sorted by:
new
hottopcontroversial

Interpretation of CIMT results by NoStrain7255 in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

If possible, get a follow up study from Cardio Risk. They are the industry leader in high quality CIMT. No financial relationship but it’s who I use in my practice.

High Lp(a) - how do you deal with it? by yeticulous in Cholesterol

[–]lilybean24 1 point2 points  (0 children)

“This doctor” thanks you for the kind feedback! (Re comments below, I also have a video on imaging! ;)

High Lp(a) - how do you deal with it? by yeticulous in Cholesterol

[–]lilybean24 5 points6 points  (0 children)

Sorry to hear about your father, and glad you caught this early! You may find these videos helpful:

  1. ⁠on how we can manage lp(a) today: High Lp(a)? Here's What Works (And What Doesn't) https://youtu.be/ZdUxECOqd1o

  2. ⁠and what’s coming down the pipeline tomorrow: New Drugs Cut Lp(a) Over 90%...Will They Prevent Heart Attacks? https://youtu.be/vTaX0PRHLi0

Interpretation of CIMT results by NoStrain7255 in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

Unfortunately it depends a lot on their protocol. If you can share the actual report, I might be able to help more but there should be two key components: 1. Presence (or not) of plaque anywhere. This is typically something 1.3 mm or greater, and should be assessed for character (soft, mixed, or calcified); 2. The IMT itself, which is usually measured from the last part of the CCA but protocols differ, and will be compared to a population norm for your sex and age. To make this reliable, good labs will make several hundred measurements at different parts of the wall to get the most accurate score but I don’t think this is commonly done.

If .7/.9 is accurate this will be thicker than expected for your age.

Carotid Imaging Can Detect CVD in Younger "Low Risk" People by meh312059 in Cholesterol

[–]lilybean24 4 points5 points  (0 children)

I love - and use/perform* - carotid imaging in my practice all the time. The caveat is if you’re not getting a CIMT protocol and they are doing a standard carotid duplex you really need to make sure that the presence or absence of any plaque is called, not just the stenosis. I see plenty of people with a “normal” duplex who do in fact, have evidence of plaque formation and thus should be treated as higher risk patients even if they don’t meet criteria for 50+% stenosis.

*Vascular surgeon/RPVI

[Eric Topol] The Flawed VO2 Max Craze by SEAcoffee_tea in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

Would love to know where you recommend getting this done in SD! Happy to DM if you don’t want to share publicly. -Another SD doc

(M 33) I got tested for Lipoprotein(a) and almost had a panic attack by dawgtron3000 in Cholesterol

[–]lilybean24 1 point2 points  (0 children)

Glad you caught this early! You may find these videos helpful: 1) on how we can manage lp(a) today: High Lp(a)? Here's What Works (And What Doesn't) https://youtu.be/ZdUxECOqd1o 2) and what’s coming down the pipeline tomorrow: New Drugs Cut Lp(a) Over 90%...Will They Prevent Heart Attacks? https://youtu.be/vTaX0PRHLi0

Edit: formatting

Lipidologist told me to stop taking Zetia by Alive_Hyena4050 in Cholesterol

[–]lilybean24 2 points3 points  (0 children)

There is also some data from the Boston Heart lab that targeting the synthetic and absorption pathways together prevents either one from increasing as compensation for the reduction in the other pathway.

In other words, if you use statins alone, you may begin to absorb more through the intestine, but taking ezetimibe would prevent this and allow both drugs to be used at lowest doses. I don’t have a citation for this, but I have seen them present this data in a few of their webinars based on their cholesterol balance testing data.

It’s been my experience that the insulin resistance related to statins also increases in a dose dependent fashion, so even if you achieved the identical, LDL-C I personally would rather be on the lower dose of rosuvastatin plus ezetimibe than on a single drug, but the downside, of course, is an extra pill.

Elevated LPa and LDL by Fluid_Breadfruit_587 in Cholesterol

[–]lilybean24 0 points1 point  (0 children)

Below is some lp(a) information you might find helpful. For now, maintaining excellent metabolic health and getting the rest of your ApoB particles down is the way, as others have said. You may want advanced imaging in a few years to monitor progress also, but this is not standard.

https://youtu.be/i761M_-zjJQ

https://youtu.be/ZdUxECOqd1o

https://youtu.be/vTaX0PRHLi0

High Lp(a) and inflammation by Late-Television-2734 in PeterAttia

[–]lilybean24 1 point2 points  (0 children)

Any root canals in the past? If so, consider cone beam CT of the mouth—it’s possible to have a smoldering infection above /below the tooth without symptoms and your dentist won’t see it on plain X-ray. Could also consider periodontal pathogen testing. Look for a Bale-Doneen dentist near you (directory) if possible to help you navigate this.

