#07 - Deep Dive: Lp(a) - what every doctor, and the 10-20% of the population at risk, needs to know
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- เผยแพร่เมื่อ 21 ธ.ค. 2019
- Original release date: 7/30/2018
This is our first “deep dive” episode that goes into detail on one topic. Pronounced, el-pee-little-a, this lipoprotein is simply described as a low-density lipoprotein (LDL) that has an apoprotein “a” attached to it…but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.
We discuss:
-A quick primer on lipoproteins [7:30];
-Intro to Lp(a) [11:00];
-Lab tests for Lp(a) and reference ranges [20:00];
-The physiologic functions of Lp(a) [31:00];
-The problems associated with high Lp(a) [34:15];
-Lipid-lowering therapies of Lp(a) [44:45];
-Lp(a) modification through lifestyle intervention [1:00:45];
-High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
-More
Show notes page: peterattiamd.com/lpa/
About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 10 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity. The practice applies nutritional biochemistry, exercise physiology, sleep physiology, techniques to increase distress tolerance, lipidology, pharmacology, and four-system endocrinology to increase lifespan (delaying the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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Lp (a) attaches to the apo B 100 by disulphide bonds and hangs off the ldl particle like a tail. This has to be achieved by oxidation with free radicals to open the sulphur side chains on the cysteine amino acid thus joining the two. This is evidence of immune action. The Lp (a) bears an uncanny resemblance to complement c3b and appears to be acting like an opsonin to prepare the ldl particle for phagocytosis because it has become immunogenic. LPS or lipopolysaccharide from gram negative bacteria is known to stick to protein. This could be a possible explanation. The opsonised ldl is now gobbled up to create foam cells which die and dump their cholesterol to form atheromatous plaques. Interestingly,heavy alcohol use may be a cause as acetaldehyde formed by breaking down alcohol is very toxic and causes leaky gut syndrome which would release bacterial LPS into the blood stream. Just a few ideas more research required,but it has long been known that heavy drinkers often die young from heart attack.
Thank you for all of your videos discussing lipoprotein a. In the past few months I've gone from 0 to 90 in my knowledge on the subject and as far as I can tell this is THE most important and underappreciated risk factor for heart disease there is. I would love to see more interviews with Dr. Dayspring and maybe some interviews with patients. Awareness needs to be increased.
Hi I'm 61 years old and have gene determined high Lp(a). It was 403mg/l in 2012 and 400mg/l this summer. I was told this is a big risk factor. Yesterday I had a scan and feared a dead sentence. However the outcome was quite positive. I have very litle to no plaque (next to zero). Only 3% at my age have less plaque I was told. My cardio age was judged to 34-39 years! I'm quite healthy and my triglyceride have been low the few times measured, which should hint I'm metabolic healthy, and have no inflammation in my artries. Maybe that's what matters? Not the level of cholesterol or Lp(a)? Why not check why oldies like me with elevated Lp(a) are perfectly healthy? How many are there with elevated level without any issues? Does anybody know? I will NOT take any drug to reduce Lp(a)😃
th-cam.com/video/zZH_zU1h7GM/w-d-xo.html The other side of Lp(a)
You are fortunate - but maybe at risk of stroke and aortic stenosis independently of any atherosclerosis
Are you on a plant-based diet? Your results are what I’m hoping for as an otherwise healthy 40yo with high Lp(a). Unfortunately I already have a calcium score of 6, and no one gives a damn because I’m not on the 10 year risk curve yet. If I’m like my father and grandfather, I have entered my final decade of life.
Thats' excellent and so reassuring to hear! I'm requesting a scan since I have it also, in the 200's. At 70 I eat well and exercise. My other numbers and ratios are great. My concern is that I do sprints on my bike and go until my heart rate reaches 160- 170 (which is normal for me) and I'm out of breath. I recover and do it 3 more times. Now I'm concerned of keeling over with a M.I. It's a cloud hanging over me and my sister.
just found out my LPa is 486nmol/L. before that I went off rosuvastatin of 4 years. I am going to wait for an si RNA drug to be approved that Medicare will pay for. I'm 66 and dad and bro had HA with LDL 110 while my mom had the high cholesterol and turned down Lipitor , firing her dr of 40 years. She said she rather die than feel that way. Then later they recommended triple bypass surgery which she turned down (due to her religion). She lived for 5 more years till 84 with what seemed like congestive heart failure and died from an infection from gall bladder surgery (which wasn't against her religion). I'm going for a CAC next if the referral ever goes through. After that will look at markers of inflammation if need be or some test to see if there is stenosis starting. On low carb diet where my cholesterol has really skyrocketed LDL prestatin was 160 and now at 255.
