Heart/Blood Issues

My History

Back in January 2005 I had a major heart attack – what is known as a widow-maker. I’ve related the details of it before (see here), so I’ll not repeat them. But following that event I began to get periodic testing – not only of my heart, but various blood tests which can give insight into some of the causes of heart issues. These insights have also been the reason for most of the medications I take – which have increased and gotten refined over the past 18 years.

Below I’d like to first give a complete list of my current medications and the reason for each, then detail the particular blood tests I currently get. I’ll end by noting some of the recent invitations I’ve gotten for various clinical studies which are related to the results of those tests.

[Blood drop]

 

My Medications

Allopurinol – This is the only one not related to these heart/blood issues. In 2001 I had a VERY painful kidney stone. This stone was not the more typical calcium stone, but one that was formed of uric acid – the same component that can cause gout. In order to prevent any future gout or kidney stones, this medication reduces the amount of uric acid in your system.

Baby Aspirin – Not a prescription medication, but a low dose of aspirin can help prevent heart attacks or stroke by acting as a blood thinner to make it easier for the heart to pump blood.

Farxiga – This works by helping your kidneys remove sugar (glucose) from your blood through the urine, which decreases your blood sugar. It can help lower the risk of heart attack, stroke, kidney disease, and heart failure in people with type 2 diabetes. (It is pretty pricy and is one of the 10 drugs on the list to have the costs addressed by allowing Medicare to negotiate prices in a few years.)

Lantus (insulin) – This is a long-acting insulin and is used primarily for adults with type 2 diabetes. I’ve been taking this for over two years now and it does a good job at helping to manage my sugar level.

Lisinopril – Used to treat high blood pressure and heart failure. It is often prescribed after a heart attack and helps to prevent future strokes and heart attacks.

Metformin – Helps treat diabetes by helping the body’s cells to better use the insulin that is still produced by the pancreas, i.e. for those with type 2 diabetes.

Metoprolol – A beta blocker which lowers your blood pressure and heart rate, making it easier for your heart to pump blood to the rest of the body. I notice that when taking this that even when getting my periodic heart testing that it’s difficult to get my heart rate up very high, so it’s very effective at that.

Niacinamide – An over-the-counter medication, this can help prevent vitamin B3 deficiency.

Omega-3 – An over-the-counter medication, omega-3 fatty acids can significantly reduce blood triglyceride levels. I had been taking this in the form of concentrated fish oil and by taking 3 tsp containing 4800 mg of Omega-3 I was getting 3900 mg of the DHA/EPA (goal was about 4000) – the part that had an impact. Earlier this year I switched to a squeeze pouch product which does not require refrigeration or measuring with a spoon. Unfortunately, I mis-read the label and saw the fish oil total of 4000 mg with just two pouches. However, of the 4000, only 2400 of the fish oil was Omega-3 and only 2100 was DHA/EPA so I inadvertently cut my DHA/EPA intake to only 2100. As you can see in the below writeup on my triglycerides, this had a negative impact, so I’ve increased my intake to 4 pouches which now gives me 4200mg of DHA/EPA.

Simvastatin – Used to treat high cholesterol and triglyceride levels and thus prevent heart attacks. I’m on the maximum dosage of this and while it appears to be very effective at keeping my cholesterol (both HDL and LDL) down, it has not had much impact on my triglycerides (see below for more on this).

Trulicity – A once-a-week injectable, this stimulates the pancreas to produce insulin secretions for those with type 2 diabetes. Like Farxiga, this is pretty pricy and I could benefit if it is put on the Medicare drug price negotiation list.

 

Blood Tests

Lipid Panel

This group of tests looks at the lipids (fats) in the blood as these contribute to coronary problems. In addition to the total cholesterol, they measure HDL (high-density lipids – the “good” fats), triglycerides, and LDL (low-density lipids – the “bad” fats). LDL is generally not measured directly as doing so is quite complicated and takes many steps. Rather it is calculated through a formula. The most common formula is called the Friedewald and calculates your LDL as equal to (Total – HDL – (Triglycerides/5)).

Because of the above medications I am taking, my total cholesterol is on the low side (100-120 v. a target of <200). Also, my HDL tends to be on the low side (30-35 v. target of 23-92). None of these are a cause for concern, except as it impacts the LDL calculation. I tend to get one of two errors in my annual Lipid results. First, if your triglycerides are more than 400 then they won’t even try the calculation. But because my triglycerides are high and my Total and HDL are on the low end this calculation results in a negative number for the LDL – for example, one test I took a few years ago had my Total at 101, my HDL at 36, and my triglycerides at 302, yielding a calculated LDL of -1. This is obviously incorrect. There are other formulas which try to account for these kinds of situations, such as the Sampson and Martin formulas. These tend to give results in the 20-45 range for my LDL. If these are correct, then since the target for LDL is to be less than 130 that means that my LDL is also pretty good.

