A lot of folks are not aware I was on a statin before all of this blood work was done in the
discovery of the Lp(a) it turns out statins for most people they will actually raise your Lp(a)
for some people it's five or ten percent but for some people it's as much as 30 or 40
it could be a drastic increase so in consultation with my doctor we decided because I wanted we had
a target LDL we needed to get my LDL down and we also wanted to get my Lp(a) down we decided
that the appropriate therapeutic for me would be a PCSK9 inhibitor and in this case Repatha which
works like similar to a statin in terms of its effect on LDL it actually correct me if I'm wrong
Dr. Brewer but I believe it has a larger impact on LDL lowering and statin generally it does a
lot of people who don't tolerate statins a lot of their in consultation with their doctors will go
on PCSK9 if they are not able to get their LDL to target range or if they're not tolerating statins
it's used for that but another really nice thing is that it happens to lower Lp(a) as well
so but before I went on PCSK9 we washed out the statin so I went completely off the statin for
three months took another baseline of my Lp(a) and interesting my Lp(a) went down five
percent from that so now it's a little movement but I'll take it it's something there is some
anecdotal research out there some anecdotal evidence that omega-3s might lower Lp(a)
in some people and so I went in consultation with my doctor I went on pretty relatively high dose of
omega-3s via fish oil supplement we targeted a level of 4,000 milligrams of EPA and checked my
levels again and actually lowered it another 5 so we had a little bit of movement then pretty soon
after that I did go on the PCSK9 inhibitor that's where I got the really big effect PCSK9 inhibitor
actually dropped my Lp(a) another 40 so I'm now at 131 nanomoles per liter most of the credit going
to PCSK9 inhibitor that's still high you know 75 nanomoles is the target range being under that
I'm still high but i'm 70 elevated instead of being 330 elevated and based on the research done
it would seem that I would be at a significantly lower risk or hazard ratio as you would say
based on my new levels of Lp(a) that's very helpful let me talk for a few minutes about some
of the things that you've raised so the first was the risk or hazards ratio yes in fact if we could
go back and talk a little bit about the image here that we discussed a few minutes ago this is risk
on the left hand side for those of you who are confused it takes a little bit to understand the
concepts and what this is actually telling us HR stands for hazard ratio and it's a measurement
of risk if the hazard ratio is one it's this the experimental group or the group with Lp(a)
has the same risk as the group without it if it's two this group has doubled the risk if it's three
it's triple the risk four and five five times the risk so here's the other thing to think about
this is levels of Lp(a) blue is a level of Lp(a) less than 6.9 up to 6.9 green is
6.9 to 23.8 and pink is 23.8 and above now so as Chuck mentioned his was like 250 so 10 times that
23.8 as we've also mentioned the vast majority of people are in these lower ranges let's
just call Chuck's range more like a world-class range with folks that have these smaller numbers
23.8 up to 50 70 numbers like that this is what you tend to see and that's most of the people
in this group this pink group had those kind of numbers unless I'm mistaken Chuck if I am please
interrupt and let me know just one point you were comparing remember I'm in nanomoles per liter
and this study did it in milligrams per deciliter so my level is about four times
the beginning point of the top level here being 23 just four times rather than 10 times anyway
significant increase and again I still say that that would put you in more of a world-class
number if you look at these units milligrams per deciliter what is it is it something like
half or more are at like 30 and then once you get to 40 you get gosh another major portion of folks
so it's a skewed curve and the vast majority of people are going to be like you said much
much lower than you well here's what happens what happens is if you start managing your
blood pressure your insulin resistance other risk factors smoking you start getting down
to these we're talking about the Framingham the classic risk factors once you start managing those
very significant risks comes back down to very manageable risk or negligible risk
that leaves again those folks that have again a hundred two hundred we've had a couple of people
on the show Joe Reilly I think said he had like seven or eight hundred and he did share with
us he had aortic valve calcification you and I talked about aortic valve before the show we can
bring that up in a few minutes but as you said the aortic valve business
is something that you're going to see with people that have other genetic risk factors and or people
like you that have world-class problems in terms of Lp(a) so it gets back to the point
and I'll repeat this often I repeated this for with you but prior to the discussion and that is
if you manage all of your other risk factors you do tend to manage Lp(a) and you very
gentle perhaps overly gentle with me to say what you should have said was hey Doc you know I'm a
poster boy for world class levels and we need more than that thank you for bringing that up and I
think I wanted to bring that up for the audience as well again I'll say multiple times the reason
that most docs have ignored it is number one we didn't have a treatment for it and number two it
had to do with managing all the other risk factors I think maybe I've butchered that point up trying
