Cholecystectomy and CVD
Good Day, I am a 43-year-old Woman, not overweight, exercising 3-4 times per week. I was sick a few years back and lost about 20lbs very quickly. I’ve since been diagnosed with gallstones, and they are causing pain at least twice a month. I am on a surgical wait list to have the gallbladder removed. My cholesterol has been high since I was in my 20s, no matter what I eat. I have been told it’s genetics and can do nothing about it. I have hormone imbalances and am on HRT- testosterone and progesterone transdermally. I also take ranitidine as needed for GERD- which is sometimes terrible, and I attribute it to the gallstones. I am concerned about two studies discussing the risk of CVD after cholecystectomy. The increase in risk seems to be substantial, but it is unclear why. I can’t get away with avoiding the gallbladder removal. My questions to you are: how do I mitigate my risks of CVD as it relates to the possible causes referenced in the articles: inflammation and gut dysbiosis? Assuming it has contributed to the stones, how hard should I be pushing my doctor to investigate my high cholesterol, and at which point should I be treating it medically? I am at a complete loss about how I should be eating to lower my cholesterol and triglycerides and take care of my liver/gut/heart post-surgery. Quality of life and longevity are my goals. Kim, Y. J., Park, Y. S., Shin, C. M., Han, K., Park, S. H., Yoon, H., ... & Lee, D. H. (2021). Risk of Heart Disease after Cholecystectomy: A Nationwide Population-Based Cohort Study in South Korea. Journal of Clinical Medicine, 10(15), 3253. V Fairfield, C. J., Wigmore, S. J., & Harrison, E. M. (2019). Gallstone disease and the risk of cardiovascular disease. Scientific reports, 9(1), 5830.
HRT for Women at high risk of Osteoporosis
From the various podcasts on the subject, it seems like HRT is an effective treatment for a menopausal woman at high risk of osteoporosis to maintain bone density. However, in the episode with Joann Manson she made the point that once the patient stops HRT, bone loss accelerates and the patient winds up in the same place as if they had done nothing. Would you recommend a woman at high risk of osteoporosis to continue HRT indefinitely after menopause? Would any doctor actually allow that in practice? (Asking as a woman nearing menopause with a significant family history of osteporosis and breast cancer, but way more concerned about osteoporosis.)
concern about cardio iq accuracy
i am a family physician. I have been doing the cleveland heart lab's cardio iq on a few patients and a recent assay has me REALLY questioning the accuracy. Due to 2 tubes instead of one having the assay run the first go around, we ended up doing a THIRD assay. LDL particle numbers ranged from 1337 to 1590 and finally 1923. the variance on the rest of the assay was similarly as much as 30% or more off, and an APO B was done on the first sample, but not on the 2nd or 3rd. The lab's quality control told me it was an instrument problem. I am inclined to stop doing the lipoprotein fractionation! Have you any such experience? I am happy to find a way to send copies of the tests to you, but am not sure how to do that.
What is tennis?
In your quest to optimize longevity you define a regime combining strict zone 2 with strict zone 5 (along many other things). Like many other people out there there are exercises that even if not directly geared to maximize longevity or even detrimental, they make us fulfilled and happy. To me, that activity is competitive tennis. And starting on the premise that I am not going to give tennis up, I am curious as to what tennis would be considered from the perspective of my weekly activities and therefore what I am actually covering with respect to my zone 2 & zone 5 regime. I play tennis 3 times a week and abour 2h each time. While as an average I will be in the middle of zone 2 my peaks are well into zone 5 (for burst of up to 30 seconds). In fact usually hit higher max HR than I would otherwise be able to do simply trying to do 4min series at max intensity running for example. How should I treat tennis then? Is it 2h of garbage zone? Is it zone 2? Is it zone 5? Is it both? Thanks.