Had a Heart Attack today at age ~30. Be safe guys.

[RockyP]

Right now my heart meds are as follows

Telmisartan 20mg
Cilnidipine 5mg (please India open back up ...thanks your friend wiz)
Icosapent Ethyl 4g 2x2g
Repatha 140 EOW
and I am considering 1mg or 2mg Pitavastatin for further lowering down the road.

BP is great, Cholesterol vastly vastly improved and dropping every 3 months. This is something to consider down the line.

Cardiovascular risk reduction with icosapent ethyl : Current Opinion in Cardiology

in ischemic events. Recent findings Mounting evidence suggests that triglyceride elevation is an independent risk factor for ASCVD. Though trials of triglyceride-lowering therapy in the statin era have failed to provide protection from ASCVD events, subgroup analyses have revealed that those...

journals.lww.com

Summary​

Icosapent ethyl was rigorously shown to decrease residual risk for cardiovascular events, though the benefits seen were likely because of mechanisms beyond mere triglyceride lowering

Interesting. I’m just thinking ahead when I ask the cardiologist for a script the first thing he’ll say is you don’t have high triglycerides.

 

[DugPrime]

If you’re on gear you should be on a statin. Pitavastatin if you can. Rosuvastatin otherwise.

EPA/DHA + Ezetimibe already do the job to be honest, but my LDL is at 70, I'd like to get is close to 40.

 

[The Answ3r]

I recently had an ECG, an ultrasound of my heart, and a carotid intima-media thickness scan (the one that shows if there are any plaques). Everything looked great except that my heart is about 15 mm larger than it should be for my size. After reading stories like this on the forum, I guess I need to keep an even closer eye on everything.

 

[Wizbang]

Interesting. I’m just thinking ahead when I ask the cardiologist for a script the first thing he’ll say is you don’t have high triglycerides.

Tell him you've been taking fish oil and would much prefer not wondering how pure or effective it is and you've been reading studies on the purified form of EPA (vascepa) and you wonder if he would be willing to prescribe it.

 

[RockyP]

EPA/DHA + Ezetimibe already do the job to be honest, but my LDL is at 70, I'd like to get is close to 40.

Is your HDL normal range?

 

[DugPrime]

I recently had an ECG, an ultrasound of my heart, and a carotid intima-media thickness scan (the one that shows if there are any plaques). Everything looked great except that my heart is about 15 mm larger than it should be for my size. After reading stories like this on the forum, I guess I need to keep an even closer eye on everything.

If you can afford it, try talking about entresto to your cardiologist.

 

[RockyP]

Tell him you've been taking fish oil and would much prefer not wondering how pure or effective it is and you've been reading studies on the purified form of EPA (vascepa) and you wonder if he would be willing to prescribe it.

Great advice. Thanks brother.

 

[Wizbang]

Is your HDL normal range

This is an important question, the ratio between HDL and LDL is telling variable it seems.

 

[DugPrime]

Is your HDL normal range?

It's around 30.

 

[Wizbang]

If he asks what studies you've read tell him JELIS as well as a couple on the pleiotropic effects of icosapent. Sometimes they like to test to see if you've actually done the homework.

 

[RockyP]

If he asks what studies you've read tell him JELIS as well as a couple on the pleiotropic effects of icosapent. Sometimes they like to test to see if you've actually done the homework.

I will send it to him. He has no reason to give me a hard time. But thank you very much!

 

[RockyP]

It's around 30.

Same. I haven’t seen one over 40 from “one of us” in a while. But that’s why I’m so aggressive with LdL lowering. My HDL is dogshit so I want my ldl so low that the HDL issue becomes unimportant / less important.

And as far as I recall there’s no real data to show that chasing HDL to try to raise it has any positive impact on cardiac events, especially if you’re ldl is under 60-70.

 

[dinfar1337]

Recovery plan is:
- 2 weeks cardio-only
- Atorvastatin, Aspirin + Ticagrelor (DAPT), Metoprolol, Lorsartan
- Following Echocardio in a few weeks

i might have missed it,

but what are your plan forward with lifestyle factors to ensure maximum heart health?

just simple stuff already when you're fully back

is bumping cardio to max 1hour daily
omega 3's dosing at 1-2g a day of epa/dha
obviously your beta blockers
stress testing your max heart rate and vo2 max preferably in a clinical setting with nurses/doctors around(inexpensive maybe 100-150$)

and looking at heart rate data, blood oxygen levels etc through a smartwatch(my inexpensive xiaomi watch does this accurately and the watch cost like 40$)

it have some nice features with 98% accuracy


"Monitors heart rate, stress, blood oxygen, and sleep. A micro-physical examination report is generated in around 60 seconds."

etc.

it would be helpful to you and others if we can workout a heart health lifestyle plan we all could follow! + full supplements list legal & illegal and nice stuff like the xiao mi watch

 

[Photon]

If you can afford it, try talking about entresto to your cardiologist.

