angiogram results are in

Hi @licklemoose
Sorry to hear of your results. However, they are mainly normal with some minor calcified plaque and artery narrowing, so it could be far worse. I hope you get an in-depth discussion with a consultant so he can explain what can be done and allay some of your fears.
Good luck!

Hi. My own angiogram a year ago also showed some low-level calcium deposits in one artery plus bi-cuspid aortic valves. I've had an exercise echocardiogram which showed my heart was coping well when under stress so things like this can be tried if you or the cardio are not sure whether the slight narrowing is a problem.

licklemoose said:

theres some soft plaque at the origin of the first diagonal which is small causing ostial stenosis. No other significant stenosis seen in the RCA LAD and circumflex vessels with tricuspid aortic valve and standard chamber antomy. The right corornary is dominant
Conclusion minor calcified plaque and an ostial stenosis to the small first diagonal. Otherwise normal corornary appearances

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Increasingly I get annoyed that ticking a box 'diabetic' adds a fixed amount to cardiac risk when diabetics aren't fixed in their response to dealing with it wrt diet exercise etc.
I had an angiogram a few months ago with results :
Minor disease throughout LAD Cx and RCA
Diffuse disease throughout LMS

Follow up/treatment : secondary prevention.

Since the same angiogram diagnosed severe Aortic Stenosis requiring surgery, this secondary prevention has not raised itself as an issue. All my current dealings are with Harefield Hospital whose main concern I would guess is my AS.
The fun should start when someone wants me to start a statin.

My reply to your post would be that many of us do damage to our bodies long before our diagnosis (and any subsequent improvements we make in our behaviour).
To me it makes sense that unchanged behaviour would continue to promote further damage.
A change in behaviour will mitigate it.
I can look back on my previous poor diet and see how it contributed, and how now I'm more informed about dietary choices.

As diabetics, taking as much care of our bodies makes every sense.
Modern thinking is that hyperinsulinemia and inflammation are the true causes of heart disease.

Your results may have come as a shock to you, but may also cause greater vigilance on your part.
You'll get through this. We're here with you.
Geoff

Disease at the ostium of a DG (diagonal) branch of the LAD usually doesn't warrant percutaneous intervention (stunting). Those branches can be quite small, too small to stent (smallest stent is 2.25mm diameter).
"Modern thinking is that hyperinsulinemia and inflammation are the true causes of heart disease." Actually hyperlipemia is a major risk factor for coronary disease, and is readily treatable and has been for years. That's why Type 2's are often recommended statins to reduce their risk of CAD events.
@librarising : your disease is evidently aortic valvular stenosis. It's routine to have an angiogram before valve surgery so the surgeon can bypass any blocked coronaries at the same time. Lipids aren't a risk factor for valve disease, the valve becomes calcified and fails to open fully as a result of old age or a bicuspid valve which increases turbulence of blood flowing through the valve with every heart contraction. Those valves often need surgery by the time the patient is 60 or so, sometimes earlier.

TheBigNewt said:

Disease at the ostium of a DG (diagonal) branch of the LAD usually doesn't warrant percutaneous intervention (stunting). Those branches can be quite small, too small to stent (smallest stent is 2.25mm diameter).
"Modern thinking is that hyperinsulinemia and inflammation are the true causes of heart disease." Actually hyperlipemia is a major risk factor for coronary disease, and is readily treatable and has been for years. That's why Type 2's are often recommended statins to reduce their risk of CAD events.
@librarising : your disease is evidently aortic valvular stenosis. It's routine to have an angiogram before valve surgery so the surgeon can bypass any blocked coronaries at the same time. Lipids aren't a risk factor for valve disease, the valve becomes calcified and fails to open fully as a result of old age or a bicuspid valve which increases turbulence of blood flowing through the valve with every heart contraction. Those valves often need surgery by the time the patient is 60 or so, sometimes earlier.

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Thanks
Geoff

i have unstable angina from a small vessel its scarcely but they are pretty good at dealing with cardiac issues. getting a good control of your diabetes and eating healthier and not smoking or worrying are the best things you can do.

thats probably the biggest health thing you can do. they may not even be willing to operate until you stop.

