Elevated liver enzymes.

[Bud Burner]

I have been on 2000 Mg of Niacin for hypercholesterolemia for
5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
increased to 45.
I do drink a glass of red wine (Merlot) witn my evening meal
but otherwise do not imbibe.
None of the other indicators have elevated:
protein, total, serum = 7.0 g/dl
albumin,serum = 4.5 g/dl
bilirubin, total = .8 mg/dl
Alk. phos. , serum = 71 iu/l

Here's the data from 5 years ago:
protein, total, serum = 6.9 g/dl
albumin = 4.4 g/dl
bilirubin, total = .75 mg/dl
Alk. phos. , serum =71 iu/l
AST =38 iu/l
ALT = 30 iu/l

Not much change other than the ast and alt. Anything I should
be thinking about talking to the doctor about? I'm 5 1/2 years post
infarct (no damage), 49 years old, quit the cigarettes the day of the
"event" and never had another. Problem was spot blockage in LAD and
another artery, rotablator removal succesful and stenting of narrowed
spot in LAD that they thought might have been narrow from birth.
Bud

[Dr. Andrew B. Chung, MD/PhD]

Bud Burner wrote:

> I have been on 2000 Mg of Niacin for hypercholesterolemia for
> 5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
> IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
> increased to 45.
> I do drink a glass of red wine (Merlot) witn my evening meal
> but otherwise do not imbibe.
> None of the other indicators have elevated:
> protein, total, serum = 7.0 g/dl
> albumin,serum = 4.5 g/dl
> bilirubin, total = .8 mg/dl
> Alk. phos. , serum = 71 iu/l
>
> Here's the data from 5 years ago:
> protein, total, serum = 6.9 g/dl
> albumin = 4.4 g/dl
> bilirubin, total = .75 mg/dl
> Alk. phos. , serum =71 iu/l
> AST =38 iu/l
> ALT = 30 iu/l
>
> Not much change other than the ast and alt. Anything I should
> be thinking about talking to the doctor about?

Seeing if a trial of abstaining from alcohol will allow the AST and ALT
to return to baseline.


> I'm 5 1/2 years post
> infarct (no damage),

Infarct means there was damage. Were you taking a daily aspirin at the
time?

> 49 years old, quit the cigarettes the day of the
> "event" and never had another. Problem was spot blockage in LAD and
> another artery, rotablator removal succesful and stenting of narrowed
> spot in LAD that they thought might have been narrow from birth.

Hopefully you are taking a daily aspirin.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

[Patrick Blanchard, M.D.]

On Tue, 02 Dec 2003 21:14:31 -0600, Bud Burner
<budburner@altdrugspot.cjb.net> wrote:

> I have been on 2000 Mg of Niacin for hypercholesterolemia for
> 5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
> IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
> increased to 45. I do drink a glass of red wine (Merlot) witn my evening
> meal
> but otherwise do not imbibe.
> None of the other indicators have elevated:
> protein, total, serum = 7.0 g/dl
> albumin,serum = 4.5 g/dl
> bilirubin, total = .8 mg/dl
> Alk. phos. , serum = 71 iu/l
>
> Here's the data from 5 years ago:
> protein, total, serum = 6.9 g/dl
> albumin = 4.4 g/dl
> bilirubin, total = .75 mg/dl
> Alk. phos. , serum =71 iu/l
> AST =38 iu/l
> ALT = 30 iu/l
>
> Not much change other than the ast and alt. Anything I should
> be thinking about talking to the doctor about? I'm 5 1/2 years post
> infarct (no damage), 49 years old, quit the cigarettes the day of the
> "event" and never had another. Problem was spot blockage in LAD and
> another artery, rotablator removal succesful and stenting of narrowed
> spot in LAD that they thought might have been narrow from birth.
> Bud
>
>
Great job getting off the cigarettes Bud. I wish more people would follow
your lead.

I am assuming your lab values are from a venipuncture (crease of the arm)
and not a fingerstick sample, is this correct?

What are your treatment goals? You did not include your lipid profile. I
would like to know why you are trying to push your niacin dose, could you
explain? Are you taking any other medications, including
botanicals/supplements, or have you in the past?

You should also ask your doctor for a liver ultrasound examination to check
for fatty liver or for other more serious causes of increased liver
enzymes. You are assuming that the increase in enzymes are from medication,
but medication may not be the cause.

As to the current level of enzymes, if it is elevated from your treatment
program, I would not be overly concerned, but would recommend checking it
every 6 months minimum, preferably monthly for a couple of months (you
won't need to include anything else for now on the test to help with cost)
until you get a handle on the trending.