This was fantastic! My functional medicine doctor recommended I listen to it she’s been a godsend for me I have so many issues but this has suddenly trumped my other issues as we watched my LP (a) jumped from 95 last August up to 154 I’m checked every three months with her and I live an incredibly clean 100% lifestyle of AIP eating 100% of the time all organic I never eat out I only cook everything from scratch I’m diligent and she knows that too she’s like if I’m the most compliant patient anybody could ever ever hope for and it’s clear with my family genetic situation and watching this happen to me my cholesterol levels have been elevated for ever but suddenly this LP(a) has just taken off like wildfire. I am like the Bob that had the widow maker heart attack I’m thin fit eat so incredibly clean and healthy yet it’s continuing to rise and not slow down she just started me on niacin yesterday and we’re going to add the red rice even though it’s not AIP compliant I’m willing to do that to see if it will help along with a vitamin E gamma tocotrienol.(spelling.) anyway my cardiologist over the years has never made anything of any of this, they don’t do these checks just traditional cholesterol panels as you talk about to. so even though my functional medicine doctor lives in a city two hours from me and I have visited her for four years now and she’s an anesthesiologist as well for 30+ years but this is her passion in her later years of practice now she’s gone this route specifically for mass cell patients like myself i’ve been a case study for her. But being that she’s my functional medicine doctor it’s difficult to get any kind of validation from any traditional doctors that what she has to say holds weight to them despite the labs showing it at all they don’t buy into this kind of blood work. so how can I find a cardiologist in my hometown or within driving distance of a couple hours that can literally be a doctor like you are this is what I’m on board with do you have any recommendations for anyone Tucson Arizona area or Phoenix? It’s so frustrating! I don’t wanna keel over but I’m like that patient that you talked about of your own that is that weird anomaly that traditional doctors don’t know enough about and or don’t want to address. Help!?
A lot of great info. at the end of the podcast you mentioned lab test for inflamaytion. Can you list them. Thanks
Found this very thought provoking with regard to blood clotting My LPa is 32.6 nmol/L w/ reference range given as
Looking for some answers as my lp a is230 my triglycerides are 37 my ferritin is380 and I’m 65 and whole food plant based diet. No added fat sugar and salt.
Because of genetics or otherwise I can completely ignore Lp(a) and proceed as though it doesn't exist. The latest test found my level at 11. Cleveland Heart lab considers any level below 75 to be optimal. I have a huge problem with small, dense, LDL. Do you have any videos on that problem?
Dr Attia, I am a 42-year-old male no other high cardiovascular risk LDL 60, triglycerides 34 HDL 90. Sadly a very high lip(a) 96. Respectfully, could you please tell me what I should do to get this down my doctor knows nothing about this or cares to do anything. He tells me it’s hereditary nothing we can do keep up the great work. Love your podcast.
Hi John, Ford Brewer recommends Niacin. You can look him up
"Nonetheless, the apo(a) size distribution in centenarians did not entirely explain the high Lp(a) levels observed in this population. Factors other than apo(a) size, and which may be either genetic or environmental in nature, appear to contribute to the elevated plasma Lp(a) levels of our centenarian population. We conclude therefore that high plasma Lp(a) levels are compatible with longevity." 1998 article by J Thillet
Mention of hscrp but not isoenzymes? Ldh?
Comment Re: estrogen decrease and increase in Lp(a), post menopause. Is it possible that this would explain increase in heart attacks for post menopausal women? N=1, I have been menopausal for 18 years so I have no idea of Lp(a) levels prior, but currently 121 mg/dl. - up from 84 in Dec. - definately not staying consistent.
Hi
Study in Japan showed high levels of LPa showed all Cause mortality to drop off a cliff. Also another study showed people who are 100 years old or greater have high levels of LPa not lower. Statins increase LPa substantially and yet I thought we needed low levels of LPa
@Bladerunner2043 the diet best for all humans is the diet our ancestors had for millions of years not foods that were invented in the early 80s.
@Bladerunner2043 paleo could work, I personally do healthy keto.
The question is what causes dyslipidemia?
One cause could perhaps be characterised as the widespread, implicit assumption that anything marketed as edible - as something that can be upended down our throats - is necessarily congruent with a source nutrition, or nourishment (along with the related idea that because such 'ingesta' fall short of delivering an overtly severe outcome (say, kill you) stat, they're therefore innocuous.
If you are interested in fundamental mechanism, perhaps Petro Dobromylskyj's blog, Hyperlipid, might be a great place to start ...
How can one check their LP(a)?
A simple blood test
My Lp(a) is non-detect,
If it's genetic one can do all you said and still have an Lpa problem. As my sister and I could not have better numbers, eat better, nor exercise better yet we both have it. Luckily at 70+ neither of us have issues from it . Lpa has been found in healing wounds. For them to talk about removing it is absurd. As absurd as taking Lipitor! Which is a trillion, yes trillion, dollar scam.
Lol, so much nonsense.
Doctors thinking they can regulate basic metabolic functioning with drugs are more successful than doctors treating syphilis with mercury compounds 100 years ago and marginally more conscientious about the results they publish.
But they still have some way to go before reaching the average car salesman.
Invest at your discretion.
Where ignorance is bliss…
The instant your guest mentions a New York times article as the source of interest, I heard enough. Americans never, I mean never learn. Gell-Mann amnesia.
Gell-Mann amnesia - great term (although, embarrassing to have only first become familiar with it now. Was glad to be introduced to it finally) ...
Seems that and the Dunning-Kruger effect are cousins ...
waste of time, way too technical
Too technical to even remotely understand unless you’re a scientist.