None smoker - all my life and have had IR and diabetes symptoms since young childhood, so 40+yrs of diabetes and only diagnosed for 16yrs of that 41yrs. Currently have have huge insulin resistance warranting around 300units of regular insulin.
My calcium score was 19 and most of that around the LAD so in fear of the widow maker stricking me dead early I had angiogram which cardiologist watered down the condition of atherosclerosis and didn't mention LAD at all.
Discharged stating no need for stents yet but if any chest pains to call an ambulance. Humf! I thought angiogram result would aliminare that need, but no I'm to expect trouble, one day.

ickihun said:

My calcium score was 19 and most of that around the LAD so in fear of the widow maker stricking me dead early I had angiogram which cardiologist watered down the condition of atherosclerosis and didn't mention LAD at all.
Discharged stating no need for stents yet but if any chest pains to call an ambulance. Humf! I thought angiogram result would aliminare that need, but no I'm to expect trouble, one day.

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There's a reason no health insurance (including Medicare) will cover the cost of a calcium score scan(m). It fails to predict who has a significantly blocked coronary artery. Only if there's NO calcium is it useful, which doesn't happen hardly at all for adults. So your LAD had calcium but the angiogram (the "gold standard") said it wasn't significantly blocked. That says it all right there. Here they used to have those CT calcium scan machines in trailers in parking lots at malls. You paid cash, your wife got it for half your price, they mailed you the results and said "go see your doctor to have this explained to you". Right? I used to say, go back to the strip mall and ask the dude who swiped your credit card what to do lol. He'll probably be 200 miles down the interstate by now.

I've been a type 1 for 2.5 years and was told by my GP that she treats all diabetics as if they already have heart disease. She sent me to a cardiologist who told me that, in a normal world, my cholesterol numbers would be fantastic. Because I am diabetic, he put me on a statin. They want the numbers very low (70 and below) because, as he explained, high blood sugar levels make the blood "sticky". Glad he explained it like I was a five year old.

sweetbloodsher said:

I've been a type 1 for 2.5 years and was told by my GP that she treats all diabetics as if they already have heart disease. She sent me to a cardiologist who told me that, in a normal world, my cholesterol numbers would be fantastic. Because I am diabetic, he put me on a statin. They want the numbers very low (70 and below) because, as he explained, high blood sugar levels make the blood "sticky". Glad he explained it like I was a five year old.

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This is the type of post that puts me in a dilemma.
It is difficult, idiotic perhaps, to argue with the advice of your cardiologist. The cholesterol debate rages on and there are many papers / videos / personal testimonies available out there. I have my own views of that.
But I have read also that Statins help CVD outcomes independent of cholesterol. I'd be interested to know whether your cardiologist prescribed you statins, even partially on this basis.
I know that TheBigNewt is a statin fan, 'uses them up the yazzoo' he wrote on here recently. Now, that's direct from a specialists mouth. He generously took time to exchange a couple of messages with me and he tipped my thinking towards a statin.
Yet why do I still dither? Two reasons really. Firstly I think the advice I got (UK) when I was diagnosed T2 was poor (and I'm not the only one). Vis, Metformin and statin and change of diet to the 'healthy plate'. None of which I liked the sound of.
Secondly I'm waiting the results of angiogram and CT scan in early January. If it's bad I'll start statins but I do want to discuss properly the ins and outs with the vascular surgeon - if he has time!
In fact I've had more advice and explanation from TheBigNewt - a man I don't know, who's three thousand miles away - than I've had with my vascular surgeon and GP combined.

Jo_the_boat said:

This is the type of post that puts me in a dilemma.
It is difficult, idiotic perhaps, to argue with the advice of your cardiologist. The cholesterol debate rages on and there are many papers / videos / personal testimonies available out there. I have my own views of that.
But I have read also that Statins help CVD outcomes independent of cholesterol. I'd be interested to know whether your cardiologist prescribed you statins, even partially on this basis.
I know that TheBigNewt is a statin fan, 'uses them up the yazzoo' he wrote on here recently. Now, that's direct from a specialists mouth. He generously took time to exchange a couple of messages with me and he tipped my thinking towards a statin.
Yet why do I still dither? Two reasons really. Firstly I think the advice I got (UK) when I was diagnosed T2 was poor (and I'm not the only one). Vis, Metformin and statin and change of diet to the 'healthy plate'. None of which I liked the sound of.
Secondly I'm waiting the results of angiogram and CT scan in early January. If it's bad I'll start statins but I do want to discuss properly the ins and outs with the vascular surgeon - if he has time!
In fact I've had more advice and explanation from TheBigNewt - a man I don't know, who's three thousand miles away - than I've had with my vascular surgeon and GP combined.

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After my angiogram I was advised by cardiologist to get on statins and stop asprin but when I started statins I was getting numb forearms and hands. That cannot be right, that's even on the best statin around. With being a woman my cholesterol was great and total was averaging 4.0 without statins even though at times I'm unable to go out walking.

