Sunday, May 12, 2013

Life Line Take Action Risk Factors

The modifiable risk facotrs are

  • Overweight
  • Taking Aspirin Daily (which I am)
The non-modifiable risk factors (finally!)

  • Cardioovascular Disease (pretty general though)
  • Family History of Stroke or TIA (sure enough)
  • Atherosclerosis (I have some -- assumed non-reversable -- but maybe not)
  • Asthma
  • Age
  • Family History of COPD or Emphysema (Dad had it)

Life Line Discussion 6 For Life Health Assessment: Lifestyle Choices

This is helpful. I've been depending on about 3-4 days of biking per week. But exercise at least 5 days a week is suggested by the AHA. I'd like to do something at least 6 days a week: harder on some days and less so on the others. Walking an hour on the Mills trail, jogging with Van can be included.

In addition, activities can be split into several short periods of 10 minutes, 2-3 times a day. This may be the mode that can provide the BP-exercise-protection. But what would they be? Wii? Walk? Chin ups?

Monday and Wednesday rides; Tuesday VG; Thursday jog with Van, Friday Mills Trail; VG on Saturday. This looks good.

But some short, intense exercises might be good on week days also. Need to think them out. And space them out so that the BP protection is maximized.


Will revisit this with the "China Diet Here"


Will be within the 14 drinks for me per week. No problem.


Avoid 2nd hand smoke (and smog)

These are all points that are noted in this section. Just on lifestyle.

Life Line Discussion Lung Cancer

Low Risk at 5 but having a history of asthma and bronchitis predisposes one to lung cancer. Also, growing up in a smoking environment predisposes.

Life Line Discussion Chronic Obstructive Pulmonary Disease (COPD)

A surprising (for me) score of "Moderate" at 35

I do have a family history, am 71 years old, and have had asthma. This may account for the "Moderate". But I'll ask my GP if there is anything else that he hears when he listens to my lungs.

I did get that bronchitis for a day or so in Istanbul which took a week or so to fully recover from. It's possible I had some phlegm at the time of the Life Line Screening but my impression is that this result is based

Life Line Discussion Diabetes

Page 11. Risk at 20 is Low.

The lifestyle indication is better diet. Portions, vegies (3 greens/meal), tofu more often, less dairy, that sort of thing.

Life Line Discussion Stroke

79 is "Very High" (and very troubling). See earlier post.

The folks at Orange County Heart Institute said that 70% is "in the genes" leaving only 30% for medication and lifestyle. I've maxed out on drugs for lipids, so that leaves only lifestyle. I've maxed out pretty much on exercise (except for frequency), so that leaves diet. Everything is coming down to diet.

In China, I lose 5 pounds/month. Can I institute the "China Diet" here? Maybe the Vegan Before 6 would work.

I like categories. Dairy? Snacks? Bread? Salt?

I certainly can cut down on salt by cutting out open-ended salty snacks.

But what would be an associated goal? 15 pounds over the next three months; plus less salt. Also, exercise every day to diminish BP spiking. Could that translate into a "High" rather than "Very High"?
Shoot doing this by Fall. If I go to China there could be additional benefits.

Life Line Discussion Congestive Heart Failure (CHF)

Page 10 has a little more material than the result page. But the score of 15 is "Low".

With CHF the chambers of the heart become weak. If it is in the left ventricle, blood and fluids collect in the lungs or heart. If it is in the right ventricle, fluid collects in the legs and feet.

CHF is the number one cause of death in people age 65 and older. With CHF, the cause of death is either acute pulmonary edema (fluid in the lungs), or an arrhythmia (irregular heart beat.

Dad's CHF involved fluids in his lungs.

Life Line Discussion Coronary Heart Disease (CHD)

58 is the result (on a scale of 100). See earlier post on CHD. The question is whether lifestyle changes, in particular diet, can lower this. Can this be lowered to "Moderate" for example?

Life Line Discussion Waist

41 where 40 is upper limit of Normal. Make getting this to 40 a goal. By Fall, 2013.

Saturday, May 11, 2013

Life Line Discussion: Blood Pressure

168/83 is of course high, but my average of the last couple of years is 120/67. Spiking is the issue. I'll be commenting more on that.

It may not take much cardio to affect BP. A ride back today from the Farmer's Market may have done it. After a shower and watching golf, my BP was 109/59; lower than the 173/73 which I got this morning in bed.

Life Line Discussion BMI

Two risk factors including this one indicate weight loss. I should shoot for 185. Keep exercise and improve diet.

My height was measured at 5' 10". I was six feet. The BMI would be affected a bit if I were a true 5" 11".

Life Line Heart Risk Assessment

The explanation on page 8 is helpful. It is based on the Framingham study. I'll quote it.

