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  • Post heart attack/stents/1 year protocol

    Hi, longish preamble to get to my questions. I'm a 67 year old male, August 2018 heart attack survivor. Mild symptoms, 4 days to see my doctor, and 2 stents to clear 100%/80% arteries.

    My cardiologists are traditional, by the book. I'm taking their "standard protocol" of atorvastatin, lisinopril (ACE inhibitor), metoprolol (BETA blocker), and clopidogrel/aspirin.

    I am otherwise healthy. I hiked the Appalachian Trail 3 years ago! No family history of heart disease. I have switched to a LCHF/Keto diet. Blood sugar always under 100, BP 120/80, cholesterol figures slightly high. Non-Hodgkins Lymphoma 1998; chemo and radiation to the chest... which I think caused a thyroid problem to where I take synthroid, 150 mcg (my only other medication.)

    It seems to me that there must be MANY people, like me, who were shocked by their event. I've spent the past 9 months on the internet, and viewed many of Dr Brewer's videos on prevention. What I have NOT seen much of is a POST heart attack scenario to both prevent a repeat, but also to strengthen the heart (as my ejection fraction is only 43%).

    So, POST HEART ATTACK:

    - I KNOW my arteries must be gummed up; where do I go from here?

    - Should I stick to the one year protocol?

    - What testing is now advised, beyond traditional blood work?

    - At the one year anniversary, my doctor said that I can reduce or eliminate my drugs, but to what extent, what markers should I look for, etc.? There's lots of controversy about statins; I HAVE had muscular side effects, but only occasionally, and right now I'm leaning to stay on a low dose.

    - I've taken a variety of vitamins over the years. Is there a post heart attack starting point?

    I'd LOVE to have Dr Brewer to a video titled "YOU JUST HAD A HEART ATTACK. NOW WHAT???"

    Thanks in advance for any leads/videos, etc. Great site and great videos from a trustworthy source. Much appreciated!

    Alan Barker


  • #2
    Welcome to the forum. Dr. Brewer did a video on a patient who had had a heart attack, but I think that he has to be very careful to not seemingly provide medical advice unless you are a patient of his. There certainly can be a bit of a grey area between wellness advice in general and specific medical advice for a patient. Dr. Brewer covers that wellness advice part. In many ways, wellness advice should be the same as medical advice that you are getting from your doctor(s). I put down my limited non-medical license knowledge advice below.

    So, POST HEART ATTACK:

    - I KNOW my arteries must be gummed up; where do I go from here? Ans: Same advice for everybody, look carefully at all aspects of your lifestyle and diet. Correct those to the extent possible as you might not be able to do some exercises such HIIT (high intensity training). However, if you can walk long distances that is a great start for re-hab and long-term health.

    - Should I stick to the one year protocol? Ans: If it was me, I would learn enough to have an informed conversation with my cardiologist about the options. I would ask if the statin could be changed from atorvastatin to rosuvastatin based upon a study that Dr. Brewer discussed in this video. https://www.youtube.com/watch?v=Yp9nvc65HiQ

    - What testing is now advised, beyond traditional blood work? Ans: You should have an advanced lipid panel and an advanced inflammation panel to provide a good understanding of where you stand at the one year point. You should also ask about a CIMT test, and I posted a link to a long video (there are other shorter videos on this topic, but you might benefit from this one in particular). https://www.youtube.com/watch?v=7n06ULF27W8&t=2s

    - At the one year anniversary, my doctor said that I can reduce or eliminate my drugs, but to what extent, what markers should I look for, etc.? There's lots of controversy about statins; I HAVE had muscular side effects, but only occasionally, and right now I'm leaning to stay on a low dose. Ans: As I mentioned above, consider rosuvastatin over atorvastatin. See if you can tolerate a moderate dose of rosuvastatin. If your cardiologist is most interested in the LDL-C lowering effect, rosuvastatin is better than most other generic statins at an equivalent dose (i.e. you can get the same LDL-C lowering benefit from a lower dose of rosuvastatin). http://www.mqic.org/pdf/UMHS_Statin_...ency_Chart.pdf

    - I've taken a variety of vitamins over the years. Is there a post heart attack starting point? Ans: I take vitamins and minerals, but this is a very grey area as far as effectiveness goes. If you eat healthy and get plenty of micronutrients (vitamins and minerals) from your diet, then some people say you are wasting money with external pills. I think that taking a daily multi-vitamin is a good back-up for me. Also many people are low on vitamin D and magnesium in particular. You should get tested for your vitamin D level, and ask your doctor if there is any harm in taking a standard magnesium tablet (400 mg/daily). There are a lot of other supplements out there, but I have no understanding on how those would enhance a post heart attack health recovery in particular.

    I'd LOVE to have Dr Brewer to a video titled "YOU JUST HAD A HEART ATTACK. NOW WHAT???" Ans: Dr. Brewer does look at the forum and occasionally responds to individual questions. I personally think that question in general is best asked of your cardiologist in an informed discussion because there may well be uniqueness in your situation that requires more extensive consultation.

    One additional thing to recommend, ask your doctor about taking metformin even if you aren't diabetic. Metformin is very helpful for those with pre-diabetes, and that is the bulk of people with health issues in their mid-60's (including me). If you do take metformin, get your vitamin B-12 level checked from time-to-time because metformin is known to decrease vitamin B-12 levels. There are supplements out there for vitamin B-12, but some doctors prefer an injection method.
    Last edited by Tom; 06-22-2019, 01:10 AM.

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    • #3
      Define the problem. At this point you have no idea why you had plaque buildup in your heart arteries. The Cleveland Heart Lab Inflammation Panel would be a good place to start. It will both rule things out as well as rule things in.

      Your cardiologist should have recommended you go to heart rehab. Did that happen?

      Another option is Dr Ornish's Program for Reversing Heart Disease® which is covered by Medicare.

      In my experience, don't look to your cardiologist for advice. Find a good integrative doctor, make an appointment with Dr. Brewer, or use some other method to find a doctor that understands how to reduce your risk.

      If you haven't already, watch Dr Brewer's videos on stents. I believe the literature now says stents don't decrease the risk of future heart attacks or stroke, and don't increase life expectancy. You have to do that through diet and lifestyle and probably some medications.

      You might consider CIMT (echo - no radiation) or calcium heart scan (radiation) to get a baseline of your current plaque. Then yearly get a follow-up to see how you are doing.

      Read, read, read. (Something we should start here is a reading list with summaries)

      I personally recommend walking. I try to do at least 20 miles a week.

      A warning - while a lc/hf diet seems to work for most people, it is not the right diet for everyone. Make sure you are getting the results you want from the diet.

      Get your dna tested (23andMe or similar) and then analyzed for clues.

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      • #4
        Tom and Rich, thanks very much for the thoughtful answers and recommendations.

        I definitely need to be proactive. The hospital scheduled a follow-up appointment on discharge, for 1 YEAR later. I did find a doc in Florida, retired from the Cleveland Clinic, who gave thoughtful but traditional advise.

        I see my GP in a couple of weeks, and plan to forewarn him that I want some extensive testing. I will see where that goes, and make a plan from there. Thanks again!

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