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CABG Questions - Statins, etc

  • 1.  CABG Questions - Statins, etc

    Posted 03-15-2021 11:14

    Question for those who have had CABG. I had CABGx1 on my Obtuse Marginal 1, which is in the back of the heart. I've been told had it not been caught pre-valve surgery I would likely have had angina and/or a heart attack. Because of its location, they did a vein graft, longevity of which is dubious. I take a baby aspirin and 20mg Crestor.

    In a visit with my cardiologist the other day, he noted:
    1. My cholesterol (various types of tests) was great, though my HDL - genetically low - wasn't where it should be.
    2. Glucose was 102, which was much higher than it would be. While it was 'in the range' he was concerned. Pre-surgery a year ago I was on 10mg Crestor. Post-surgery I was put on 40mg, then we cut it down to 20mg. The obvious issue is the statin-related push toward diabetes.
    3. He mentioned PCKS9 inhibitors as an alternative.

    My questions for the crowd: Anybody here on PCKS9? Seems like a pain in the neck (er, side.) If so, in the subset anybody had glucose issues pre? Also - of those who've had CABG - if you had veins used, what were you told about durability. I guess chance of failure is high at 10 yrs, but it can be resolved with a stent(s). (For the marginal obtuse, apparently they use a vein b/c it's behind the heart and difficult to reach - and it's a small segment.)

    Ira, hoping you have insight here b/c something tells me you do!

    Cheers,
    Herb




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    Herb Greenberg
    San Diego CA
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  • 2.  RE: CABG Questions - Statins, etc

    Posted 03-15-2021 15:11
    Hi Herb:  I had a CABG x4 in July 2002.  They used a small piece of vein from from a leg and another vein from the left arm.  No issues at all since the original surgery.​​​​​

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    Terry Bailey
    terry.bailey@ecdresources.com
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  • 3.  RE: CABG Questions - Statins, etc

    Posted 03-15-2021 17:54
    Great to hear and encouraging, Terry!!! Thanks.

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    Herb Greenberg
    San Diego CA
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  • 4.  RE: CABG Questions - Statins, etc

    Posted 30 days ago
    Herb, the PCKS9 drugs are a relatively new group of medications and they are still learning about them. All I can offer is to go with your Cardiologists guidance and play it as it comes. I was on lipitor for uears to reduce the risk of heart attacks but never used PCKS9 drugs. Mostly focused on Ace inhibitors.

    I had quad by-pass in 2007 and they used the great Sapheous vein in the leg due to the amount of tubing they needed for four bypasses ( at least thats what the travel brochure said). So that was 15 years ago and while my right foot is still numb, i haven't had any by-pass failures. Course I can't dance the macarena anymore but at my age nobody cares.

    Hope you sort things out. Keep us apprised.

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    Warren
    TucsonAZ
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  • 5.  RE: CABG Questions - Statins, etc

    Posted 30 days ago
    Hi Ralph,

    By the time I had mine they took the vein out of two small holes. Still, truth be told: I wouldn't have been able to dance the Macarena before let alone after!

    Thanks for the insight.

    Herb

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    Herb Greenberg
    San Diego CA
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  • 6.  RE: CABG Questions - Statins, etc

    Posted 30 days ago
    I don't remember having ANY numbness from CABGx4 in 2016.  Is your cardiologist and/or GP concerned about this?





  • 7.  RE: CABG Questions - Statins, etc

    Posted 30 days ago
    Nah, the only thing they are worried about is me paying my bill before departing.

    In fact they informed me right after surgery that numbness might be a side effect of harvesting the saphenous vein as there's a nerve bundle that runs near and inadvertent damage is not uncommon. I think the surgeon trainee was in a hurry to get to the golf course and stood on that nerve bundle with his golf shoes while wrenching the vein out. I'm just thankful it wasn't a vasectomy...

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    Warren
    TucsonAZ
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  • 8.  RE: CABG Questions - Statins, etc

    Posted 30 days ago
    Herb,

    I had CABGx5 and they used my left mammary artery for my LAD.  The remaining four grafts were veinous grafts from my legs.  Based on what I've read, this is considered good practice because arterial grafts tend to remain unblocked better and longer than vein grafts, but I have never heard of anyone doing five arterial grafts.  I imagine there are technical reasons for this, including availability of appropriate arteries, location and perhaps other factors, but I have not researched this issue any further.  I was content that they utilized my left mammary artery for the big LAD and that this was the preferred course of treatment.

    I can also tell you that I never experienced any angina, before or after surgery, including during or after vigorous physical activity such as running and lifting maximum weights for low reps and walking friends into the ground at a rapid pace after a heavy meal in freezing weather, all shortly before my heart attack.  It is why people (including a cardiologist friend) were shocked that I had a heart attack and such severe blockages.  I guess family history, in my case, trumped all other factors.  Based in my utter lack of angina or other symptoms prior to the heart attack, the fact that I was told I had excellent collateral circulation despite the blockages and some recent and not so recent studies I've read that mortality rates from blockages are NOT materially improved by CABG surgery over purely medical treatment, although angina problems are improved, I have wondered whether CABG surgery was unnecessary in my case and whether I might have done just as well by only taking the Lipitor, baby aspirin and metoprolol that I now take anyway.  By the way, it is now three years post-CABG for me and both a recent echo and a recent nuclear stress test reveal that my grafts all remain clear.

    All's well that ends well, so I'm not complaining, but I do have a fair degree of scientific skepticism about the state of medical knowledge in this area, and I wonder about the tendency of medicine to start by bludgeoning problems to death, only to subsequently discover that there are more elegant solutions, for example lobotomies and leucotomies being replaced by drug treatments in psychiatry and radical mastectomies being replaced in many cases with lumpectomies and radiation in the treatment of breast cancer.  If there are any physicians, including but not limited to cardiologists, who are reading this, I invite their comments.  Maybe I'm missing the picture by my intellectual musings in areas where I have no formal scientific training but, as the old TV commercial used to say, "inquiring minds want to know."

    Good health, Herb!

    Ira


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    Ira Reid
    Hoboken NJ
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  • 9.  RE: CABG Questions - Statins, etc

    Posted 29 days ago
    Excellent analysis and insight, Ira. The skepticism is critically important. Thanks!

    Herb

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    Herb Greenberg
    San Diego CA
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