2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines | Circulation

'I Almost Died Of A Severe Artery Blockage—This Is The Sign That Saved My Life'

When discussing cardiovascular health, our minds often drift right to the heart. The heart is, indeed, at the heart of the cardiovascular system. However, numerous other body parts, including the arteries, play vital roles in ensuring our heart functions as it should.

According to the Cleveland Clinic, the arteries are vessels responsible for carrying oxygen-rich blood from the heart to the rest of the body. When healthy, the artery walls are strong enough to manage the blood pressure your heart puts on them with each beat.

However, plaque build-up can contribute to high cholesterol. High cholesterol and even high blood pressure don't typically have symptoms but can lead to narrowed, blocked arteries, per the Cleveland Clinic. Artery blockages also don't usually have signs. Left untreated, these conditions can put a person at a higher risk for a heart attack.

One man did have a symptom of a severe artery blockage. He initially chalked it up to a less severe illness he was recovering from. Thankfully, he didn't wait too long to seek help. He shares his story, including how a commercial led to a quick action that saved his health and prevented a heart attack.

Related: These Are the Exact Cholesterol Numbers You Should Aim for if You Want to Prevent Heart Disease, According to a Cardiologist

The Severe Artery Block Sign That Saved One Man's Life

Mark Vallery, 69, of Orlando, Florida, says he didn't experience symptoms of artery blockage until February of 2024. It was only then that he began having severe chest pain and right arm pain.

"I thought that I was having lung issues when my chest started hurting, as I had been dealing with an upper respiratory infection," Vallery tells Parade.

Vallery says he has some known risk factors for heart attacks, including high cholesterol, being older (most people who die of heart disease are over 65), obesity and a family history of heart attacks. He's also used a pacemaker since he was 14.

According to the American Heart Association, other risk factors include:

Smoking

Diabetes

High blood pressure

Being a male

Now, Vallery wasn't having a heart attack, but the day after he started feeling chest pain, he began to think he was. While some people like to make fun of "kids these days" for "watching too much TV," a little tube time actually may have saved Vallery.

Seeing the Signs of a Heart Attack

Vallery sat down in a recliner after going on a walk with his wife, which left him exhausted.

"During that walk, I had a tightness in my chest, couldn't get a good breath and there was a burning sensation across my chest and down my right arm," Vallery says. "While I was resting, a commercial came on that talked about symptoms of a heart attack you shouldn't ignore."

Vallery called the doctor immediately, being sure to mention his recent upper respiratory illness in case it had to do with his lungs. His doctor told Vallery to go straight to the emergency room.

"They didn't even need to do a stress test," Vallery says. "The cardiologist said based on my age, weight and ultrasound, they would go ahead and put a stent in. It turns out I had a 99% blockage in one of my arteries."

Sometimes, a blockage this significant is classified as a heart attack. Luckily, that wasn't the case for Vallery—but he knows it could have been.

Related: 8 Real People Explain Exactly What Having a Heart Attack Feels Like

Severe Artery Blockage: One Man's Treatment, Recovery and Moving Forward

Six weeks after his trip to the emergency room, Vallery followed up with his care team. He'll do the same later in 2024 to reevaluate treatment for the remainder of the year. He's not out of the woods, but doctors are watching him, and Vallery is taking steps to improve his heart health.

"I have a 65% blockage in my middle artery, so my cardiologist put me on a strict diet, cholesterol medication, blood pressure medication and blood thinner," Vallery says. "When I was in the hospital, my cholesterol was 264. Now, almost six months, medication and a very restrictive diet later, my cholesterol is 94. So, I'm off the cholesterol medication because it's actually too low now."

The American Heart Association's recommendations for cholesterol are:

Total cholesterol: Less than 200 mg/dL

LDL cholesterol: Less than 100 mg/dL or below 70 mg/dL if a person has coronary artery disease

HDL cholesterol: 60 mg/dL or higher

Triglycerides: Less than 150 mg/dL

Overall, Vallery feels like he's trending in the right direction. "I felt 100% better the day after the stent was installed," Vallery tells Parade. "I can now exercise all I want with no chest pain. Eating a healthy diet has helped me lose 20 pounds, and I feel so much better all around."

Now, Vallery is speaking out, hoping others don't need the same harrowing wake-up call. "Get your blood tested regularly, keep your cholesterol level low and eat a heart-healthy diet now before you have a problem and it is too late," Vallery says. "I am lucky to be alive."