The alcohol is not helping the ALT, AST, or cardiovascular risk, but the
flavanoids in the merlot can help your cause against heart disease. There
are many forms of flavanoids, but they may not taste as good as the merlot!

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard
~~~
SonoScore
Winning against heart attack and stroke
http://www.sonoscore.com

[Bud Burner]

On Wed, 03 Dec 2003 05:49:55 GMT, "Dr. Andrew B. Chung, MD/PhD"
<andrew@heartmdphd.com> wrote:

>Bud Burner wrote:
>
>> I have been on 2000 Mg of Niacin for hypercholesterolemia for
>> 5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
>> IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
>> increased to 45.
>> I do drink a glass of red wine (Merlot) witn my evening meal
>> but otherwise do not imbibe.
>> None of the other indicators have elevated:
>> protein, total, serum = 7.0 g/dl
>> albumin,serum = 4.5 g/dl
>> bilirubin, total = .8 mg/dl
>> Alk. phos. , serum = 71 iu/l
>>
>> Here's the data from 5 years ago:
>> protein, total, serum = 6.9 g/dl
>> albumin = 4.4 g/dl
>> bilirubin, total = .75 mg/dl
>> Alk. phos. , serum =71 iu/l
>> AST =38 iu/l
>> ALT = 30 iu/l
>>
>> Not much change other than the ast and alt. Anything I should
>> be thinking about talking to the doctor about?
>
>Seeing if a trial of abstaining from alcohol will allow the AST and ALT
>to return to baseline.
>
>
>> I'm 5 1/2 years post
>> infarct (no damage),
>
>Infarct means there was damage. Were you taking a daily aspirin at the
>time?
>
>> 49 years old, quit the cigarettes the day of the
>> "event" and never had another. Problem was spot blockage in LAD and
>> another artery, rotablator removal succesful and stenting of narrowed
>> spot in LAD that they thought might have been narrow from birth.
>
>Hopefully you are taking a daily aspirin.
>
>Humbly,
>
>Andrew

Hi Andrew,
It was called an infarct, but the cardiologist said there was
no lasting damage. The diagnosis was made from the cpk, another enzyme
marker I do not remember, and my blood pressure which was 170 over 90
at the time I was admitted but rapidly declining to 125 over 70 within
minutes of my getting horizontal on a gurney. Color doppler confirmed
blockages were present and subsequent angiography procedures ablated
the trouble spots.
My treatment has consisted of diet and lifestyle modification
and immediate tobacco cessation, with daily dose of asprin and Toprol
XL. Initial dose post-event was 100 mg. once daily, Plavix 75 mg once
daily for one month (because of stent placement previously mentioned),
plus Norvasc 2.5 mg once daily.
Initial lipid panels post-event were: Triglycerides 182 mg/dl,
total cholesterol 177 mg/dl, LDL 95, HDL 45.9 mg/dl. Current lipid
panel (which reflects the addition of Niacin 2000 mg/daily regimen
about three years ago) is total cholesterol 191, triglycerides 159,
HDL 54, LDL 105, and (not previously done) the VLDL is 31.
The Norvasc regimen was discontinued after approximately 6
months due to postural hypotension. Toprol XL doseage was reduced to
50 mg daily after about 2 years and further reduced to 25 mg within
the last year. Red wine was something I occasionally had with a meal,
which is the only time I drink any alcohol. Due to alleged health
benefits, it was continued with the evening meal on a nearly daily
basis. Small amounts of cannabis are occasionally consumed for the
relief of arthritis, which has caused me to be able to stop taking
Aleve at all any more for soreness in my hands. (I can see the
eyebrows going up over that one, but my hands make me my living, and
it works superbly. My physician is aware of it, I have no secrets from
my health care provider.)
Subsequent stress echo has indicated restenosis has not
recurred and having maintained my weight at 150 for the last 15 years
with only a few pounds excursion either way has kept me feeling quite
well.
Bud

[Bud Burner]

On Wed, 03 Dec 2003 06:06:42 -0600, "Patrick Blanchard, M.D."
<blanchard@sonoscore_nospam.com> wrote:

>On Tue, 02 Dec 2003 21:14:31 -0600, Bud Burner
><budburner@altdrugspot.cjb.net> wrote:
>
>> I have been on 2000 Mg of Niacin for hypercholesterolemia for
>> 5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
>> IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
>> increased to 45. I do drink a glass of red wine (Merlot) witn my evening
>> meal
>> but otherwise do not imbibe.
>> None of the other indicators have elevated:
>> protein, total, serum = 7.0 g/dl
>> albumin,serum = 4.5 g/dl
>> bilirubin, total = .8 mg/dl
>> Alk. phos. , serum = 71 iu/l
>>
>> Here's the data from 5 years ago:
