LP(a) - A better way to measure CV risk?

[sengsational]

On a whim, I ordered an "LP little a" test from LEF. I think it was $39.



I don't have the results yet... just had the draw yesterday, but I wondered if there are any fans/detractors of this test, and why you take that position.



There was a long, technical netcast that I attempted to listen to, but most of it went over my head (Peter Attia "The Drive"). For a while I thought the test could really tell you something, then I thought maybe it wasn't as helpful as the particle number.



It was done at LabCorp and I suspect that it's the variation of the test that's not as helpful...the LP(a)-mass, but I'll probably need to call LabCorp to find out because it wasn't obvious on the sample report I looked at.

 

[Chuckanut]

It is very confusing, IMHO.

I am one of those weird people with somewhat high LDL and total cholesterol levels, but also a very low Trig/HDL ratio. From what I have read this ratio is a much better indicator of CVD than total cholesterol and LDL. But high LDL is also a bad sign. So, some bad signs and some good signs.

Go figure.

For the body hackers in the group:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

CONCLUSION

Nearly all routinely assessed lipid variables were associated with the extent of coronary disease, but only the ratio of triglycerides to HDL-cholesterol or to HDL-c were robustly associated with disease extent. Elevation in the ratio of TG to HDL-c was the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined.

 

[sengsational]

We're similar in that we've got lots of HDL. My ratio is typically in the 0.5 to 0.7 range. Too many doctors just look at an elevated calculated LDL-C and break out the prescription pad. If I'm going full guns on low carb eating, my ratio goes to 1.5 or something, but I don't really do ultra low carb any more. Instead, I just keep away from the high glycemic index foods (highly refined white stuff), and that seems to be enough.

 

[bjorn2bwild]

My first exposure to LP(a) was through this blog post (linked to in an earlier thread). While the drive podcast goes into more detail this gives a nice outline.

If you have had a heart attack at an early age or one of your parents did but your standard risk factors for coronary heart disease are normal you should consider getting tested for Lipoprotein(a) or Lp(a).

It is the strongest single inherited (monogenetic) risk factor for the early development of coronary artery disease, heart attacks and strokes.
In addition to increasing risk of atherosclerosis, high Lp(a) is strongly associated with the development of calcific aortic valve disease which can result in narrowing of the aortic valve and aortic stenosis.
Depending on the cut-off used up to one in five individuals may have elevated Lp(a)
Levels of Lp(a) can be measured with a simple blood test that should cost no more than 50 to 100$. This is not included in standard lipid or cholesterol testing.
Risk for heart attack starts to rise with levels above 30 mg/dl and Canadian guidelines from 2016 (see here)) consider >30 mg/dl to be a risk factor and they recommend measuring Lp(a) in those with a family history of premature CAD or those at intermediate risk.
The European Atherosclerosis Society (EAS, 2010), suggested levels of <50 mg/dl as optimal. The EAS advised measuring Lp(a) once in all patients with premature CVD.

https://theskepticalcardiologist.co...now-about-lipoproteina-and-heart-attack-risk/

 

[haha]

We're similar in that we've got lots of HDL. My ratio is typically in the 0.5 to 0.7 range. Too many doctors just look at an elevated calculated LDL-C and break out the prescription pad. If I'm going full guns on low carb eating, my ratio goes to 1.5 or something, but I don't really do ultra low carb any more.

Is there a reason for this, other than taste preference?

Ha

 

[PatrickA5]

While all of the various Lipid blood tests will more or less tell you if your "at risk", the only way to know if you have heart disease is to have a test that actually looks at your arteries such as a CT Scan. A local hospital's heart clinic had a special for only $399, and I decided "why not?". Yup, 40% blockage of the LAD. It was a quick, simple test and now I know. I've had other tests since then to further confirm. I also have had a Carotid Doppler done which showed blockage in my neck arteries.

At this point, I'm working on keeping things from getting worse.

 

[misshathaway]

If I'm going full guns on low carb eating, my ratio goes to 1.5 or something, but I don't really do ultra low carb any more. Instead, I just keep away from the high glycemic index foods (highly refined white stuff), and that seems to be enough.

I discovered after recording mood for awhile that on days when I went above 20g carbs, the next day my mood was brighter. This was after a few years of 20g. Now I've loosened up, like with the purse strings. For me that just means a greater variety and quantity of vegetables. We'll see what the bloodwork says this year.

My old primary care retired and I will have a new one for the annual. Old one didn't care about the high HDL since LDL was OK. For all I know the new one will think everybody should be eating the Standard American Diet and I should be on statins.

 

[sengsational]

Is there a reason for this, other than taste preference?

Before, I was eating "the most important meal of the day"* (breakfast), and lunch and dinner. All those eating opportunities made it easy to put on a pound or two, even doing low carb. Once I switched to a snack and one meal, the pounds didn't show up, even though I added many more grams of (healthy) carbs.


Oh, and now I can have a beer!



* Not sure there's any real science behind that accepted premise.

 

[Texas Proud]

Before, I was eating "the most important meal of the day"* (breakfast), and lunch and dinner. All those eating opportunities made it easy to put on a pound or two, even doing low carb. Once I switched to a snack and one meal, the pounds didn't show up, even though I added many more grams of (healthy) carbs.