"Your Heart Risk Assessment Score, reported as "10-Year CHD Risk", is greater than 30%. That means about 1 out of 3 people with this level of risk will have a heart attack or die of heart disease within the next 10 years. Although this level of risk is high, there are many things you can do to reduce your risk, such as diet and exercise in addition to medications that can help you proactively reduce your risk. We recommend you speak with your physician about what you can do to reduce your heart disease risk."

It seems that we are left with lifestyle choices since drugs are giving the desired lipid profile.

Question: is this locked? Or would lifestyle changes bring this down to say 20%? What would it take to do that?

Life Line Lipids & Metabolic

The good lipid profiles are confirmed by the pin-prick tests adjusting for my not fasting.

Glucose of 107 is high but is accounted for by my not fasting. Same with tryglycerides.

C-Reactive Protein is a low-risk indicator for cardiovascular disease. It is part of my immune system which seems to be working well. A caveat is that it is non-specific.

Life Line Discussion of Results: Carotid to Osteoporosis

Life Line prepared a 20 page report. Beginning on page 5, there is a narrative account of the results. I'll remark on sections of interest.

Carotid Artery Disease - "Your screening revealed minor plaque buildup which does not affect blood flow."

Atrial Fibrillation - Normal, but an "Important Note" says "A possible abnormality has been identified: At the time of your atrial fibrillation screening, your heart rhythm indicated a possble conduction abnormaility." I wonder if this is the PAC that has been identified before. I left the EKG with my GP.

Abdominal Aortic Aneurysm - Normal. But that means 3 cm or greater. There could be small ones?

Peripheral Arterial Disease (PAD) - Inconclusive. Normal is with an ABI (Ankle-brachial Index) of between 0.90 - 1.3. The ultrasound device measures systolic pressures in arms and legs. A ration of less than 0.90 indicates plaque buildup. Mine at greater than 1.3 could suggest that small arteries of the legs are calcified. You see this with people with diabetes or chronic kidney disease. This could be a falsely high ankle to brachial index. (I need to know more about the ratio.)

Here is a Wikipedia account. The ratio is between the systolic BP of the arms and the legs. Lower blood pressure in the legs would indicate blockage. My reading is higher. Could be inconclusive. Could be worse. :) I should be able to reproduce the results and will post back. There is some indication that exercise can increase sensitivity of this test, so I can try it just after exercise.

I ran my own tests of BP on left arm and let, then right arm and leg with my monitor. On the left the ration was 1.34 which was outer limit of normal. With some exercise of the ankle, it might be within normal range. On the right arm and leg the ratio was 1.2 or in normal range. This is important since it was the right side only that was inconclusive in the last Life Line screening. I would seem that my GP was right in not worrying about the finding last time.

  • The left arm: 128/68; leg: 171/73; ratio   171/128 = 1.34
  • The right arm: 122/67; leg: 147/65; ratio 147/122 = 1.20

Diabetes, heavy smoking, kidney problems can all give elevated ABI ratios. (Not a happy thought.)

Osteoporosis. Low Risk at -0.3.

Expected, but calcium, Vitamin D and weight-bearing exercise are all recommended.

Life Line Lung Cancer

"Low" (0-20) at 5. Good news.

I suspect that this is a result of my not smoking and that my parents didn't have lung cancer I suspect that if you factor in Uncle Baker and Cousin Allen, this indicator would go up.

Life Line Chronic Obstructive Pulmonary Disease (COPD)

"Moderate" (21-40) at 35. This is a cause of concern.

This was not a direct test. I didn't blow into anything. It would be helpful to know what it's based on. The gap between 35 and low is 15 which appears appreciable.

Given my level of exercise I suspect this may be a false positive. Will check with GP.

Life Line Diabetes

"Low" (0-20) at 20. Good.

In fact my glucose result was a little high 107 but I had not been fasting. My ACT's have been in the normal range. Gridley thought I might have some insulin resistence, but this doesn't appear to be the case.

I do have some indication of a "fatty liver" and my ferretin levels have been high in the past.

The scale is the same for all six Life Disease Conditions.

Life Line Stroke

"Very High" (71-100) at 79 - This is very troubling.

Again, the gap between the measure (79) and "Moderate" seems immense. (79-40=39). I would have to descrease this measure 50%.

Again, with this measure change with lifestyle changes? Could I shoot for say a "35" in a year? Six months? Two years?

Mom had small strokes (MID) which resulted in Alzheimer's-like symptoms.

Life Line Congestive Heart Failure

"Low" risk (Green - 0-20) at 15.

This is a good result. Again it appears to be a 0-100 spectrum with the same thresholds as the CHD scale. "Congestive Heart Failure" was on Dad's Death Certificate.

