Well, there's four tests for cardiovascular inflammation. That's
because there isn't one good simple reliable "yes or no" tests.
Got great questions from viewers this one's from Patrick Nabors.
"Hello and thanks for the videos! You've been very helpful in working out
my many questions. I have a question about this, the PLAC 2 test. On the old
PLAC test I was getting them high numbers, 230s then I started taking
Crestor and cut the carbs..." Good work. That's what you need to do. "Recently, I
got a 118 on the PLAC2 (activity) test. There's a lot of disagreement in the
range for this test and I see Cleveland Heart wants it under 75, but both you and
my provider seem to say under 180 is good. Can you clarify this? I see that
yours is 70. I'm hoping to continue bringing mine down, but while eating the
"Mediterranean diet" I had massive calcium build-up going on
due to spiking blood glucose which I was unaware of, since fasting blood glucose
and A1C were "normal"... 5.5 which I now know is very high." So yep, it's
always something in it Patrick, but you you've already demonstrated... I think one
of the key things that most folks are not aware of and that is there's more
than one Lp- PLA2 test. Let's go back and let me just say this.
You know one of the golden rules is to look at the range on the test that
you're using. Some labs are still have not switched over to the activity test.
Some are still using the old mass ELISA. Now that if that's beginning to
sound like mumbo-jumbo or a little bit complicated, let's go on and talk a
little bit more about it, and I'll explain some of that. First of all, what
is Lp-PLA2. It's... pardon me but if you're asking here's what it is.
Lipoprotein-associated phospholipase A2. Now what does that mean? What is it
really? We'll cover that in just a minute. Bottom
line (quick spoiler): it's an enzyme released by the macrophages which
is supposed to result in oxidation of LDL in the plaque. Now even that is
debated right now whether or not it's an actor in causing inflammation or just a
marker for inflammation. And the reality is there's a debate on either side of
this fence. There's no debate, however, that increased Lp-PLA2 is very much a
sign of plaque activity and even more so what we would call thin cap and necrotic
core plaque. Some people may be tempted to call that a
like this getting ready to pop and
that is exactly what it is. Now there are... there's been way too much research and
going down a bunny hold of looking for that one plaque that's going to pop, the
reality is there's not one. If you've got... if you've got this process of
inflammation, it's systemic and it's going on throughout the body, not just at one
vulnerable plaque. And if you have a question about that vulnerable plaque
discussion again, I've got other videos on it, go take a
look. If one plaque... but the biochemistry is... if one plaque is
vulnerable, all of them are. But what's the point behind that again?
Lp-PLA2 is a marker for it. Is Lp- PLA2 actually causing some of that again? It's
up for debate. Now let's get back to Patrick's question. He mentioned the
activity assay and that's a whole different kettle of fish.
Actually, there are two different assays that are or tests that are in battle
for supremacy. There are multiple tests even just for something like Lp-PLA2
test kits methods for measuring this enzyme Lp-PLA2. The two biggest ones
right now are a mass test or ELISA. ELISA stands for "enzyme-linked
immunosorbent assay." So what you do is you put a marker on antibodies to
this enzyme Lp-PLA2. You then permit or cook or leave the enzyme in with
the immune markers. After you do that, you put them on a gel of electrophoresis.
It's... again pardon me it's a technical discussion and you see how much of the
enzyme is linked to the... into the antibody. That's one test. That's ELISA.
That's the standard test up until about a year or two.
And it became pretty clear to many labs, Mayo and Cleveland for example, that an
activity assay was better. A lot of these reasons were technical reasons. For
example, you see this. "Do not shake" down here. There are issues in terms of the
stability of the testing kit and testing process that the activity assay appears
to be far superior. Again, so again, we've gotten we started at a high level with a
very simple question then we got way deep and way complicated very quickly.
Let's go back and just summarize real quick you know and I'll cover another
couple of studies I think later in other videos. But the bottom line is what is
PLAC2... what's the PLAC2 test? The PLAC2 test shows significant
cardiovascular risk. Is it the only test? Why don't we just use that one test and
not use a panel? Because as you see, you know, there's an old lab analogy and it's
the same as an old treatment analogy for doctors as well. The lab analogy goes - why
use four tests when there's one good one. Well, there's four tests for
cardiovascular inflammation. That's because there isn't one good simple
reliable "yes or no" test. The same thing goes for treatment you know. When you see
diseases where there's four or five treatments, that means there's no one
good treatment. But let's get back to this question. So what is Lp-PLA2? It's
an enzyme released by the macrophages or foam cells when they get involved with a
plaque. It has been associated with thin capped and necrotic core plaques. In
other words, what used to be thought of as vulnerable plaques. But again, as we
know now, if you've got one vulnerable plaque, most of your plaques are
vulnerable. This image actually came from an article where they were talking
about agents to possibly even reduce the activity of PLAC2.
What do Mr. Nabors looking for this test? Look at
the normals or the cutpoints for average or normal or risk that are given
to you by the lab itself. If you've made it this far through all that confusion,
I'm impressed and thank you very much 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. 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.