Cool Coronary Lasers

Every year, 300-thousand Americans have bypass surgery. Unfortunately, more than half of those bypasses block up again in less than 10 years. A couple of years ago, your best bet would have been a second bypass operation. But there’s another option — doctors are clearing arteries using a refined laser technique that was developed back for submarine communications and monitoring the ozone layer.

Thanks to the excimer laser, Arnold can now walk with his wife. Thirteen years ago he had triple bypass surgery, and this year his angina came back. Walking was too painful.

Arnold:
“Or even if I was sitting, watching television in that leather chair, I would feel a heaviness on the chest doing absolutely nothing.”

He could have had another bypass operation. Instead, a laser-tipped catheter was threaded through his leg and into the blocked blood vessel. Beams of ultraviolet light turned the plaque buildup into harmless gas.

Arnold:
“I knew right away I don’t feel any heaviness anymore. And although I was confined to the bed for two days, I knew right away that my angina, at least for the moment, is gone.”

Cardiologist:
“Lasers got a bad name in this business because the first lasers that came out were hot-tip lasers using heat to remove plaque. And heat’s a very bad thing to do to coronary arteries because it causes clot and spasm and the initial results were terrible.”

The excimer laser is cool, but can still bore through tissue if it comes in direct contact. So it’s often used to partially open the blockage and the remainder is compressed using balloon angioplasty.

The excimer experts say success rates are over 90-percent. But the laser isn’t perfect. Half of those treated have a recurrence within six months. Still, he says it’s worth taking a chance. “As far as I’m concerned, it’s a miracle.”

The excimer laser is valuable for about five- to seven-percent of patients — those for whom balloon angioplasty alone won’t do the job. And when it’s used instead of performing a second bypass operation, it can save a patient anywhere from 10- to 25-thousand dollars, as well as reducing recovery time dramatically.

Autoimmune Diseases

Your immune system is supposed to respond to injury, infection, and other irritation by inflaming and thus protecting the affected area. It does this with the release of antibodies, which combat the problem. The immune systems of people with autoimmune diseases, on the other hand, trigger this response without being prompted by outside stimuli. These antibodies are called auto antibodies, and they attack normal, healthy tissue.

There are many different autoimmune diseases. They are classified according to the single body part they affect or whether they are systemic. Systemic disorders affect the body as a whole, and the attack occurs to many of the body’s organs. When a single organ or tissue is involved, the disease is referred to as localized. Ti is possible for a person to be affected by more than one autoimmune disease. At the same time, some share similar symptoms.

Most autoimmune disease are usually either genetic or caused by a bacteria or virus. Treatment can vary depending on the type of autoimmune disease, but often consists of immunosuppressive drugs, anti-inflammatory medication, or an effort to alleviate symptoms and relieve pain. If you believe you may have an autoimmune disorder, you should see your physician.

LIPID DISORDERS AND HEART DISEASE

What is a lipid disorder?
It is more than just elevated cholesterol and more than elevated LDL cholesterol. Any abnormality in lipids (fats in the blood) that would increase risk of getting coronary artery disease and atherosclerosis.

We’ve all heard a lot about cholesterol, what else is there?
If you look at people that have coronary artery disease they don’t often have just one lipid abnormality. They don’t just have elevated total cholesterol. In fact, you can have normal cholesterol and have heart attacks. And you can have normal LDL (bad) cholesterol and still have a heart attack. You can have low HDL (good) cholesterol for example, and have heart attacks in presence of normal LDL cholesterol.

HDL is a protective cholesterol?
In lipoprotein-a, for example, 10 percent of people with lipoprotein-a can have heart attacks with a normal LDL. It’s a special LDL lipid particle.

Are there other lipid disorders?
There are others. For example, if you have high triglycerides and low HDL, commonly seen in diabetes, that’s a risk factor, or if you have small dense LDL particles instead of large fluffy ones, that’s a risk factor.

IMPROVED EARLY DETECTION

Now the average person isn’t going to know if they have any of this, right?
That’s right. And most doctors don’t have the laboratory facilities to really measure all these either.

Why is this important?
It’s important because with the way it’s approached now I think you reduce the disease about thirty, thirty five percent, we’re going to have to attack all these other lipid particles to get it on up toward a hundred percent.

PREVENTING LIPID DISORDERS

What two or three things can people do today to help prevent development of these lipid disorders?

Probably the most important thing that people can do is to avoid saturated fat in their diet.