to hammer it home you have any clarification for me Chuck no I think that's very true you know
people because that's the big question you know again a lot of doctors saying don't test for it
there's nothing you can do well there is a lot you can do and controlling your risk factors we
sometimes call those the Framingham risk factors but be controlling your cardiovascular disease
risk factors it's important for everybody to do that but because Lp(a) is an independent
risk factor it's extremely important for people that have elevated Lp(a) I mean obviously
you're going to get some people in the population they just say like give me a pill I don't want
to change my lifestyle and see what the pill can do for me but for those folks that are motivated
to try to do what they can to minimize their risk there are a lot of things you can do and
you know I mean the thing that I would want to emphasize where you get so much bang for the
buck in lowering your risk of Lp(a) would be bringing your weight into the optimal range
and that I think you would probably concur Dr. Brewer that for to control insulin resistance and
they're overlapping obviously because controlling insulin resistance you get a lot of bang for the
buck there but when you bring your weight down you improve your insulin sensitivity you improve
your generally most people improve their LDL profile and you also for a lot of would say
for most people you're going to improve your blood pressure certainly did for me so you get this huge
all these benefits by doing that and of course you know things like smoking you know please
don't smoke and one thing I'll point out I said my grandpa died at age 52 obviously I found out
at age 52 I was still alive one difference he wasn't overweight but he smoked his dad who died
at age 54 he smoked you know don't smoke but if you have world-class Lp(a) and you have one
of these other risk factors if you smoke you're a ticking time bomb am I wrong to say that Dr. Brewer
not at all again that's the point that I've tried to make so many times speaking of insulin
resistance let me ask I don't think you heard me a few minutes ago what age were your family members
again when they had events 42 and 51 is that we had my maternal grandfather was 52 his father was
54 and then there was a cousin so the grandfather's cousin was actually 44
when he had an event so I can tell you this in my experience as you know you're not the only patient
that I have with again that pardon the term maybe it's overused world-class Lp(a) I just
don't know another term to use for it like I've said multiple times it starts happening at the
same age that insulin resistance starts happening and insulin resistance by the way starts happening
at the same time that we start having blood pressure problems and at the same time that we
start gaining weight so again you tend to not see problems in our 20s and you tend to start seeing
problems when our other risk factors start piling up on us as you've said managing all those other
risk factors being aware of them and dealing with them is not easy dealing with insulin resistance
is not an easy thing to do losing weight is not an easy thing to do until you get the hang of it
but it's very effective at dealing with this risk another thing that you talk about the people start
having heart attacks when they have elevated Lp(a) in their 40s and 50s and that does
is certainly correlates when people start with when people generally start to develop
decent levels of insulin resistance there's some studies being published showing and if you talk
to people who are in the space of treating Lp(a) patients like yourself and doctor
talk to you listen to Dr. Ronald Krauss he's a luminary in the lipidology field he treats a
lot of Lp(a) patients he talks about and I believe he's published a lot about
small dense LDL particles he talks about when you get these patients you know of course Lp(a)
elevation can increase your hazard ratio you know three to four times he estimates when you
get people that have those high levels of Lp(a) and then you combine it with small
dense LDL you're talking ticking time bomb maybe 10 times the hazard ratio and it's all overlapping
because actually what causes high levels of small dense LDL high levels of triglycerides what causes
high levels of triglycerides insulin resistance and high levels of insulin you start seeing these
studies and you start connecting the dots and you realize boy I better get my insulin resistance
under control there's so many independent risk factors that start working together
if you don't start controlling the ones that you can control treatments you didn't
mention niacin did you ever try that about 10 years ago I was on niacin for a couple years
to try to lower my LDL and then a doctor told me that a study came out that showed that it doesn't
do any good and so and I think we both know that probably he was reading uh either HPS-THRIVE or
AIM-HIGH on that and no I'm not currently on niacin but that's an interesting topic
do you want to talk about that or I've had several people most of my folks with Lp(a) do take
it and I've had some pretty good results with it it's certainly something that I would recommend
consideration if someone has it I think the biggest issue that you and I talked about is just
the failure of the medical community including the labs to screen for this problem and you coming on
board as a patient is very very helpful to help people begin to be aware and start taking a
look
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 evolved
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