Reminder... Risk Factors for Stroke and MI - review

Obviously, it’s reasonable (and smart) for afibbers to be concerned about the risk of stroke because of so many potential, influencing factors. If you’ve been reading here for years, then you know my concerns and the story about my clot issue. And for newer members, I want to remind that there are numerous underlying factors that contribute to what makes blood more likely to clot especially when it’s ‘churning’ during the arrhythmatic ‘cycle’

This report from 2012 details factors that all afibbers should be monitoring and even after ablations solve the Afib factor, that doesn’t absolve us from the ‘thick, sticky blood factor’ that puts everyone at risk for stroke. [www.afibbers.org]

Again, for newer members… my AF began in 1995 and around 2002, I found Hans’ website and started learning. Back then, warfarin/Coumadin and aspirin were all that was typically recommended. I had low platelets so neither was a comfortable solution for me but for my ablation in 2003, I was placed on warfarin before and for 3 months after. That was the typical regimen back then. There is a post about my clot experience.

Excerpt..

My next experience was post-ablation, (you've heard this before) when, at 103 days, I went into AF. I called for a cardioversion appointment immediately and was told to wait out the day and come in the following day at a designated time which would have been before the 48 hours as I was not on coumadin at that time. I was cardioverted at hour 39 and sent home. The EP attending the cardioversion said if patients are not on coumadin, they don't automatically tell them to go back on it, and that was exactly what I wanted to hear. I had resumed taking nattokinase once I stopped the coumadin after ablation so I just continued on with that.

A week after cardioversion, I had my post-ablation check-back which included the spiral CT scan of my heart to check for stenosis. At that visit, I was told I had no stenosis and my heart was fine. However, when I received a copy of the CT scan report by the radiologist, it was noted that I had a clot in the Left Atrial Appendage. This was about 5 weeks later and I was still living! I had been on the nattokinase but only at a dose of 4000 FUs a day.... had I known about the clot, I would have increased the dosage significantly.

I spoke with Dr. Natale's nurse after learning of the clot and she said I could come in for another scan, which I opted not to do (avoiding radiation)...... and I said, most likely since I was still alive, the clot had dissolved with the use of nattokinase.

So... what you need to realize is that coumadin/warfarin does not guarantee 100% that a clot will not form. Hans has published this data many times.

Nattokinase reduces the level of fibrin in the blood and reduces viscosity both of which help to form clots. It also inhibits PAI-1 which is in high levels during the ‘wee hours’ when clotting activity is high.

At the time, Hans had shared with me these study results about efficacy of warfarin… so after reading, I felt extremely fortunate to have had the knowledge provided to me by Dr. Holsworth on Nattokinase.

There is a reference to the questionable effectiveness
of warfarin in the October 2004 issue of "The AFIB Report".

A group of German researchers observed that 53% of permanent afibbers
admitted to hospital while on effective anticoagulation still had thrombi
in the left atrial appendage. Sixteen per cent of these thrombi
disappeared after 1 month of anticoagulation, but even after 12 months 44%
were still present. The researchers concluded that continued effective
anticoagulation does not prevent thromboembolic events in patients with
permanent AF and prevalent LA thrombi.

There is also a study that investigated the use of stroke prevention in
afibbers admitted to hospital with a stroke. It found that 32% of 596
patients were on warfarin at the time of their stroke, 27% were on aspirin,
and 42% did not use either warfarin or aspirin. This study was reported in
the December 11, 2004 issue of NEJM. You can find an abstract at
[www.ncbi.nlm.nih.gov]


There is an abundance of information on hyperviscosity and which lab tests are useful in determining that status.
My FM MD does those labs either annually or sooner, if any of the markers are out of range and she’s recommended protocols to normalize. Here’s an excerpt from a previous post on the topic..

THE IMPORTANT TESTS

People with high levels of C-reactive protein were over four times more likely to have heart attacks than people with low levels.

1) Cardiac CRP levels should be less than .80mg/dL ( also called High Sensitivity CRP), but it is not the only test you need to consider. Labs that perform these include Immunoscience Labs, Quest Diagnostics and Lab Corp just to name a few. [He's raised his acceptable range a bit - he used to say 00 - .50 mg/dl with ideal being as close to zero as possible].