We’ve heard that about cholesterol, but it holds true for all lipid disorders?
Most of them. Saturated fat is the most important thing. And people that have any problem in handling saturated fat should keep it out of their diet. And that’s probably three-fourths of the people in the country. There are some people that have no genetic abnormalities to speak of that can handle all this fat in their diet O.K. without getting disease, but that’s a minority of the population.

Is that an American or a worldwide phenomenon?
That’s a worldwide phenomenon. It’s seen very clearly, for example, in the Japanese population migration from Japan to Hawaii and from Hawaii to San Francisco. And if you expose this, or any, population to a high-fat diet they’ll get heart disease.

Anything else that can help prevent development of these lipid disorders?
There are other more minor things, like you should avoid too much cholesterol itself, although saturated fat is more important than cholesterol itself. Cholesterol – you could probably eat the equivalent of two eggs a day of cholesterol, but eggs are in baked goods and a lot of other places, so you have to know what you’re getting. And you have to add it all up, of course. And you get cholesterol from other sources like meats and dairy products and so on. So you have to know your foods, to add it up, but don’t just get up and have two eggs every morning.

Are high blood pressure and lipid disorders reversible?
You can treat them.

So not only can these behaviors help you prevent these conditions, they can reverse these conditions once they’ve developed?
The behaviors can have an effect, but you may have to use a medication to get the blood pressure or lipids to goal levels.

But we can’t at this point eradicate these conditions?
That’s right, these are problems that stay with you the rest of your life unless you’ve got a problem that is causing it. There are secondary causes of both hypertension and lipid disorders that when alleviated the blood pressure and lipid disorder can be corrected.

What might an example of that be?
Renal artery stenosis (constriction of the artery to the kidney) causing hypertension.

That’s just something that some people have and some people do not?
That’s right. Less than five percent of the population have secondary causes of hypertension. And an example of a secondary cause of high cholesterol that can be treated is hypothyroidism. Cholesterol goes up pretty high in hypothyroidism, but you give thyroid replacement medication and it comes down. So you have to be aware of things that can elevate but can be corrected.

What age should they begin to be monitored?
I think in their early twenties is a good time to begin. That’s about as early as people are going to be compliant enough to do anything with them. Teenage years and college years are rough. It’s tough, it just won’t go. I always say after twenty three then people have enough sense to do something.

High Blood Pressure Prevention Q & A

What three things could a person start doing today that would help prevent the development of high blood pressure?
Probably the most important thing is to get salt out of the diet.

I wondered if that was still the case because I’ve started to hear that maybe it’s not that important for the average person?
It is a big deal. If you’ve got genes for developing high blood pressure, you need to get the salt out, that’s the most important thing. Populations that don’t have salt in their diet don’t have hypertension or very little of it as compared to countries that have a lot of salt.

Are there any other things that someone could do today?
Control body weight and, contrary to what you’re reading now in some books, it is important not to gain weight because the incidence of rates of hypertension goes up as you gain weight and it will come down with loss of weight in fifty five percent of people that have hypertension. Therefore, losing weight and keeping an ideal body weight is important.

Are there any other preventions one can take?
Yes, exercise will lower blood pressure so staying physically fit is good. And also not consuming too much alcohol.

Explain more about alcohol consumption.
Three drinks or more of alcohol will cause high blood pressure. Put another way, the incidence rates go up two to three fold in people that take three or more drinks per day.

Is this true for people who are not genetically prone to high blood pressure?
Yes, and then it will come down if you quit drinking. And this is probably the main risk factor that causes increase in cardiovascular events in people that drink too much.

Would you recommend no alcohol at all, or would you say maybe one beer or glass of wine is O.K.?
Well there is a national guideline of no more than two drinks in any one day, and there is a definition for that. And no more than ten per week. So those are good national guidelines and a drink is defined as one beer, a five ounce glass of wine, or an ounce and a half of whiskey.

What do you consider high blood pressure, are you using the standard guidelines?
It has to be adjusted for various situations. 140 over 90 is the standard cutoff for the population. But then you have to consider isolated systolic hypertension in the elderly. As people get older, systolic pressure (the pressure during heart muscle contraction) tends to go up and diastolic pressure (pressure during the filling of the heart) may remain normal and this is a separate problem that has to be addressed and treated. Systolic hypertension in the elderly (over age 65) would be considered abnormal if it’s over a hundred and sixty.