Low 0-20
Moderate 21-40
High 41-70
Very High 71-100

Life Line Coronary Heart Disease

"High" (41-70). 58 is my risk score. It would help to know the units. It looks like a spectrum from 0-100.

0-20 Low
21-40 Moderate
41-70 High
71-100 Very High

It looks like a big leap to get from 58 back down to 40 which is moderate. According to the Orange County Heart scan, I'm in a "High" category. Check back to the beginnng of this blog or click here to see their results. Although I don't remember the time line, there was a 1 in 5 chance of a heart incident with it. Another measure suggested I was 21 times more likely to have a heart attack if left untreated. Again, time frame and specific treatment need to be specified. The heart risk assessment of Life Line showed a 30% chance of heart risk in the next ten years.

My GP (and others) hold the position that some reversal can occur with plaque build up in the heart. But the test to establish that is both expensive ($300 last count) and adds more radiation, of which I have probably had my share. I remain curious. My GP did suggest a full body scan (to look for hidden issues that he can't feel directly) and that would include a retest of the heart scan. That's about $600.

But whatever the scan would show, the current medication would still be prescribed. In other words, since the results would not affect the treatment, the tests are not medically indicated.

Of course lifestyle including diet are still variables. Losing 15 pounds would be a good thing. A still better diet would be a good thing. A question for my GP is if I lost those pounds and became a vegetarian would the "58" change? In six months? In a year?

Even if there is no reinforcement, a response to that number might well involve weight loss and diet changes.

What if I lost an inch on my waist and reduced the BMI 10%? Would the CHD indicator come down? That would be a nice reinforcement.

Life Line 6 for Life Disease Condition

Life Line uses a "proprietary Life Line Screening ...algorithm" to identify disease conditions which they call "6 for Life Disease Conditions." My question is whether these are "locked in" or whether the measures on which they are based can be improved. I'll take them up in order. (Reverse the order if you are reading postings sequentially in this blog.)

They are:
  1. Coronary Heart Disease (CHD)
  2. Congestive Heart Failure (CHF)
  3. Stroke
  4. Diabetes
  5. Chronic Obstructive Pulmonary Disease (COPD)
  6. Lung Cancer

Life Line Waist

A nice feature of the Life Line tests is that they are all markers of risk. I know the circumference of one's waist is a good indicator however humble its origins. Mine is 41 where "Normal" maxes at 40. This is a good goal.

Friday, May 10, 2013

Life Line Blood Pressure

168/83! This was the 3rd try and it was on my wrist. The left and right arms didn't yield a result. My average, resting and lying down is 120/67. See my post on spiking earlier.

Life Line BMI

"Moderate" risk. 25-29.9. "Normal" is 18.5-24.9 It is a reasonable goal to get this to normal. I probably was normal at 189 pounds in Hangzhou in the Fall of 2010.

Life Line Heart Risk Assessment

"High Risk" (Red) at "Greater than 30" where that's percent. As I read it, I have a 30% chance of a heart incident in the next ten years. I will come back to this. The Orange County Heart Institute also gave this as a result. It comes from correlating know risk factors from the Framingham Study with my known risk factors, including heart issues in the family. The question is whether this is still 30% given my response including medication, exercise and diet. I'm hoping to hear my GP say that my risk is now lower than 30%. This may be tantamount to checking to see whether there has been a roll back of heart plaque from my last test at the Orange County Heart Insitute. My GP may say "You clearly have risk but we are addressing it in every way possible. It is less than it would otherwise have been. Surely, but is it less than 30% over the next ten years?

Life Line C-Reactive Protein

"Low Risk" (Green) at 0.10. Good news.

Life Line Glucose

"Pre-Diabetic" (Yellow) at 107. In fact, fasting, I typically get less then 100. Previous results have been in the low 90's. This is an anomaly.

Life Line Complete Lipid Panel

I had already had a panel done the previous day (see earlier post). But this came with the package so I went with it even though I had not fasted. This elevated some of the readings.

Total Cholesterol: 156 which is "Desirable" (Green).
HDL is only 34 (and lower than the 39 of the earlier test) and is reg-flagged.

This of course is the familial predisposition (hyperlipoprotenemia type ????) which I share with my brother. Low HDL, average overall Cholesterol, elevated triglycerides, elevated LDL's -- and probably small trait LDL's - the small, gritty kind. Omega3 can help bump that up to 40 and slightly more, but the 50's are probably out of reach, though maybe niacin can do it.

But I've shown 40's previously and the last result was 39 and my GP though the profile was fine.

Triglycerides are shown as borderline here but probably because I wasn't fasting. With the Trilipix they are typically within the "Normal" range which is shown here as <150 .="" p="">
So the lipid panel can yield a "Desirable" result. The lingering question is whether this reflects the same state was the same test finding without drugs.

