No need to re-invent the wheel

2. May 2007 William Davis (0)
I seem to be repeating myself lately, but I think this does bear repeating:

There's no need to re-invent the wheel when it comes to gaining control over your heart scan score.

The Track Your Plaque program is the most powerful approach known to help you gain control over your coronary atherosclerotic plaque and CT heart scan score, bar none. While 100% of people do not drop their score, more and more people every week are doing so. (One of the admitted weaknesses of the Track Your Plaque website is our failure to list more success stories; we're working on it.)

The basic program is quite simple:

--The Rule of 60 for lipids (LDL 60 mg/dl; HDL 60 mg/dl or greater; triglycerides 60 mg/dl or less)

--Identify hidden causes of plaque, esp. small LDL, Lp(a), and IDL, followed by specific corrective action

--Fish oil--minimum 1200 mg per day of EPA + DHA

--Normal vitamin D3 blood levels (We aim for 25-OH-vitamin D3 of 50-60 ng/ml)

--Normal blood sugar (<100 mg/dl)

--Normal blood pressure (<130/80)

--An optimistic attitude



Much of the other stuff--vitamin K, matrix metalloproteinase reducing strategies, flavonoid strategies, exercise-induced hypertension, etc.--are, for the majority, fluff. Their real role is in people who may have failed in stopping the rise of their heart scan score just doing the basics of the program.

If you neglect the basics, hoping to find some magic potion, I'm afraid the overwhelming likelihood is that you will fail. I've seen it happen time and again. Someone will come to my office with an extraordinary list of supplements--hawthorne, dozens of anti-oxidants, EDTA, concentrated flavonoid preparations, and on and on. Not only is it shockingly expensive to do this, it's also unnecessary and foolhardy. This kind of unfocused, hocus-pocus in the hopes of getting it right fail time after time.

The Track Your Plaque program, while not foolproof, is the best I know of. Stick to the basics and wander off when the basics fail. But there's extraordinary power in just achieving the basics.
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Lipoprotein(a): Surprising Poll Results

Lipoprotein(a): Surprising Poll Results

6. May 2008 William Davis (5)
No doubt, our little informal poll asking readers whether they have lipoprotein(a), is skewed towards people inclined to respond because they have this genetic trait.

Nonetheless, the response is telling. Of 82 respondents:

--40 (48%) said they did have Lp(a)

--16 (19%) said that they did not have Lp(a)

--26 (31%) said that they did not know whether or not they had Lp(a)


Though admittedly an informal analysis, I'd draw several conclusions from this simple "experiment".

One, while the proportion of people responding that they have Lp(a) may not be accurate, it is a prevalent genetic risk factor that, according to formal studies, is present in 17% of people with coronary or vascular disease, 11% of the broader population. This number may be even higher if the newer particle number assays (measurements) are used (with results expressed in nmol/L), since an occasional person with a "normal" Lp(a) in mg/dl (weight-based) will prove to have increased Lp(a) by nmol/L (particle number-based). (The reason for this phenomenon is not clear. It may be consequent to variation in apo(a) size, with larger apo(a) varieties of Lp(a) occasionally escaping detection .) As our little poll shows, plenty of people have Lp(a).

Two, readers of this blog tend to be highly motivated, sophisticated, and knowledgeable about health and heart disease. Yet a substantial portion--31%--did not know whether they have this crucial risk factor. That shouldn't be. The unnecessary difficulty of getting this simple blood test performed has been driven home to me repeatedly when I identify this factor in someone and then suggest that their grown children and parents, each of whom have a 50% chance of having Lp(a), be tested. It's not uncommon for a 35-year old son, for instance, to say that his doctor refused, claiming it is an unproven risk marker, or to simply say that he/she doesn't know what it is.

No doubt, just knowing whether you have Lp(a) or not is not the end of the story. Reducing Lp(a) and its associated co-factors is no easy matter. With several hundred patients in my practice with Lp(a), it occupies much of my time and energy. Sometimes it leads to enormous successes , but it can also pose a real challenge.

There should no longer be any doubt that Lp(a) is associated with significantly increased risk of cardiovascular disease. This has been demonstrated conclusively across dozens of studies. Risk from Lp(a) is over and above that posed by other risk factors; it also amplifies the risk posed by other factors, e.g., small LDL, inflammatory phenemena, homocysteine, total LDL, low HDL.

In the world of Lp(a), our two most desperate needs for the future are:

1) Better education of physicians and the public, and

2) More effective treatment options.

Thus, our reasons to form The Lipoprotein(a) Research Foundation. Steps to gain tax-exempt status are being pursued as we speak.

I can't help but wonder whether, like vitamin D, a solution is right beneath our noses. An investment in research to fund the trials to better explore both basic science as well as practical treatment options might yield an answer more readily than we think. Wouldn't that be great?
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Comments (5) -

  • mike V

    5/6/2008 3:53:00 PM |

    Thanks for your work in achieving these goals.

    I am one of the naieve do not know my Lp(a)score.
    As I have mentioned in the past, I am fortunate to have no detectable plaque by recent CTA.
    What tests do you advocate for your patients in this circumstance?
    (I have long followed preventive nutrition similar to your advice.)
    Is age a factor? I am 72.
    Thanks again.
    mikeV

  • Ross

    5/6/2008 7:33:00 PM |

    Well, I didn't answer the poll because my Lp(a) was 16mg/dL in November and is now 12mg/dL.  So it was borderline and is heading down.

    So, do I "have" Lp(a)?  Yes.  There is Lp(a) in my blood.  But not so much that I'm worried about it.  And I do know what my Lp(a) is, so the "don't know" response isn't right.

    None of the responses seemed to fit me.  So I didn't respond.

  • Anonymous

    5/7/2008 3:17:00 AM |

    Similar for me too.  My lp(a) was 6 mg/dl in the first test, 7 mg/dl in the second and 11 mg/dl in the third.  Not quite sure what to make of this so I answered the poll "don't know."

  • Bad_CRC

    5/7/2008 3:08:00 PM |

    Ross,

    Dr. D has said that Lp(a) is not one of the markers where a normal value is 0.  In the TYP book and online library, he says that a desirable score is <30 mg/dL (again, with the caveat about mass vs. particle size).  Superko's book puts the threshold at 20, and the VAP score sheet puts it at 10.  Mine was 7 by VAP, and I took this to mean that I don't "have" Lp(a).  Sounds like you're in the same boat.  See Dr. D's response to me under "Red flags for lipoprotein(a)."

    I didn't respond to the poll simply because I didn't notice it until it was closed.

    Dr. D, out of curiosity (if you have time to respond), what percent of the population scores zero for Lp(a)?

  • Dr. William Davis

    5/8/2008 2:37:00 AM |

    bad_crc--

    Curiously, a Lp(a) of zero is rare.

    Perhaps this provides some insight, though I'm not sure precisely what.

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