Up Next: 

Related: 'I Almost Died of a Heart Attack At 48—This Is the First Symptom I Wish I'd Paid Attention To'

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Edoxaban Outperforms Edoxaban Plus Antiplatelet Agent In Patients With A-fib And Stable Coronary Artery Disease: Study

Edoxaban monotherapy reduced net adverse clinical events compared with edoxaban plus a single antiplatelet agent, when used as long-term antithrombotic therapy, in patients with high-risk atrial fibrillation (AF) and stable coronary artery disease (CAD), according to late-breaking research presented in a Hot Line session Sept. 1 at ESC Congress 2024.

The EPIC-CAD trial has been simultaneously published in the New England Journal of Medicine.

"There was a lack of evidence regarding the best maintenance antithrombotic strategy in patients with high-risk AF and stable CAD, particularly as long-term dual therapy with an oral anticoagulant and an antiplatelet drug may increase the risk of bleeding.

"In the EPIC-CAD trial, we were able to show that edoxaban monotherapy resulted in fewer net adverse clinical events compared with dual antithrombotic therapy in the 12 months after randomization, with less clinically important bleeding and no increase in major ischemic events," said study presenter, Dr. Gi-Byoung Nam of the Asan Medical Center, Seoul, Republic of Korea.

The EPIC-CAD trial was an investigator-initiated, open-label, adjudicator-masked, randomized trial. Eligible patients had high-risk AF (CHA2DS2-VASc score ≥2) and stable CAD (if prior revascularization: after ≥12 months for acute coronary syndrome and after ≥6 months for chronic angina).

Patients were randomly assigned in a 1:1 ratio to either monotherapy of standard-dose edoxaban (60 mg once daily or 30 mg once daily with dose-reduction criteria) or dual antithrombotic therapy of standard-dose edoxaban plus a single antiplatelet agent (either aspirin or clopidogrel).

The primary endpoint was the net composite outcome of death from any cause, stroke, systemic embolism, myocardial infarction, unplanned revascularization, and major or clinically relevant non-major bleeding at one year after randomization.

Key secondary endpoints included the individual components of the primary endpoint, a composite of major ischemic events (death, myocardial infarction, ischemic stroke and systemic embolism), and a composite of major and clinically relevant non-major bleeding.

In total, 1,040 patients were randomized from 18 major cardiac centers in South Korea. The mean age was 72 years and 23% were women. The mean CHA2DS2-VASc score was 4.3. The mean HAS-BLED score was 2.1, indicating a moderate risk of bleeding.

Two thirds had undergone previous revascularization (66%) and the median time from last revascularization was 53 months. Patients in the dual antithrombotic therapy group more often received aspirin (62%) than clopidogrel (38%).

In the 12 months after randomization, edoxaban monotherapy significantly reduced the risk of the primary endpoint by 56% compared with dual antithrombotic therapy (6.8% vs. 16.2%; hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.30−0.65; p<0.001).

This difference was mainly driven by a 66% reduction in the risk of major bleeding or clinically relevant non-major bleeding with edoxaban monotherapy vs. Dual-antithrombotic therapy (4.7% and 14.2%, respectively; HR 0.34; 95% CI 0.22−0.53).

The rates of major ischemic events were 1.6% in the edoxaban monotherapy and 1.8% in the dual-antithrombotic therapy groups (HR 1.23; 95% CI 0.48−3.10). There was no difference in the rate of all-cause mortality in the edoxaban monotherapy and dual-antithrombotic therapy groups (0.6% and 0.7%, respectively; HR 1.29; 95% CI 0.29−5.76).

"Our results are similar with the AFIRE trial in patients with AF and stable CAD, which showed that rivaroxaban monotherapy was non-inferior to dual therapy for efficacy and superior for safety. EPIC-CAD used a globally approved dosing regimen.

"EPIC-CAD provides additional new evidence on the appropriate antithrombotic strategy with standard-dose edoxaban to guide the treatment of patients with AF and stable CAD," concluded Principal Investigator, Professor Duk-Woo Park of the Asan Medical Center, Seoul, Republic of Korea.

More information: Min Soo Cho et al, Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease, New England Journal of Medicine (2024). DOI: 10.1056/NEJMoa2407362

Citation: Edoxaban outperforms edoxaban plus antiplatelet agent in patients with a-fib and stable coronary artery disease: Study (2024, September 2) retrieved 2 September 2024 from https://medicalxpress.Com/news/2024-09-edoxaban-outperforms-antiplatelet-agent-patients.Html

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