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Dx Acute Coronary Syndromes/ Dx Heart Attack/ Dx MI/ Dx Myocardial Infarction Treatment: Read More...


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SUMMARY:
The best treatments and prevention of Acute Coronary Artery Syndrome/ Myocardial Infarction (MI) rely on:
*(1)Diagnosis: the use of the Coronary Artery Calcium Score (CT-Chest) is the best predictor of risk of disease (independent or, or with the Framingham Risk Score). The John Hopkins group further states that the individual with a C.A.C.S. of zero or even less than 100 "is at virtually no risk of having a heart attack" and for these "older individuals...they do not need routine prescribed cholesterol lowering medications or aspirin."
*(2) Testosterone injections/ pellets has been shown to dilate the coronary arteries. The fact is that only rarely does a plaque break off and block the artery. Most often, the artery is narrowed by plaque and without adequate levels of testosterone there is a narrowing (vaso-spasm) that does not allow normal dilation under stress. After a heart attack, the testosterone level is reduced and the estrogen level is increased. Those whose ratio does not return to normal at 30 days have a higher risk of recurrent heart attacks. Channer supports giving intramuscular weekly testosterone injections (not topical gels or creams); this will raise the testosterone levels and potentially reduce the risk.
*(3) Anticoagulants: Aspirin is recommended for prevention. With a heart attack or atrial fibrillation, warfarin/ Coumadin®, Pradaxa®, Xarelto® or Eliquis® are most often prescribed. Overall, there are benefits and disadvantages of all therapies, but, the subsequent risk of myocardial infarcts are the same. See Fibrinolysis for the risks of benefits of these therapies.

The British Medical Journal in 1971 described the combination of stanozolol and metformin were able to reduce the risk of venous thormbosis (clotting) by a completely different mechanism, reducing PAI-1. Stanozolol also reduces SHBG, an independent risk factor for heart diseaes in men. See fibrinolysis for more information.

Morgentaler clearly identifies that the media has misused statistics to scare the public about the beneficial use of testosterone injections.

Acute Coronary Syndromes/ Heart Attack

The Merck Manual Home Edition
states:
"Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount of blockage.
  People who experience an acute coronary syndrome usually have chest pressure or ache, shortness of breath, and fatigue. People who think they are experiencing an acute coronary syndrome should call for emergency help and then chew an aspirin tablet.
  Doctors use electrocardiography and measure substances in the blood to determine whether a person is experiencing an acute coronary syndrome.
  Treatment varies depending on the type of syndrome but usually includes attempts to increase blood flow to affected areas of the heart.

Statistics:
In the United States, more than 1.5 million people have a heart attack each year. About 400,000 to 500,000 of them die, half before they reach the hospital. Almost all of them have underlying coronary artery disease and about two thirds of them are men."

Medications Used in the Treatment:
1. Beta Blockers: metoprolol, Toprol® XL, Tenormin®, etc.
2. Calcium Channel Blockers: Norvasc®, Cardizem®, Cardizem®LA, etc.
3. Anticoagulants: Aspirin, Fragmin®
4. Nitrates: Nitrostat®, isosorbide, etc.
5. Arteriolar Vasodilators: amyl nitrite.
6. Calcium Channel Blocker/ Statin Combination: Caduet®.
7. Anti-anginals: Ranexa®.
8. Anabolic Steroids: testosterone
9. Estrogen Replacement Therapy: in appropriate women see ERT increases women's survival

Testosterone:
[The British Andrology Group] (T. Hughes, K. Channer, D. Kapoor) treat men with Low-T with and without heart disease. They establish that testosterone replacement (injections not creams/gels) not only strengthen the heart muscle, improves ejection fraction,   but also dilates the coronary arteries. "Total and bio-available testosterone levels fell acutely following myocardial infarction (11.9 +/- 3.8 nmol/L to 9.7 +/- 3.3 nmol/L, p < 0.05; 1.95 +/- 0.76 nmol/L to 1.55 +/- 0.67 nmol/L, p < 0.05). This reduction was associated with elevation of PAI-I activity and reduction of tPA activity, independent of changes in plasma insulin levels. Patients with lower baseline levels of testosterone and higher levels of 17 beta-estradiol had a relatively pro-thrombotic fibrinolytic profile and increased risk of complications."

