The first question is what is Lp(a) it's a large sticky protein made by the liver and found
in blood plasma it's a variation of the protein that forms LDL it consists of an LDL-like particle
ApoB but again like I said before it's got this little patch of velcro it's called each of these
is a kringle repeat and as I said before there are a couple of mechanisms one is that this kringle
repeat makes it sticky another is that this something about this part of the protein actually
makes triggers clot formation any comments about your own story specific to these two issues Chuck
no not really nothing specific so as you mentioned most docs don't know this and you asked me what
portion of docs and your estimate was like five percent I would think that's a generous estimate
I mean even among primary care docs who need to be the folks that are aware of things may
not know how to treat everything but at least can find stuff and can triage it to the correct place
I don't think even five percent that means one out of twenty probably more like cardiology as
far as cardiologists it might be more like five percent I think you're right now that would be my
guess it's probably closer to one out of twenty among the cardiology community and you know the
rest of the story on this too and it's like well we don't know anything that we can do to fix it so
just tell them to do everything else and we won't even look that's why most primary care docs even
more primary care docs are just not aware of and patients aren't aware of it let's talk for
a minute about some of the risks so significant elevation gives you twice to four times the
increased risk for cardiovascular disease you talked about a range so most people have a range 5
to 29 in a milligrams per deciliter and that's 13 to 73 nanomoles per liter now the risk depending
on what level of risk you're talking about starts at 30 milligrams per deciliter or 75 nanomoles per
liter and it starts rising much more steeply when you get about just a little bit less than double
that 50 milligrams per deciliter and 125 nanomoles per liter now let's go back with those numbers
in front of us and you tell us a little bit more about your numbers I think you were saying you got
up to a couple of hundred nanomoles is that correct yeah my level was 243 nanomoles and you mentioned
that it's also measured in milligrams per deciliter it's really important to understand what
you're looking at and a lot of people even doctors I've talked to a lot of them will get this wrong
it's amazing it's unfortunate that there's not a uniform you know measurement used the conversion
factor is approximately 2.5 to 1 so it's not an exact figure it varies person by person but if you
take your milligrams per deciliter number multiply it by 2.5 that would give you an approximation of
your nanomoles per liter and you know go backwards if you're in nanomoles you could go backwards to
look at your milligrams per deciliter by dividing by 2.5 which is important if you're looking
at research and trying to understand you know if they're talking about milligrams per deciliter and
you've got a measurement for yourself that you're looking at nanomoles per liter you might want to
do that little conversion to understand relatively where you're at but yeah so again 243 at baseline
and uh that was honest and so basically there's a slide this shows this was a study published
in 2007 by Dr. Tsimikas and Florian Kronenberg and several others and it showed many things
one of the things they looked at was Framingham risk factors graph against Lp(a) tertiles
and really interesting finding to me this was one of the studies I came across early on in my
research if you can control your Framingham risk factors which are you know your weight your BMI
your blood pressure your LDL level whether you smoke or not whether you have obesity or not
or whether you have diabetes or not and if you control those and if you can get you know all
of what this graph and what this study suggests that if you achieve near optimal level for your
Framingham risk factors even if you have elevated Lp(a) you can bring your hazard ratio
or your risk you know pretty close to the normal population might be a little different for someone
like me I'm this is top tertile so you're talking about people at 23 milligrams per deciliter and up
I'm four times that that might not be enough to just control the Framingham risk factors
for somebody like me that's up in the top five percentile but what it suggests to me is that
my gosh and this is why I think it's so important for everybody to know Dr. Brewer you mentioned
that a lot of doctors will have this attitude well there's nothing you can do about it so
why measure it why test for it this is a great reason why if you know that you have something
if you have an Lp(a) is an independent risk factor it's been fully established settled science
that is an independent risk factor if you know that you have something that might give you three
or four times risk of a normal person you that might be something that would be highly motivating
for somebody to lose that extra 25 pounds or 15 pounds because there are things that you can do
you know to for most people that have elevated Lp(a) there probably are things you can do
in terms of lifestyle or maybe therapeutics that could bring your risk you know again this is
based on you know what the studies seem to suggest you could probably bring your risk let's just say
you could bring a risk down substantially you know and possibly close to that of a normal person so
what I did I decided that I was going to you know lose 25 pounds to try to get to BMI my target BMI
was 24 and I was able to achieve that I had sort of borderline hypertension my high end of my blood
pressure I was about 135 over 90 so wonderful thing about losing weight is it just hits so
many of the Framingham risk factors I'm now in the target for the BMI my blood pressure when I lost
the weight my blood pressure came down I'm now 115 over 75 my blood pressure so that's optimal
so I'd like to talk with you a minute about the webinar people don't understand what the webinar
is it's actually a great way to get some access to health care that you're just not going to
get any other way you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things inflammation and
prediabetes that your doctor just does not know about and here's the thing Harvard Health and many
others have said look sudden death is not always so sudden the Hollywood picture that it's a bolt
out of the blue is not realistic it's more like real lightning preceded by clouds wind and rain
stop that metabolic storm before the lightning strikes and here's where that metabolic storm
comes from it's inflammation and it has to do usually with prediabetes so again we actually
get labs we go over them in the webinar and then you can start finding out how you can
prevent that heart attack others said that you couldn't even predict we can show you how thanks