every test possible and all came back normal. My sister asked the doctor if it could be a reaction between the 2 meds. Oh No he said. A nurse overheard and took my sister aside and told her that Doctors don't know much about medications and told her to go down and ask the hospital pharmacist. The pharmacist said OH YES. You can get all kinds of reactions mixing those 2 drugs. He stopped taking the Statin and problem solved.

 

There's 2 lessons in this--Always use the same pharmacy. They know about drugs and your medical history with drugs.

Lesson 2-- Always ask the pharmacist when adding a new medication if there could be a reaction with any other meds. you are taking and the side effects of the new med before you have the prescription filled.

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stevenal

Diabetes also puts you at increased risk of cardiac issues. 

Ezetimibe (Zetia) is an a non-statin ldl lowing drug that should not increase risk for diabetes. 

 

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tovli
5 hours ago, stevenal said:

Diabetes also puts you at increased risk of cardiac issues. 

Exactly the concern.  

 

I got a good grade in my statistics class (40 years ago) because I was a good test taker, not because I understood anything.

 

I'm still a good test taker - blood glucose, heart rate, blood pressure, and I still don't understand anything.

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tovli

Update August 2021:

- Wife went from H1c 6.3 to 5.5 but I went from 5.6 up to 5.9 (from 5.7 two months ago)

- Cardiologist says heart is primary concern so "watch your sugar intake, and stick with Rosuvastatin 20mg"

- Two primary care doctors say "keep doing what you are doing (BMI under 25, diet & exercise), and don't worry about 5.9 glucose/H1c",

- When asked should I go back down to 10mg Rosuvastatin, prim_care responded: "No.  Your H1c needs to be above 7.0 for 10 years before problems"

 

I understand the "save 9 heart attacks for every additional diabetes 1:1000 person years NNT for Rosuvastatin", and yes, upping the dosage to 20mg got my LDL-C to the target 70, but it just seems like the increased Rosuvastatin dosage completely undid all the really hard diet restriction benefit.

 

All the hours listening to talks on the "evils of sugar", "the coming diabetes pandemic", carb counting, testing blood after each new food or combination, and worrying about pre-diabetes, now just seems like sensationalism, and obsessive worry about avoiding diabetes.

 

A type 2 once replied there is no such thing as pre-diabetes; just a matter of the degree of diabetes.  It seems like the doctors are telling me "there is no such thing as pre-diabetes period."

 

 

 

 

 

GL_H1c_Historical-2021.png

Edited by tovli

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Dowling
21 hours ago, tovli said:

Update August 2021:

- Wife went from H1c 6.3 to 5.5 but I went from 5.6 up to 5.9 (from 5.7 two months ago)

- Cardiologist says heart is primary concern so "watch your sugar intake, and stick with Rosuvastatin 20mg"

- Two primary care doctors say "keep doing what you are doing (BMI under 25, diet & exercise), and don't worry about 5.9 glucose/H1c",

- When asked should I go back down to 10mg Rosuvastatin, prim_care responded: "No.  Your H1c needs to be above 7.0 for 10 years before problems"

 

I understand the "save 9 heart attacks for every additional diabetes 1:1000 person years NNT for Rosuvastatin", and yes, upping the dosage to 20mg got my LDL-C to the target 70, but it just seems like the increased Rosuvastatin dosage completely undid all the really hard diet restriction benefit.

 

All the hours listening to talks on the "evils of sugar", "the coming diabetes pandemic", carb counting, testing blood after each new food or combination, and worrying about pre-diabetes, now just seems like sensationalism, and obsessive worry about avoiding diabetes.

 

A type 2 once replied there is no such thing as pre-diabetes; just a matter of the degree of diabetes.  It seems like the doctors are telling me "there is no such thing as pre-diabetes period."

 

 

 

 

 

GL_H1c_Historical-2021.png

 

I Think that Diabetes should be your main concern. Yes there is no such thing as Prediabetes. It's just a beginning phase of diabetes.

 

I can only relate my results. I have had very high cholesterol since they started measuring it years ago around 1987-1988 and I must have had it before that too. I'm 81 now so that's a lot of years. My doctor then wanted to put me on a statin. I did start taking it but started to feel awful after a couple of weeks. At that time I wasn't on any other medication so I knew it had to be the Statin. I stopped taking it and did some research. I found that High cholesterol was touted by doctors following the faulty research of Ansel Keys. I found out that every person makes their own Cholesterol. Some more than others and cholesterol is necessary for the body to function.