The reference article by K.S. Channer explains the cardiac and life-promoting benefits of testosterone for men.
The mainstay of this office's program is to couple
1). K.S. Channer's use of testosterone and the
2.) British Medical Journal article of 1971 utilizing stanozolol concurrently with metformin for their anti-clotting actions. These three medications together are a mainstay of this office's treatment approach.
Channer states "Other studies of acute intravenous testosterone therapy have demonstrated increased cardiac output mediated by a reduction in the systemic vascular resistance and increased ischaemic threshold in men with CAD. Clinical trials have demonstrated that chronic and physiological dose testosterone supplementation significantly improves anginal symptoms and the time to electro-cardiographic ischaemia on exercise treadmill testing, an effect which is proposed to be mediated by testosterone's vasodilatory action."

*[Editor] : Every man over the age of 45 and woman over the age of 60 should have a Coronary Artery Calcium Score (C.A.C.S.). This is a 30-second rapid C.T. scan of the chest that documents the presence, size, and volume of calcification. If he/she has calcification C.A.C.S. strongly predicted future major adverse cardiac events." On the positive side, having a score of zero or even a C.A.C.S. score less than 100, says the John Hopkin's group, "will find that individual is at virtually no risk of having a heart attack and "for older individuals without calcium in their arteries, it means they do not need routinely prescribed cholesterol lowering medications or aspirin because they are at a lower risk of a heart attack."

*[Editor]: Recent publications have shown a strong correlation to low levels of DHEA-S and high levels of Platelet Aggrevator Inhibiton(PAI-1) to cardiovascular disease.
*[Editor]: Prevention of Acute Coronary Syndrome in men may depends on adequate levels of free testosterone replacement by intramuscular injections(Channer) (weekly [Editor]).
*[Editor]: Free testosterone depends on lowering the Sex Hormone Binding Globulin and blocking P.A.I.The importance of the British Medical Journal protocol with Stanozolol and Metformin must be restated.
*Metformin orally added to Stanozolol positively affect fibrinolysis by lowering PAI-1 and promoting dissolution of clots.


*[Editor]: In the future, based on the literature about testosterone in men, men experiencing heart attacks might do better by:
*applying a healthy dose of testosterone topically at home,
*Having the ER doctor inject a water-based testosterone intravenously in the acute phase of the Acute Coronary Syndrome, and
*After operating room or catherization initiate testosterone and anabolic medications to reduce the increased estrogen and clotting factors (PAI-1) which are associated with poorer survival. Future consideration should be given to replacing testosterone, stanozolol and metformin medications in men recovering from acute coronary syndrome, acute myocardial infarction and stent placement.


*See the Editor's video presentation entitled Andropause: Low Testosterone (Low-T) and Video entitled Andropause: Testosterone Deficiency and Diseases in men.

Statins and Blood thinners (Warfarin®, Pradaxa®, Eliquis®, Xarelto®, ...)

Cholesterol Critics:
*It has been suggested by Cholesterol Critics that statin therapy not be prescribed until there is evidence of coronary obstruction (heart attack) or a C.A.C.S. of greater than 100-400.
Most physicians are not aware that the newest guidelines for prescribing statins could apply these drugs to 80% of the population with a C.A.C.S. score greater than 300, yet, not significantly affect risk of heart attack.

*Furthermore, The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for Arterio-Sclerotic Cardio-Vascular Disease risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis

* No study "has been performed on older adults (greater than 80). Considering the patient's functional and cognitive status, comorbidities and other therapies to avoid drug interactions, use [statins] should be based on individual decision."

*[Editor]: The use of antiplatelet therapy as compared with placebo or aspirin, Oral Anti-Coagulant with or without aspirin does not reduce mortality or reinfarction, reduces stroke, but is associated with significantly more major bleeding.

*[Editor]: The addition of low dose warfarin 1.25mg to 75mg aspirin reduced the occurrence of stroke but was associated with increased bleeding.

*[Editor]: Warfarin is indicated for the prevention of thromboembolism in patients with anterior-wall Acute Myocardial Infarction and should be given for three months in most cases...longer term therapy for patients with additional risk factors for thromboembolism.

While dabigatran 150mg (Pradaxa®) twice daily was shown to be superior to warfarin in preventing stroke with non-valvular atrial fibrillation (SPAF) and in the (RE-LY) trial, Pradaxa® experienced [almost 50%] more myocardial infarctions occurred in the dabigatran group than the warfarin group. Pradaxa® was associated with a much greater number of gastro-intestinal bleeds.

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