>> protein, total, serum = 6.9 g/dl
>> albumin = 4.4 g/dl
>> bilirubin, total = .75 mg/dl
>> Alk. phos. , serum =71 iu/l
>> AST =38 iu/l
>> ALT = 30 iu/l
>>
>> Not much change other than the ast and alt. Anything I should
>> be thinking about talking to the doctor about? I'm 5 1/2 years post
>> infarct (no damage), 49 years old, quit the cigarettes the day of the
>> "event" and never had another. Problem was spot blockage in LAD and
>> another artery, rotablator removal succesful and stenting of narrowed
>> spot in LAD that they thought might have been narrow from birth.
>> Bud
>>
>>
>Great job getting off the cigarettes Bud. I wish more people would follow
>your lead.
>
>I am assuming your lab values are from a venipuncture (crease of the arm)
>and not a fingerstick sample, is this correct?
>
>What are your treatment goals? You did not include your lipid profile. I
>would like to know why you are trying to push your niacin dose, could you
>explain? Are you taking any other medications, including
>botanicals/supplements, or have you in the past?
>
>You should also ask your doctor for a liver ultrasound examination to check
>for fatty liver or for other more serious causes of increased liver
>enzymes. You are assuming that the increase in enzymes are from medication,
>but medication may not be the cause.
>
>As to the current level of enzymes, if it is elevated from your treatment
>program, I would not be overly concerned, but would recommend checking it
>every 6 months minimum, preferably monthly for a couple of months (you
>won't need to include anything else for now on the test to help with cost)
>until you get a handle on the trending.
>
>The alcohol is not helping the ALT, AST, or cardiovascular risk, but the
>flavanoids in the merlot can help your cause against heart disease. There
>are many forms of flavanoids, but they may not taste as good as the merlot!

Hi Patrick,
Yes, the hepatic and lipid panels are taken from left arm
venipuncture. I see my internal medicine specialist every six months.
He has not been at all concerned with the ALS and AST because he had
said if I was really working physically hard for a few days those
levels would be elevated due to the act of building muscle tissue in
the arms and legs from the repeated exertion, sort of like a person
who works out with weights. I was concerned mainly because I was
seeing numbers increase without knowing their importance or lack
thereof. I see all my bloodwork results and keep a graph of how I'm
doing with each level. Just curiosity.
I responded and elaborated to Andrew Chung's post before I
read yours, so rather than repeat alot of things please have a peek at
my reply to him.
Yes, the Merlot is high in Resvertrol, as is Cabernet Sovig.
and Pinot Noir. If one is lucky enough to get a hold of a New York
Pinot Noir, they have the highest concentration of that enzyme of any
wines.I think the New Yorker's keep them all to themselves, I cannot
find one here in the Midwest.
Bud

[Dr. Andrew B. Chung, MD/PhD]

Bud Burner wrote:

> On Wed, 03 Dec 2003 05:49:55 GMT, "Dr. Andrew B. Chung, MD/PhD"
> <andrew@heartmdphd.com> wrote:
>
> >Bud Burner wrote:
> >
> >> I have been on 2000 Mg of Niacin for hypercholesterolemia for
> >> 5 1/2 years now. Over time, my AST (SGOT) has slowly increased to 50
> >> IU/L. My last lipid and hepatic panel showed ALT (SGPT) has also
> >> increased to 45.
> >> I do drink a glass of red wine (Merlot) witn my evening meal
> >> but otherwise do not imbibe.
> >> None of the other indicators have elevated:
> >> protein, total, serum = 7.0 g/dl
> >> albumin,serum = 4.5 g/dl
> >> bilirubin, total = .8 mg/dl
> >> Alk. phos. , serum = 71 iu/l
> >>
> >> Here's the data from 5 years ago:
> >> protein, total, serum = 6.9 g/dl
> >> albumin = 4.4 g/dl
> >> bilirubin, total = .75 mg/dl
> >> Alk. phos. , serum =71 iu/l
> >> AST =38 iu/l
> >> ALT = 30 iu/l
> >>
> >> Not much change other than the ast and alt. Anything I should
> >> be thinking about talking to the doctor about?
> >
> >Seeing if a trial of abstaining from alcohol will allow the AST and ALT
> >to return to baseline.
> >
> >
> >> I'm 5 1/2 years post
> >> infarct (no damage),
> >
> >Infarct means there was damage. Were you taking a daily aspirin at the
> >time?
> >
> >> 49 years old, quit the cigarettes the day of the
> >> "event" and never had another. Problem was spot blockage in LAD and
> >> another artery, rotablator removal succesful and stenting of narrowed
> >> spot in LAD that they thought might have been narrow from birth.
> >
> >Hopefully you are taking a daily aspirin.
