Here is a good article:
Although only tangentially related to your question, it can give you some useful background.
My advice is that you probably should get some more information. I think there is reasonable consensus that it is the LDL particles themselves – that is, the number of them – that confers risk. Not the amount of cholesterol they carry. So getting an actual LDL-P number assay done (NMR) would be helpful.
Past this, if your LDL-C is very high, then your LDL-P will almost certainly be high also. Whether you choose to use statins or not should be a discussion between you and your doctor. Otherwise what is the point of having a doctor?
Thank you, I’ll take a look. My doctor was unfamiliar with FH, and I had to request the lipoprotein(a) test which showed my low density lipoprotein(a) was around the 300 range. Triglycerides 41, HDL 87. TC 249. I did request the Lp(a) test on the advice of my mother, who does see a cardiologist, and diagnosed her with FH by specifically requesting lipoprotien (a) testing. The problem with FH is that diet has no positive effect on Lp(a), although I’m sure I could make my LDL worse. It’s a genetic defect. Now, my lifestyle makes it much more likely I would survive the heart attack… bonus I guess. The issue is that statins seem to lower numbers overall, to include HDL, and might have negligible improvements. So much of this research I have been able to find deals with people with high triglycerides and poor HDL, when really, the only marker I have that would indicate I’m not incredibly healthy is the 400+ lipoprotien. I’m military insurance, so my doctor is whoever I happen to have at the time at the military treatment facility, and I don’t exactly have a valid reason to request a referral to a cardiologist. I mean, I’m a marathoner and my resting heart rate is 55 BPM (female).
You could listen to the Dayspring lipid podcasts that Peter Attia posted last week on his site:
It touches on many of the topics you mention here. Recent evidence is that high HDL isn’t actually protective–all drugs that increase it appear to have failed to produce lower levels of CVD. So at best, it is a marker for some other process that may be protective.
Also, don’t confuse Lp(a) with LDL-P. LDL-P comes from an assay (usually NMR) that counts/calculates the LDL particles per liter of blood. Lots of small LDL particles are thought to be much more atherogenic than lower numbers of large LDL particles – even if the amount of cholesterol they carry (LDL-C) is the same. If your LDL-C is what is 300, it is still within the realm of possibility that your LDL-P is okay. But you would need to get the NMR test to tell you that.
Lp(A) is an LDL particle with an additional lipoprotein – apolipoprotein A – added to it. Peter Attia had an earlier podcast that went into some detail on Lp(a):
If you did have your Lp(a) tested and it is high, then you should listen to this. It is currently much more difficult to treat than high LDL and many doctors know nothing about it. Just treating it with a statin is unlikely to be sufficient.
Also, keep in mind that FH is not a single genetic condition, but rather a host of genetic predispositions to high blood cholesterol levels. Some probably do respond to changes in diet.
Best summary of Attia/Dayspring current lipidology knowledge I’ve seen! A keeper. Thanks!
Yes, I definitely had my Lp(a) tested, and last one was 333 (I pulled my last labs just to double check my numbers.) Looking for info on this topic that few know very much about was one of the things that led me here. I have been listening to some of Peter Attia’s stuff over the past couple of days to include the Lp(a) podcast you referenced, and it’s been interesting. I’ll take a look at the ones you posted, as well. Thanks!
I’m glad you’re investigating your options. Ask your doctor for a referral to a FH / lipoprotein specialist.
Also check out the Valter Longo interviews with Rhonda.
Beg Peter Attia to review your case.
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youtube Ivor Cummins, he covers this in depth and has some very convincing scientifically backed protocals
Thanks, I’ll take a look!
First and most important, comments here shouldn’t replace medical advice. Given that, some people take niacin to lower Lp(a) levels modestly. High does niacin (2-3 gm/day) does have a tendency to increase insulin resistance, and thus might not be a good option for everyone. Some of the people taking the extended-release niacin vs. immediate release niacin (to limit flushing effect) notice increases in liver function enzymes (ALT in particular I think). PCKS9 inhibitors provide a much more potent Lp(a) lowering effect, but from what I have heard most insurance plans won’t cover it. There is an Lp(a) inhibitor being tested now that is looking promising, but it will be another 6+ years likely before that study is finalized and published. So there is hope on the horizon, you just need to hang in there and try to manage what you can for your health. The publicly quoted cost of Repatha was significantly reduced recently, but it is still quite expensive.
Thank you! And yes absolutely not looking for medical advice, rather information. :) I hadn’t heard there was anything new in development as far as Lp(a) inhibitors, but was aware niacin had some positive effect. It seems the side effects for anything we have now outweigh the benefit if you’re otherwise healthy. Good news at least that Lp(a) is being looked at. Thanks again!
Not as straight forward as one would think.
check out the week of Tom Dayspring podcast to learn more than you ever wanted about the world of lipids.
Thank you! Looks like a ton of information here. It’s been a difficult topic to research because so much of the things you find are from “all fat is bad, cholesterol is bad” sources, and statin topics range from they are either life-saving or incredibly damaging.
Yes check out the Dayspring interviews. You could skip to the last one on statins and also get his take on niaciin that segment. . Attia puts Dayspring on top as his lipidolgy guru and they both also respect Dr Ron Kraus. All of these folks and Rhonda appear to endorse each other and together they carry more weight as peers. Attia is not supportive of Ivor Cummins' approach, though not apparently totally against, he has disputed the focus on calcium and the cac test’s utilify. Poke around to find details. Attia could be wrong, but hes a very experienced and scientific doc as well as a serious athlete and works with the top lipidologists. So as much as Ivor Cummins (the engineer ) appeals to common sense, I have to go with Attia/Dayspring/Kraus conclusions first and foremost.
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