Oh, and now I can have a beer!



* Not sure there's any real science behind that accepted premise.

There is (or maybe was) science on breakfast.... but FWIR it was based on kids and school... not sure if adults were in the mix...

 

[bjorn2bwild]

The tricky thing about an elevated LP(a) reading is that 'healthful' tweaks to diet/exercise appear to have no positive effect on outcomes.

 

[RAE]

My ratio is typically in the 0.5 to 0.7 range.

If your Triglyceride/HDL ratio is in this range, your odds of having a heart attack within the next decade are very, very low, based on everything I've read. Anyone with a Trig/HDL ratio under 2.0 is in pretty good shape.......less than 1.0 and you are in great shape. So if I were you, I wouldn't worry too much about it.

I would be curious, though, how your Lp(a) test results come back, if you don't mind sharing them with us. My guess, based on your very good Trig/HDL ratio, is that it will come back showing you have mostly the big, fluffy LDL particles (which are harmless), and very few of the small, dense LDL particles (which is the ones that cause the damage).

 

[braumeister]

Anyone with a Trig/HDL ratio under 2.0 is in pretty good shape.......less than 1.0 and you are in great shape.

All my reading over the years has pointed out three ratios that seem to be indicative of potential CVD:

Total cholesterol/HDL (you want it to be under 5)

Trig/HDL (you want it to be under 3)

LDL/HDL (you want it to be under 4.5)

And as you say, the better the ratios the less you need to worry.

 

[Chuckanut]

I just ran some numbers through this calculator:
ACC/AHA ASCVD Risk Calculator

These are not my actual numbers, just a set of what I consider pretty darn good numbers. I wanted to see how low my cholesterol and BP had to be, and how good my health had to be to avoid taking a statin.

age 67
male
none African American
Total Col - 160
HDL - 80
Blood Press 105/60
non smoker
no diabetes
no BP treatment

The results:

On the basis of your age and calculated risk for heart disease or stroke over 7.5%, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin.

I had to get Total Cholesterol down to 148 to just barely drop into the no-drug range. Is that really possible for most people in their 60's and above?

I guess I am a bit amazed that a person with very good BP, total chol 40 points under the limit of 200, HDL of 80, no bad health habits still needs a drug.

 

[audreyh1]

Yeah - it sucks. If you are a certain age range and male, you are pretty much guaranteed to fall into that "high risk" group.

 

[razztazz]

I used to use various calculators like that. One day I punched in all numbers. In order to lower my risk appreciably my HDL need to be 100 and my LDL needed to be close to zero. Not medically possible nor feasible.

Then I just kept increasing my age and it kept telling me every year I needed higher and higher doses of statins no matter what my numbers were. My risk could never be lowered enough to be considered healthy. Don't tell me it's not a plot.

This whole mishigahss belongs in a business class, the one on "Bunko and Other Passive Income Techniques", not in the world of medicine.

 

[PatrickA5]

I put my numbers in and was told I don't need a statin or aspirin. Only problem is, I'm taking both. I assume my statin is the reason my numbers are good. Don't know for sure. At any rate, I have CAD and disease of the carotid arteries, so I'll continue on my statin.


My HDL and BP aren't as good what you put in, but I'm a little younger and have slightly better cholesterol (likely due to the Statin).

 

[PatrickA5]

I just ran some numbers through this calculator:
ACC/AHA ASCVD Risk Calculator

These are not my actual numbers, just a set of what I consider pretty darn good numbers. I wanted to see how low my cholesterol and BP had to be, and how good my health had to be to avoid taking a statin.

age 67
male
none African American
Total Col - 160
HDL - 80
Blood Press 105/60
non smoker
no diabetes
no BP treatment

The results:


I had to get Total Cholesterol down to 148 to just barely drop into the no-drug range. Is that really possible for most people in their 60's and above?

I guess I am a bit amazed that a person with very good BP, total chol 40 points under the limit of 200, HDL of 80, no bad health habits still needs a drug.

When I plugged in these numbers, I get the "no need for statin" result.

 

[homestead]

age 65
male
none African American
Total Col - 144
HDL - 43
Blood Press 124/60
non smoker
no diabetes
no BP treatment

Calc says I need med-high statin.
Doc said everything was fine.

 

[bjorn2bwild]

High HDL appears to give a pass for statin recommendation (CVD risk over next 10 years 6.1%) -
Age - 63
Male
Tot Col -192
HDL -98
BP - 119/78
Non smoker
No DM
No meds

 

[aja8888]

age 74
male
none
Total Col - 166
HDL -56
Blood Press 110/60
non smoker
no diabetes
no BP treatment

Calc says I need med-high statin.
Doc said everything was fine this week's visit

 

[RAE]

I just ran some numbers through this calculator:
ACC/AHA ASCVD Risk Calculator

The problem here is that you used a calculator developed by the American Heart Association. In my opinion, any and all advice from AHA is not to be trusted. All you need to do is follow the money, to figure out why AHA is always recommending drugs like statins (even for those that do not need them) and pushing pseudo-foods such as soybean oil. Their funding largely comes from the big drug companies, and the mega-agricultural companies that produce stuff like soybean oil.