> >
> >Humbly,
> >
> >Andrew
>
> Hi Andrew,
> It was called an infarct, but the cardiologist said there was
> no lasting damage.

If s/he called it an infarct, heart muscle cells died. Unfortunately, they
do not grow back. It sounds like your heart function probably normalized
after other undamaged parts started doing more. Were you taking aspirin at
the time?

> The diagnosis was made from the cpk, another enzyme
> marker I do not remember,

These markers proved that heart muscle cells died.

> and my blood pressure which was 170 over 90
> at the time I was admitted but rapidly declining to 125 over 70 within
> minutes of my getting horizontal on a gurney. Color doppler confirmed
> blockages were present

Actually, they would have confirmed heart muscle injury/damage which could
have happened from other things besides blockages.

> and subsequent angiography procedures ablated
> the trouble spots.

You mean interventional angioplasty procedures. The term ablation is
reserved for EP procedures (for electrical disturbances).

>
> My treatment has consisted of diet and lifestyle modification
> and immediate tobacco cessation,

Good. Hopefully you are now telling all your friends and family that they
should quit smoking else they will likely relive your experience.

> with daily dose of asprin and Toprol
> XL. Initial dose post-event was 100 mg. once daily, Plavix 75 mg once
> daily for one month (because of stent placement previously mentioned),
> plus Norvasc 2.5 mg once daily.
> Initial lipid panels post-event were: Triglycerides 182 mg/dl,

Too high.

>
> total cholesterol 177 mg/dl, LDL 95, HDL 45.9 mg/dl. Current lipid
> panel (which reflects the addition of Niacin 2000 mg/daily regimen
> about three years ago) is total cholesterol 191, triglycerides 159,

Still too high.

>
> HDL 54, LDL 105,

Too high.

> and (not previously done) the VLDL is 31.
> The Norvasc regimen was discontinued after approximately 6
> months due to postural hypotension. Toprol XL doseage was reduced to
> 50 mg daily after about 2 years and further reduced to 25 mg within
> the last year. Red wine was something I occasionally had with a meal,
> which is the only time I drink any alcohol.

Alcohol should be avoided by those who have hypertension.

> Due to alleged health
> benefits, it was continued with the evening meal on a nearly daily
> basis. Small amounts of cannabis are occasionally consumed for the
> relief of arthritis, which has caused me to be able to stop taking
> Aleve at all any more for soreness in my hands. (I can see the
> eyebrows going up over that one, but my hands make me my living, and
> it works superbly. My physician is aware of it, I have no secrets from
> my health care provider.)

Speaking as a cardiologist, there are more objections for the alcohol given
that you are hypertensive.

>
> Subsequent stress echo has indicated restenosis has not
> recurred and having maintained my weight at 150 for the last 15 years
> with only a few pounds excursion either way has kept me feeling quite
> well.
> Bud

How tall are you?

If you are shorter than 5'10", you may still be overweight.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

[Bud Burner]

On Fri, 05 Dec 2003 13:56:06 -0500, "Dr. Andrew B. Chung, MD/PhD"
<cardiologist@heartmdphd.com> wrote:


>> Hi Andrew,
>> It was called an infarct, but the cardiologist said there was
>> no lasting damage.
>
>If s/he called it an infarct, heart muscle cells died. Unfortunately, they
>do not grow back. It sounds like your heart function probably normalized
>after other undamaged parts started doing more. Were you taking aspirin at
>the time?
>
>> The diagnosis was made from the cpk, another enzyme
>> marker I do not remember,
>
>These markers proved that heart muscle cells died.
>
>> and my blood pressure which was 170 over 90
>> at the time I was admitted but rapidly declining to 125 over 70 within
>> minutes of my getting horizontal on a gurney. Color doppler confirmed
>> blockages were present
>
>Actually, they would have confirmed heart muscle injury/damage which could
>have happened from other things besides blockages.
>
>> and subsequent angiography procedures ablated
>> the trouble spots.
>
>You mean interventional angioplasty procedures. The term ablation is
>reserved for EP procedures (for electrical disturbances).
>
>>
>> My treatment has consisted of diet and lifestyle modification
>> and immediate tobacco cessation,
>
>Good. Hopefully you are now telling all your friends and family that they
>should quit smoking else they will likely relive your experience.