Life Line Osteoporosis

"Low Risk" (Green) less than -1.2; Actual reading -0.3

Thought so.

Chronic Venous Insufficiency

Not tested but recommend NOW. Deals with venous refill time in seconds, right and left sides.

Life Line Peripheral Arterial Disease

"Inconclusive" on both sides with "2.11" entered. The clinical measure is the "Ankle Brachial Index".

Previously, I had gotten an inconclusive on my right ankle (which was the one which had been broken) but not the left. My GP didn't seem concerned. But I'm puzzled there is an issue here with peripheral arteries given the amount of exercise I have given them (or maybe not!).

Life Line Abdominal Aortic Aneurysm

"Normal" - Less than 3 cm. Good news and same as last screening a couple of years ago.

My Did had a ruptured aortic aneurysm and was pulled through it. My Aunt Cay also had one and didn't get by it.

Life Line - Atrial Fibrillation

"Normal" - as expected. Heart Rate 61 beats per minute.

I do have a mild PAC - Premature Atrial Contraction" or "missed beat" that has been diagnosed on several occasions. But that was not identified here.

An associated EKG however was flagged (more on that later).

Life Line Screening Tests Carotid Artery Disease

My GP thinks highly of the relatively inexpensive Life Line Screening tests for identifying risk area early. These are not covered by Medicare (why not?) but are based on finding risk areas and correlating them to the Framingham Study for  risks identified there. I had a set done on April 26, 2013 and have just gotten back the results. The first is for Carotid Artery Disease.

The result is a "Mild" risk. I was obviously hoping for "Normal" but at least did not get "Moderate" or "Significant' finding. The "Mild" risk is associates with a PSV flow volume of less than 110cm/s on both the left and right side. Here is a learned discussion about velocities, age, and hypertension.

The Screening Results report define the risk as "Mild - Small amount of plaque. Blood flow still normal. Blood velocity  less than 110.This also gets into the question of how a stress test can mask issues with conditioned athletes. The regular test doesn't get them to where there may be an issue. 

Blood Pressure Spiking and Exercise

On the Life Line testing April 26, 2013 I had a BP count of 168/83, quite high for me. The helpful attendant suggested it might be the "white coat" syndrome, and it might be, but I've noticed that my BP tends to show high if I have not had recent excercise. This morning, for example, it was 128/81 where the latter was much higher than my long time average of 68. I'd remarked earlier in this blog about spiking.

I tested it a few minutes after and found it 129/67, essentially my average (120/68 is the year's average in Hearwise). I do take BP readings lying down and after a few minutes wait. So when things settle, my Blood Pressure is fine.

But there is a lot of time when I am not relaxed and lying down. I suspect that my BP is significantly higher then.

Still later today I took my BP after hiking up to the water tank on the Cobol side of the Mills Wilderness Trail. After my shower and lunch I took my BP relaxing on the couch. 104/51! Quite clearly exercise has a profound effect.

The moral of the story? Exercise is good and can protect against BP spiking. But how long does the effect last? What about the period before exercise and after. When does the BP creep up?

In particular, how often is it a good idea to do excercise to keep one's readings low?  For example, it is worth doing a 45 minutes walk in the morning, and then one in the afternoon? Each day? Or is it a good idea to do a bike ride in the morning and then a walk in the afternoon? Each day? 

These questions are testable. I'll have a 26 mile bike ride on Saturday in the morning. I can check my BP an hour before and an hour afterwards. Then I could do a walk in the afternoon and check my BP before and after at similar time intervals.

What would I project?

My BP tends to be low in the morning, so at 7am I'd project 120/70

After the ride, shower, etc., I would project a low reading 105/60

In the early afternoon my BP may indeed creep up. 120/80?

After a half-hour walk, relaxing on couch, etc., I'd project 105/65. (In other words, I wouldn't expect the disastolic number to be quite as low as earlier. I see some higher reading in previous afternoon checks.)

If the numbers check, then the afternoon walk would some some protective effect on BP, which would otherwise have a slighter higher diastolic and an appreciable higher systolic reading.

But these numbers may not be significant overall in terms of protection against cardiac events. In other words, the "extra" afternoon walks  may lower BP a little but not be significant in terms of preventing actual cardiac events.

But I suspect that some exercise each day would be useful. It couldn't be heavy exercise each day like a 4 hours bike ride to the beach. The idea would be to find the level of "recovery" exercise (say every other day) that will just produce this beneficial effect. It would vary for fitness levels, but for me I image it would be a 45 minute vigorous walk, maybe the Mills walk to the water tank. Maybe it could be my 8 miles Thompson Creek bike ride.These are testable obviously. I can check and post separate entries on them.