2) Homocysteine (HCY) is an amino acid that causes your body to lay down sticky, artery-hardening platelets in your blood vessels. Some HCY is fine but an excess may destabilize atherosclerotic plaque by prompting LDL cholesterol to oxidize. HCY results from your body's ineffective breakdown of methionine, an essential amino acid found in all proteins. Meat, eggs, milk, and cheese have two to three times the methionine than grains and vegetables. Levels should be less than 10 umol/L. [My doctor wants it 6 or lower- Jackie]

While commercial blood test labs say 'normal' HCY can range from 5-15 micromoles/liter of blood, medical studies show that HCY above 6.3 are unhealthy and associated with a steep, progressive risk of coronary artery disease and heart attack. The average American's HCY is 10, more than 50% above the low-risk threshold. HCY concentrations now widely accepted as normal are associated with increased likelihood of coronary artery disease and this risk increases with rising HCY concentrations. Each 3-unit increase in HCY is equal to a 35% increase in heart attack risk. [Read more on HCY at [www.hsfighters.com]. Excellent article with references]

If you've had a heart attack or other cardiovascular event, have a family history of early heart disease, or are hypothyroid or have lupus or kidney disease, you should ask your doctor to test your HCY levels.

Drugs that elevate homocysteine - niacin (for cholesterol lowering) theophylline (for asthma) methotrexate (cancer or arthritis or L-dopa (Parkinson's). If used, you're a candidate for testing.

3) Lipoprotein(a) - LP(a) is a cholesterol particle that has adhesive protein surrounding it which gives it sticky properties and can cause inflammation and clogging of blood vessels. LP(a) deposition in arterial walls causes inflammation because of its repair properties. In the presence of vitamin C deficiency, Lp(a) can become one of the most dangerous risk factors for atherosclerosis. High levels are not affected by dietary habits and is entirely a heredity factor, so if you have a family history, you need to be checked.
Levels should be less than 30 mg/dL

4) Fibrinogen is a coagulation type of protein that determines the stickiness of blood by enabling platelets t stick together. You need adequate fibrinogen to stop bleeding when injured, but higher than normal levels are associated with too much blood clotting and is an independent risk factor for heart disease. By itself, high fibrinogen can cause abrupt formation of a coronary thrombosis (heart attack.) High levels can indicate a genetic tendency. Women who smoke, take oral contraceptives or are post menopausal should also be tested.
Range is 180-350 mg/dL

5) Serum Ferritin - Iron is necessary for stimulating the production of hemoglobin, the red blood cell pigment that carries oxygen to cells. However, newer research indicates that iron overload, or hemachromatosis, an acquired or heredity defect of iron metabolism, can actually contribute to heart disease risk. Iron is stored in tissues and muscles and over the years, toxic levels can accumulate. A 1992 Finnish study indicated men with excessive levels of ferritin were more than twice as likely to have heart attacks and that every one % increase in ferritin translated into a 4% increase in heart attack risk. Lab ranges 10-191 ng/ml. with a preferable below 100. [ My doctor likes it around 50. Jackie]

6) Interleukin-6 - stimulates the liver to produce CRP. Studies indicate elevations of IL6 and CRP are associated with increased risk of both cardiovascular disease and general mortality in healthy older people. Dr. Sinatra thinks IL6 may be better marker than CRP for inflammation. Optimal range is 0.0-12.0pg/ml.

7) Oxidized LDL - cholesterol is still linked to inflammation, so you aren't off the hook with high lipids and HDL tends to be low. Oxidized LDL is a blood lipid component that can lead to the production of pro-inflammatory chemicals that can activate white blood cells to ingest cholesterol-containing particles. Foam cells are then formed, setting the stage for further inflammation.

Who gets oxidized LDL?
- female, particularly with a family history of early, malignant heart disease
- over-exercise, such as running marathons
- exposure to radiation (Chernobyl)
- heavy metal toxicity, especially if your mercury or lead levels are high
- are under severe emotional stress

Continue for more details:
Sticky, thick blood - risk of stroke or MI [www.afibbers.org]

Red Flags to Beat the Odds - Re-posted from 12/29/02 [www.afibbers.org]


Jackie

Thanks for sharing Jackie. I have high hematocrit levels. They've been high for years. I'm always right at or above the upper limits.

I've had all the blood tests done looking for hematocritosis and everything came back negative. I'd really like to get the levels down but not know how to do that besides giving blood. Which of they don't want because I have high iron levels.

Rocketritch - I am familiar with iron overload. The doctors here (Hematologists), treat it by regular blood draws (phlebotomy).. .just like donating...but they discard the blood. They test first to check the level and if out of range, you have the blood draw. I know a person who has been doing this for a number of years. He goes every 3 months and sometimes, he tests OK and others, he needs the phlebotomy.

It's known that in iron overload disorder or hemochromatosis, symptoms can be arrhythmias and palpitations. He had some type of heart activity but not formally diagnosed as Afib and having regular phlebotomies has helped reduce that.

Just FYI.

Jackie

Rocket

IDK if this is true but MD told me high HCT from OSA

Also from T therapy,

I have to give blood and have them toss it away. Will have to do it again soon.

Right before my ablation I had to give two pints to get into range.

I am on "T" therapy. However, it has had no affect on my hematocrit levels.

I even gave blood and it had no affect on the levels.