Thus, my primary concern here is focusing on my triglycerides. The ideal is to have that be less than 150, but mine has never been anywhere near that. Before taking any Omega-3 supplements mine was over 900. Thus, when I can get it into the 200-300 range then I consider that success. I was pretty much there in December of 2021, but as noted above I made a miscalculation when converting from a liquid fish oil to some squeeze pouches and it went back over 400 again. I’ve now corrected that and hope to have it back in the proper range at my next blood test in 2024.

 

CBC (Complete Blood Count)

This analysis looks at all the various components of your blood with a count of each of the physical components – red blood cells, white blood cells, platelets, monocytes, ovalocytes, etc. Most of my results are within the normal range with two exceptions. First, my red blood cell count is on the low end and this can also be seen in the fact that my iron level (hematocrit and hemoglobin) are at the low end of normal. This not a cause for particular concern except that I have to watch my diet just before I give blood every 8 weeks as there have been two occasions when my iron level excluded my giving blood that day. Secondly, my platelet count runs around 90-100 when “normal” is 140-350. Again, it’s not low enough to be a concern (if too low a clotting factor they would not be able to perform things like brain surgery), but I am not excluded from anything at this level as it’s pretty stable. While I’ll continue to monitor the results of this test, there is nothing here that is concerning.

 

CMP (Comprehensive Metabolic Panel)

This analysis is looking at the various elements of the blood that relate to kidney function – things like sodium, potassium, calcium, etc. All my results are consistently in range with the exception of my glucose level. For more on that see my A1C results below where it is also tested.

 

A1C with eAG (est. avg. glucose)

This is the primary measurement of blood sugar that is used to monitor diabetes. There is a good detailed explanation here, so I’ll not repeat all that you can read there.

In summary, these are measurements of the percentage of glucose that is attached to your red blood cells. The A1C is the percentage of cells that have glucose attached to them. Since these cells have a lifespan of about 90 days, the A1C is the average over those 90 days. This can be converted to the amount of sugar in the blood which is measured in mg/dL (milligrams per deciliter). This latter measurement is the same as the numbers that you get when taking a fingerstick and having a drop of blood analyzed by a glucose meter. This fingerstick measurement is an instantaneous measurement of the amount at that moment – which will vary all day long as food is taken in and the sugar in that food is absorbed.

Here is a summary of my A1C results over the past several years with some commentary on the medication changes that I was getting at the time:

·       2015 – 8.5 (197) – first measurements, obvious that I had diabetes which is anything greater than 7.0

·       2016 – 6.6 (143) – started taking Metformin

·       2018 – 8.1 (186) – dosage maxed out, need additional medications

·       2019 – 6.7 (146) – began taking Farxiga and Trulicity as well

·       2020 – 7.8 (166) – still increasing

·       2021 – 8.0 (183) – time to start on insulin (Lantus), met with nurse specialist and slowly ramped up amount until results acceptable

·       2022 – 6.9 (154) – doing well, anything under 7.0 is considered “managed”

·       2023 – 6.7 (146) – continuing to do well, in fact improving

It appears that I have finally gotten my sugar levels under control. In addition to the various medications, I also watch my diet (eat healthy and only take diet soda). As I monitor my sugar each day with a glucometer, I take note whenever it is high and think back through the prior day and what may have caused it. In addition to breaking my diet for the day, things like stress have an impact. I wish I could cut out the high-priced medications (Farxiga and Trulicity), but they are designed to work on other parts of the whole picture than Lantus, so I’ll keep them for now.

Some of the impacts of diabetes such as diabetic retinopathy I’ve avoided by never having my glucose levels be real high (over 9.0), but unfortunately, I do have peripheral neuropathy in the front halves of both feet and that damage is permanent so I have to be careful to not injure my feet as I will not feel it. But for the most part, I’m pretty comfortable with where I am now.

 

Clinical Trials

I’m now starting to get calls about clinical trials related to the above. At the end of August I got one call from a hospital in Philadelphia that was helping to test a new drug that was designed to help with lipid levels. The requirements were that the person had to have had a heart attack (check!), was maxed out on taking a statin (check!), and had a starting LDL of 55 or more. I drove down to Philly to get some blood testing to confirm my LDL level since I really didn’t know what it was due to my high triglycerides. Unfortunately, (?) the blood test came back and assigned me an LDL level of only 17. While I’m happy with those results, it meant that I didn’t qualify.

Last week I got another call from a hospital in Horsham about another drug trial. Over the phone I confirmed that I met the initial screening criteria of having had a heart attack and being on long-term use of a statin. I’m awaiting a second call to go over the exact details. I don’t yet know if I will still be qualified after going through all those details.

 

Conclusion

While the number of medications I take is not insignificant, I seem to have things in this area fairly well under control. My heart remains healthy, my diabetes has been stable to improving for the past few years, and while my last triglyceride level was too high (again!), I have identified the cause and am pretty confident that it will be back where it needs to be when I next get it tested in 2024. But there are a lot of moving pieces that I’m keeping track of.

I’m not sure what clinical trials I may qualify for, but I’m open to doing so to improve our scientific understanding of this area, and to help test new drugs which may help others.