So he's got an LDL of 29 and he's happy about it. He's actually got good reason
and we'll go into that on this video.
So the patient's name is Joe Reilly and he posted all of this information. I'm
not sharing anything that Joe hasn't already posted. Joe actually did a video
with us a couple of months ago and he shared with us he's had LDL values over
225 and he's had a world-class LP(a) value not over.. actually over 1,100.
According to Joe, he's also had the aortic valves calcification surgery.
That's been associated with these very high levels of LP(a) but you
can find all the information that Joe posted including his own lab values and
imaging values. Go to the PrevMed website, click on Blog/Forum. Then once you
get to the forum, if you go over the next couple of days, you might see the Brewer
effect there. If you don't see that, you can enter the Brewer effect here in the
search area. Search for it and that that'll come up. Here's what you'll find
in terms of what Joe has posted and again started out here's what happened.
Joe came to the Orlando event and he's recommending that others come to it too.
He said you know and it's true you get not only a two-day boot camp but you
also get the complete labs, the evaluation with me one on one. So you
get all of the stuff done. Oh and I forgot the CIMT (the artery scan). You get
all these things done at one fell swoop and you can start taking care of your
health. And that was a big challenge for Joe. Again, it's not common
to see somebody with FH (familial hypercholesterolemia). The estimates on on
prevalence are between 1 in 250 and 1 in 500 people. In
addition, it's even more rare to see an LP(a) as high as Joe's has been. So
he's got two major factors. In addition he was starting to get some insulin
resistance. So again, Joe had some challenges and
he knew it and he needed some work. He and I talked about this LDL value and
whether or not to go on a statin. He was already on Repatha, one of the PCSK9. If
you don't know what a PCSK9 inhibitor is, you can google my name in YouTube and
Ford Brewer PCSK9 inhibitor. We've got several videos on it. Here's the thing. I
know there's huge debate about LDL levels and a lot of folks coming out
these days say, "No, you really want it higher." I myself and somebody who
routinely says it's not LDL, except in some cases, and in Joe's case, it does
appear to be an issue in people with familial hypercholesterolemia. And if
you're not familiar with that, I've got several videos on that as well. Actually,
after these studies on PCSK9 inhibitors, you got a whole new mantra, a whole new
push with cardiologists out there saying LDL does matter. Here's the point. I don't
think any of us know for sure and I as a physician, well, will certainly support a
patient that wants to take either of the the routes that may be documented and
show real evidence and this route certainly shows real evidence I think.
And I was telling Joe, I think if I were in his situation, with his combination of
issues, I would probably go for the lower LDL as well. And here's why. Not one, not
two, but three studies all coming out, indicating the same thing - decreased
heart attack and stroke events for these for this class of patients using PCSK9
and going all the way down to levels of 20 to 25 for LDL. So anyway, let's take a
little bit deeper look at what Joe posted. As you see here, his LP(a)
went from what was that 450 down to 373. And again, when we added the statin
back to his Repatha,
his LDL level went from 78 to 29. And here's what Joe was
actually excited about. He had you know a PLAC2 level of
126, got that down to 81. We did several other things with Joe, a major part being
a focus on insulin resistance, Obviously, that is clearly the most
important thing to me out of all of the activities that Joe could be
doing. Added niacin and again for the LP(a) and you did see a significant
drop in LP(a). Of my patients that have LP(a), most of them say, "You
know, I want to get it down to zero." Well, that's not practical and it's not going
to happen. But what you do tend to see, similar to what happened with Joe, is
you can... if you can get that LP(a) to decrease another 20 to 30
percent, you'll usually start to get some decrease in the inflammation as well. So
the goal for LP(a) is not to just totally eradicate it. The goal is to get
it down maybe a third or so. As you see here, Joe's got some significant CIMT
challenges again which he posted on the forum. As I said, Joe's done a video to
explain all this with us before. Now let's take a quick look at the studies
that are saying you really do need to get to those lower levels
especially if you have these problems. New England Journal, the FOURIER study
May 4th, 2017. Evolocumab, it's again one of the PCSK9 inhibitors and what
they showed what was it was a large study 27,000 people
and they did get significant decreases with the PCSK9 inhibitor.
On the LDL levels, they got lower LDL, heart attack rates as well in their
study. They go in to talk more about the PROVE IT-TIMI studies & the TNT trials
which said that you wanted to get LDL levels down to about 70. And again, to
my point, there's still way too much focus on LDL and
nearly enough focus on the major driver which is insulin resistance, pre-diabetes,
metabolic syndrome on this. They went ahead and mentioned the GLAGOV trial.
With the GLAGOV trial, they got decreased heart attack and stroke rates down to
levels of 20 to 25 LDL within they got decreased heart attack and stroke rates
down to the high 20s. With these kind of numbers, you'd expect to see brain fog
and other neurological problems. Right well, not so fast, actually they didn't...
they didn't see the brain fog and the other neurocognitive
problems. How about the ODYSSEY study. New England Journal, November 29, 2018. The
same thing. They got these low rates of low levels of LDL and continued to
see decreased rates of heart attack associated with that.
What about ODYSSEY and the neurocognitive side effects? There
were actually fewer neurocognitive side effects in the placebo group and ODYSSEY
guys that had the higher LDL levels. So again, major debate about these
issues out there. And again, I'm totally comfortable in supporting my patients,
assuming they have some well-documented reasons for going where they want to go.
And as I said with Joe's case, at the end of the day, I'm not sure, but I
think I may want to go there with him if I had the same issues. Thank you again
for your interest. I've had so many patients come to me because they quote
their diet here why don't you take this statin and let's see what happens what
let's see if a heart attack or stroke happens. No, prevention is a science. We
know what's going to happen, we know what to look for, we know how to prevent it.
Come see us in Louisville on November 8th and 9th. Get your CIMT artery scan,
all your labs. See me and spend two days learning usually what your doctor
doesn't know yet about the science of prevention. Look forward to seeing you
there. Thanks.