 

In that 40 plus years every doctor I had wanted to put me on Statins and every time I refused. I've never had a heart problem in all that time even after I was diagnosed with Diabetes 10 + years ago. I still have high cholesterol but I just ignore it.

 

There have been new studies that claim that Statins are over prescribed. I would take it seriously but do a lot of research if there was a history of family heart problems or if I had some kind of heart problem. The decision of whether or not to take a Statin should be yours not the doctors

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tovli
30 minutes ago, Dowling said:

if I had some kind of heart problem.

That is one of the fuzzy variables in this risk A or risk B vs risk C and risk D. 

 

There is some kind of heart problem, both evidenced and measurable, as well as a qualitative "non-normal heart rhythm" statement.  

There is also some kind of "metabolic problem" that is measurable but not evidenced as yet.

 

The statistical probabilities of benefit and harm for treat, not treat, treat with this and treat with that are all much less than "likely" - 12% in 10 years for heart that can kill, perhaps 20-30% for diabetes which might not kill but might be quite serious.

 

There are so many unknowns in the science, with differing opinions among the scientists and doctors, that weighing the publishings (when I can get my hands on full reports) spins my head with more less-than-likely statistics.

 

I have to wonder how much the doctors are being influenced by "we have a pill for everything that ails you", so if we keep you alive with this pill today, and you end up with diabetes, we've got a pill (or more) for that too.

 

If I was an optimist, I would love the fact that the prediction is 90% I won't have a heart attack, and 70-80% that I won't progress to diabetes, and even if I do cross some arbitrary official diabetes threshold, the more than 50% likely I will not become disabled by diabetes would be comforting.  So if nothing is likely to happen, why am I so worried about any of this?  Because I'm not an optimist, and I really don't want to look back and wish I had not trusted the "it probably won't happen to you" statistics.

 

I've decided to keep eating to the meter (1hr <140), keep exercising (180 mins/week vigorous), maintain my weight steady (not lose any more), and take the advice of the three docs to keep taking the Rosuvastatin at 20mg dose. 

 

I wish I felt as nonchalant about the HbA1c being 5.9% as these doctors, and change my eating-to-the-meter target to 160 or 170, but I think "my cheat" is going to be the Rosuvastatin 20mg.  

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Dowling
33 minutes ago, tovli said:

There is some kind of heart problem, both evidenced and measurable, as well as a qualitative "non-normal heart rhythm" statement.  

There is also some kind of "metabolic problem" that is measurable but not evidenced as yet.

 

Statins do nothing for heart rhythm. They install pace makers for that

You say you do vigorous exercise. Do you rehydrate yourself and have a carby snack half way? You use a lot of energy with vigorous exercise. I know you've cut carbs but if you don't replace that energy you can pass out or even have an abnormal heart rhythm. You will burn off those extra carbs when you continue to exercise.

 

My son lifts weights as well as being very active. He is in excellent health but after one weight lifting session he passed out. They took him to the hospital where they did lots of tests and they said he had an abnormal heart rhythm. They were going to put in a pace maker but were undecided if that was really what was needed. They finally decided to put in a heart monitor instead. It constantly monitors his heart and they can get readings off of it if he would have another episode. That was 4 years ago. He regularly has it checked and has not had another episode since then. We both assume that it was caused by lack of hydration and energy. That could be your problem too. In any case it wouldn't hurt to try hydration and energy while working out and see if it helps

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tovli
On 9/2/2021 at 8:11 PM, Dowling said:

Do you rehydrate yourself and have a carby snack half way?

Thank you for asking.  I am very careful about hydration before, during, and after exercise as I have to drink a lot of fluids to minimize kidney stone formation.  The running helps encourage stones to travel, but there is a risk of concentration if I don't keep my fluids in line with my perspiration.  Running in the Florida heat does pose a challenge on the water front.

 

I haven't taken to snacking during my exercise.  I believe my liver is OK at balancing glucose levels during my runs.  I am sometimes very, very slightly into ketosis post exercise.  (I don't seek ketosis, or eat keto - just measure it when I smell it.)   I've checked BG levels before and 1h after my post-exercise meal - always excellent (no "carb loading" foods anymore...)

 

Back in 2014, when I was trying to figure out my fastest 5k time, I did carry a small amount of dark chocolate and found it to improve my performance.  I was able to get my times up from 20-th percentile to 30-th percentile for my age, but I settled to running for my heart not for my ego.

 

These days, I don't have enough ego to even keep running for the whole time.  My walk/run time is faster than my run the whole way time, but perhaps I should dig out some dark chocolate next time, and see if it takes 10 years off my age.   

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