Just a note.
I once had a professor who told me to stop metformin in ivf treatment. Durr! It was definitely the wrong thing to do. It failed because of weight gain on stopping metformin. They only know what theyve read. Research and study books and after research adding their name to a book so a professor.
They don't know everything. Human just like us.
I trusted no asprin as it can make a stroke bleed more and a worse stroke for us diabetics but statins are no use unless taken very very long term.
However if I had a family gene of very very high cholesterol I'd definitely be on them like hubby.

@bulkbiker can you get an angiogram? I'm worried now that your calcium scan is not reliable. Please.

I'm sure I probably could.. but to be honest what's the point. I've had the CAC scan and am not worried about the state of my heart.

Over 3 years ago I had 2 angioplasties in ten months and am fine (I am a slim, healthy non-smoker - these things can happen to anyone).
A cardio surgeon will inevitably put you on statins if you have heart disease, not matter how low your cholesterol. Mine was a top surgeon at Papworth and he was emphatic about this.
I think the key is to discuss with your GP. Make sure you are put on the lowest dose, and make sure you are monitored carefully (they should check liver function after a month or so). If you get unusual muscle pain or weakness then ask to have your creatine kinase levels measured. I had this done when I was getting muscle pain a year into treatment, and the levels were fine (so many other things can cause muscle pain but it is good to cancel out statins as potential cause of myopathy so you can focus on other causes).
Statins are being pushed in an aggressive and undiscriminating way -- as with so much treatment nowadays, it is important to take control and monitor yourself carefully.

TheBigNewt said:

Disease at the ostium of a DG (diagonal) branch of the LAD usually doesn't warrant percutaneous intervention (stunting). Those branches can be quite small, too small to stent (smallest stent is 2.25mm diameter).
"Modern thinking is that hyperinsulinemia and inflammation are the true causes of heart disease." Actually hyperlipemia is a major risk factor for coronary disease, and is readily treatable and has been for years. That's why Type 2's are often recommended statins to reduce their risk of CAD events.
@librarising : your disease is evidently aortic valvular stenosis. It's routine to have an angiogram before valve surgery so the surgeon can bypass any blocked coronaries at the same time. Lipids aren't a risk factor for valve disease, the valve becomes calcified and fails to open fully as a result of old age or a bicuspid valve which increases turbulence of blood flowing through the valve with every heart contraction. Those valves often need surgery by the time the patient is 60 or so, sometimes earlier.

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I'm lucky that my bi-cuspid valves don't produce much regurgitation so the efficiency remains fairly high at age 73. I'm interested in the statins discussion over the last day. I believe you are a strong supporter of statins and so is my otherwise excellent cardio who would like me to have a zero cholesterol level if he could! I would still challenge this rather extreme view of statins bearing in mind their downside and the suspect research aided and abetted by Big Pharma. I do take statins but make sure my lipids don't go lower than needed. My cardio at this week's review wanted me to start BP tablets as my BP was into the 130 region. Even though based in the UK he was following the new USA guidance which says a level of 130 is now defined as High BP Level 1. I'm highly suspicious of this new guidance as it says 77% of those over 70 should be on BP pills and even 50% at age 50! Big Pharma again? Not helped by the fact that the nurse only took one reading, didn't wait 5 mins before the test and didn't ask whether I'd had a caffeine drink beforehand. My home readings are generally in the 120 region so my BP isn't high.

I'm suspecting my kidneys causing high blood pressure now. Hereditary too thou even thou none diabetic.
All grandparents and parents had high blood pressure.

The so-called "calcium score" CT scan is only of value if you have ZERO calcium. Then it's very unlikely you have any coronary disease, if that's you I wouldn't take a statin. But it's rare to have zero calcium especially if you're older. On the opposite end of the spectrum is someone with "established coronary disease" which includes anyone who's had a coronary stent or a heart attack or bypass surgery or an angiogram with, say, a 50% lesion. Statins have shown their most benefit in these patients, and high dose statins like Lipitor 80mg at that. For Type 1 diabetics I think they are not proven in primary prevention (before you have established disease). There are too few Type 1's to enroll in a primary prevention trial. Type 2's are different, they tend to get "macrovascular" disease (coronary, cerebral vascular/stroke, peripheral vascular disease in legs/feet). We Type 1's tend to get "microvascular" disease (eyes, kidneys). Statins are not a big deal for that, better blood sugar control is. High blood pressure's major risk is a stroke, not coronary disease. Coronary disease's major risk are lipids. And the risk of a smoker having a cardiac "event" drops to that of a non smoker within a year of quitting. Just my .02.