>
>> with daily dose of asprin and Toprol
>> XL. Initial dose post-event was 100 mg. once daily, Plavix 75 mg once
>> daily for one month (because of stent placement previously mentioned),
>> plus Norvasc 2.5 mg once daily.
>> Initial lipid panels post-event were: Triglycerides 182 mg/dl,
>
>Too high.
>
>>
>> total cholesterol 177 mg/dl, LDL 95, HDL 45.9 mg/dl. Current lipid
>> panel (which reflects the addition of Niacin 2000 mg/daily regimen
>> about three years ago) is total cholesterol 191, triglycerides 159,
>
>Still too high.
>
>>
>> HDL 54, LDL 105,
>
>Too high.
>
>> and (not previously done) the VLDL is 31.
>> The Norvasc regimen was discontinued after approximately 6
>> months due to postural hypotension. Toprol XL doseage was reduced to
>> 50 mg daily after about 2 years and further reduced to 25 mg within
>> the last year. Red wine was something I occasionally had with a meal,
>> which is the only time I drink any alcohol.
>
>Alcohol should be avoided by those who have hypertension.
>
>> Due to alleged health
>> benefits, it was continued with the evening meal on a nearly daily
>> basis. Small amounts of cannabis are occasionally consumed for the
>> relief of arthritis, which has caused me to be able to stop taking
>> Aleve at all any more for soreness in my hands. (I can see the
>> eyebrows going up over that one, but my hands make me my living, and
>> it works superbly. My physician is aware of it, I have no secrets from
>> my health care provider.)
>
>Speaking as a cardiologist, there are more objections for the alcohol given
>that you are hypertensive.
>
>>
>> Subsequent stress echo has indicated restenosis has not
>> recurred and having maintained my weight at 150 for the last 15 years
>> with only a few pounds excursion either way has kept me feeling quite
>> well.
>> Bud
>
>How tall are you?
>
>If you are shorter than 5'10", you may still be overweight.
>
>Humbly,
>
>Andrew

Andrew:
I'll drop the wine from the diet for a few months and then see
how we do on the regular scheduled get-together with my doctor. Heh,
he was the one that suggested making the wine a daily thing, and it
was also at that time the triglycerides went up according to the chart
I keep.
When the Niacin was first introduced, six months later this
was the lipid panel and hepatic panel: HDL 51, LDL 106, Total
cholesterol 177, triglycerides 99. Looking back, my triglycerides have
always been in the 150-180 range and the Niacin lowered it some while
it raised the HDL (good thing) and the LDL (bad thing). As the alcohol
was introduced, the triglycerides went up again.
I mis-spoke when I said "angiography and ablated trouble
spots", it was rotablator at the trouble spots which I believe is
another term for arterectomy? They removed plaque and were able to
retrieve the pieces and they did some labwork on it for whatever
reason; the charge for it was on the bill but nothing was said about
it.
I'm 5' 9 1/2", am I still safe at ~150? I look gaunt if I get
much below 150. :-)
When I was 38 years old I had some bloodwork done as part of a
routine physical, my LDL was 129, HDL was 39, triglycerides was 121.
Blood pressure was 130/70 (at the time I was a 2 pack-a-day smoker).
No meds were prescribed by the doctor (different doc, since retired)
and no comment was made as to any need to intervene on the cholesterol
numbers. Btw, AST was 17 and ALT was 9.
There are 6 different labs' names on the bloodwork reports I
have as they bid out the labwork yearly and it's been a different lab
every year now and the numbers vary due to that somewhat too. The last
report from my Sept. '03 visit was from yet another lab, which will
likely be the same lab for my March '04 visit, so we'll drop alcohol
of all forms from the diet after the holidays are behind me and see
what happens, that'll give things 3 months to level out.
I've been told that Aleve can raise the hepatic panel somewhat
too; now that I no longer need to take it perhaps that will also
contribute to the lowering of AST/ALT. My dose was typically one 220
mg. tablet before bed and another in the morning if needed (maybe 3
mornings a week for pain in the hands). I haven't needed Aleve now for
several months.
As to asprin, I was not taking asprin at all prior to the
heart attack as a preventive measure, just for occasional pain relief.
Asprin never really worked well for pain with me anyway. Now, of
course, it's a daily regimen and has been since the "event".
Thank you for your advice, we'll see where this leads and I'll
let you know how things turn out come March.
Bud