With regard to drug company funding:

"The financial ties between large pharmaceutical companies and the AHA are numerous and very remunerative for the AHA, including huge donations from Abbott, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Merck and Pfizer."

Guess who sells most statins worldwide? Pfizer and Merck.

 

[PatrickA5]

The problem here is that you used a calculator developed by the American Heart Association. In my opinion, any and all advice from AHA is not to be trusted. All you need to do is follow the money, to figure out why AHA is always recommending drugs like statins (even for those that do not need them) and pushing pseudo-foods such as soybean oil. Their funding largely comes from the big drug companies, and the mega-agricultural companies that produce stuff like soybean oil.

With regard to drug company funding:

"The financial ties between large pharmaceutical companies and the AHA are numerous and very remunerative for the AHA, including huge donations from Abbott, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Merck and Pfizer."

Guess who sells most statins worldwide? Pfizer and Merck.

So, who are you supposed to listen to? I probably read 20 articles about heart health on their website today, not a one was promoting statins or other drugs. Most were about eating more healthy, etc. I guess I shouldn't take their advice on eating healthy since you say "any and all advice from AHA is not to be trusted"? At some point we need to have some trust in organizations and our own doctors. They can't all be lying to us for the sake of $$$ from Big Bad Pharma.

 

[razztazz]

At some point we need to have some trust in organizations and our own doctors. They can't all be lying to us for the sake of $$$ from Big Bad Pharma.

Yes, but it's hard to tell which ones aren't

Having to eventually trust them at some point is not the same as actually trusting them

 

[RAE]

So, who are you supposed to listen to? I probably read 20 articles about heart health on their website today, not a one was promoting statins or other drugs. Most were about eating more healthy, etc.

My advice is to listen to people and organizations that do not have major financial ties to the companies/industries whose products they are pushing. It is unfortunate, but in this country big money controls almost everything, including diet/health/medical advice. The AHA rakes in millions from food companies which are also million dollar donors and which pay from $5,490 to $7,500 per product to gain the “heart-check mark” imprimatur from the AHA, renewable, at a price, every year. Many of those products are not at all healthy to eat.

I just reviewed the dietary guidelines from AHA, and they are still promoting eating at least 6 servings per day of grains, and promoting fats like soybean and corn oil as healthy. If you eat like that for a number of years, you will most likely develop heart disease (and then you will be prescribed a statin, so AHA profits again, from Pfizer and Merck). You really need to do your own independent research and look hard at who is giving out the advice and what they have to gain from it.

I hesitate to recommend any one person as someone to go to for health/diet advice (there are several good ones), but if I had to pick one, I'd start with Chris Kresser. He's done a ton of research on nutrition and health over the years, and I think his advice is sound, and free from financial bias. He wrote a series of articles a while back on heart disease and statins, etc. You can find those articles here: https://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/

 

[Chuckanut]

I guess I shouldn't take their advice on eating healthy since you say "any and all advice from AHA is not to be trusted"? At some point we need to have some trust in organizations and our own doctors. They can't all be lying to us for the sake of $$$ from Big Bad Pharma.

I think that the AHA shot itself in the foot when it started giving out healthy heart awards to cereals like Froot Loops and Coco Puffs. And there were other such foods that got the award also. This only ended in 2010 after an article exposed what was happening.

https://www.livestrong.com/article/358980-froot-loops-vs-healthy-cereals/

Sugar is the first ingredient on the list in Kellogg's Froot Loops. Grains include whole-grain corn flour, wheat flour, which is not a whole grain, and whole-grain oat flour. Froot Loops contains oat fiber and soluble corn fiber. This cereal contains hydrogenated vegetable oil, a trans fat. It also contains natural fruit flavors and several dyes and artificial colors. It's fortified with vitamins and minerals and contains BHT, a chemical preservative. A 1-cup serving contains 110 calories, 1 g of fat, 25 g of carbohydrates, including 3 g of fiber and 12 g of sugar, and 1 g of protein.

Coco Puffs made the Heart Healthylist

http://www.cureality.com/blog/post/2010/04/29/is-cocoa-puffs-no-longer-heart-healthy.html

Until recently, Cocoa Puffs enjoyed the endorsement of the American Heart Association (AHA) as a heart-healthy food.

For a price, the AHA will allow food manufacturers to affix a heart "check mark" signifying endorsement by the AHA as conforming to some basic "heart healthy" requirements.

Odd thing: The list of breakfast cereals on the check mark program has shrunk dramatically. When I last posted about this, there were around 50-some breakfast cereals, from Cocoa Puffs to Frosted Mini Wheats.

Fruity Cheerios got the OK also.
Weighty Matters: American Heart Association loves sugar and butylated hydroxytoluene

Well each serving has over 2 teaspoons of sugar made up from 4 different sources:

Sugar (2nd ingredient)
Corn Syrup (4th ingredient)
Orange Juice Concentrate (6th ingredient)
Dried Corn Syrup (7th ingredient)

IMHO, the AHA's reputation has suffered at their own hands. My 2¢.