It's now a generic and will be covered by almost 100% of the insurance companies out there.

Without insurance, $1 a pill. CostPlus.
With insurance coverage, close to free.

 

[Wizbang]

i might have missed it,

but what are your plan forward with lifestyle factors to ensure maximum heart health?

just simple stuff already when you're fully back

is bumping cardio to max 1hour daily
omega 3's dosing at 1-2g a day of epa/dha
obviously your beta blockers
stress testing your max heart rate and vo2 max preferably in a clinical setting with nurses/doctors around(inexpensive maybe 100-150$)

and looking at heart rate data, blood oxygen levels etc through a smartwatch(my inexpensive xiaomi watch does this accurately and the watch cost like 40$)

it have some nice features with 98% accuracy


"Monitors heart rate, stress, blood oxygen, and sleep. A micro-physical examination report is generated in around 60 seconds."

etc.

it would be helpful to you and others if we can workout a heart health lifestyle plan we all could follow! + full supplements list legal & illegal and nice stuff like the xiao mi watch

This is a great idea.

 

[dinfar1337]

This is a great idea.

maybe, its just my first thought if i even had heart issues i hope he indulged in some of the same thoughts already

 

[Photon]

Interesting. I’m just thinking ahead when I ask the cardiologist for a script the first thing he’ll say is you don’t have high triglycerides.

Icosapent Ethyl is the generic.

Ask for Vascepa, its the branded version.
Send to a physical pharmacy.
Use discount coupon found here Official Patient Site -- show it to the pharmacist.

90d supply is 9$.

 

[Wizbang]

Icosapent Ethyl is the generic.

Ask for Vascepa, its the branded version.
Send to a physical pharmacy.
Use discount coupon found here Official Patient Site.

90d supply is 9$.

you mean i've been paying 35 a month for no reason?! shame on me.

 

[Photon]

you mean i've been paying 35 a month for no reason?! shame on me.

Download the discount coupon from the website.

 

[Ghoul]

@Ghoul I do think there is an "x factor" missing from the equation of all of this (blood lipids and cardiac events etc). I feel like there needs to be a better way to determine plaque formation/build up/ predictability and a focus on potential avenues for stabilization/regression which does not seem to be showing in the literature. I know you and I have spoken about vascepa (icosapent ethyl) which I am currently on 4g/day, but when I asked my cardiologist about figuring out a way to determine efficacy he was a bit flabbergasted.

There are certainly other factors. The reason for all the focus on LDL is because it carries the vast majority of total risk, and with current treatments easiest to control with lowest sides. So if there's one thing to focus on, LDL has the biggest impact. And the sad fact is, only a small percentage of people at risk control it. Even after heart attacks, most people will stop LDL lowering therapy within a year.

People with low LDL have the lowest rate of cardiovascular "events". It's that straightforward.

BP control is next.

(skipping chronic disease risk factors like diabetes, ckd)

Everything beyond this point is small potatoes by comparison.

Lp(a). Not much to be done at the moment if it's elevated. It's mainly used to guide how aggressive someone should be lowering LDL. IMO you should be as aggressive as the strictest guideline, below 40, regardless. If it's high, meds are coming soon to lower it.

Low HDL: Not much can be done here either besides exercise. Pharmacologically increasing it doesn't reduce risk.

Inflammation and endothelial function. This can be controlled, and can cause ruptured plaque if you have significant existing buildup. The main thing for this however is still, to reduce LDL. Over time existing plaque stabilizes by fibrosis and calcification. Statins (and many other things) reduce inflammation. Daily cialis, GLPs, Telm, Cilnidipine, and other drugs/supps contribute to improved endothelial function.

It would take too long to cover all the other things that reduce risk in this post. But suffice to say, if LDL is lowered sufficiently, all other risk factors (except BP and Lp(a) ) become even less significant (but still worth pursuing ofc).