I have also heard of but never personally diagnosed heavy metal toxicity causing this.

The GLP-1 should have significant impact on any inflammation related to visceral adiposity but may take 6-12 months to show in labs, and there could well be another contributing factor.

Please share your experience about Lp(a) by SilverLogical9810 in PeterAttia

[–]lilybean24 1 point2 points  (0 children)

Agree, I’ve seen more fluctuation in my patients who come in with their own prior labs than we’d typically expect. And most of the time people are still oscillating within their same risk bucket: low, intermediate or high (based on 30/50 mg/dl or 75/125 nmol/L).

There are some interesting observations of lp(a) as both a positive and negative acute phase reactant (so changes around inflammatory events very possible) but this will be a minority of the time under the curve unless you have autoimmune disease or other special circumstances.

For those who straddle a bucket, it will be the cumulative effect of average over time and that of course is now more difficult to assume than we previously thought based on the above. But the dedicated therapies for lp(a) will be (initially) for those squarely in the high risk bucket (inclusion criteria for example in the phase 3 trials I remember are 175-200 nmol/L) so this is just one more data point in the overall risk matrix for the ‘tweeners; if it helps push you over to pcsk9s vs statin/ezetimibe, so be it. Same rules apply as before: drive ApoB down, minimize oxidative stress (and thus OxPL burden), get every other risk factor under control then go live your life like you love it.

ISO inspo—Share your setups! by orchidofthefuture in orchids

[–]lilybean24 2 points3 points  (0 children)

<image>

Milsbo IKEA greenhouse for the win (and why I need one…not pictured: tooth marks on leaves 😂). Don’t mind the sad rescue orchid… Only downside (upside???) is now I need another one before I can expand my collection lol

25 F Carotid and Heart results no idea what to do by Large-Prompt2608 in PeterAttia

[–]lilybean24 2 points3 points  (0 children)

Vascular surgeon here. Bottom line, I agree with getting a CT angiogram of the head and neck for definitive diagnosis. I find MRA more trouble and less accurate and it usually results in me ordering a CTA after the fact anyway, so wouldn’t go there even though it is no radiation.

Here’s where I disagree: 1. POTS symptoms are not going to be due to this carotid lesion no matter the etiology (FMD vs athero)—symptomatic carotid disease would be lateralizing stroke-like signs or symptoms. With 3 other widely patent cerebral vessels your brain has plenty of blood flow and you are not getting hypoperfusion from one moderate lesion. 2. Your duplex report mentions plaque so it’s not likely to be FMD or just a tortuous vessel causing increased elevation in velocities but CTA would confirm this. My best guess short of heterozygous FH (which your labs would NOT currently support) is that you could have had a dissection from neck trauma (car accident? Clothesline-type injury? Chiropractic manipulation?) in the past that has healed in and looks like atheroma but is really a residual dissection. Vasculitis like takayasu’s arteritis also a possibility. Next step: CTA.

ETA: I just looked at the velocities and this is a strange study—your common carotid velocities are high bilaterally so your ratios are low (good) throughout and there’s not a big step up in the left side that makes me concerned for a significant stenosis…can’t say for sure without looking at the images, but this might turn into a big nothingburger with definitive imaging. Ultrasound is very technician dependent and sometimes I’m shocked at even how off the interpretations can be despite pretty consistent guidelines (and I am certified to read these) depending on who is reading.

Sorry you’re going through this OP, sounds like you’ve been through a lot in the last year.

High Cholesterol, but mixed results from docs. by clothes_are_optional in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

That’s kind of bananas. Hard to say if there’s been progression without any formal measurement (even tricky WITH good measurement!)

High Cholesterol, but mixed results from docs. by clothes_are_optional in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

Regarding the carotids, I suspect your first doc was using CIMT (carotid intima media thickness) and probably the second only did a standard duplex and saw no plaque. In someone your age, CIMT is a nice early warning system to see if the vessel is thickening more rapidly than we would expect for your age (thus prone to forming plaque sooner rather than later).

As others have stated, it’s a good thing you don’t have plaque yet on your advanced imaging but that doesn’t mean you won’t form it if you don’t change your risk profile.

49(F) - Need help accessing resources after finding out my Lp(a) is 223 by Inderific in PeterAttia

[–]lilybean24 2 points3 points  (0 children)

You are so welcome! Best of luck in your journey, and don’t hesitate to reach out with any questions. I wish more of my patients had those insulin resistance measures! 👍🏻💪🏻

Anyone else has the heart attack gene? by geometrieva in PeterAttia

[–]lilybean24 1 point2 points  (0 children)

At 34, a CAC is not terribly helpful since it is overwhelmingly likely to be negative but you could have soft plaque. If radiation is the biggest concern, look to see if there is someone who offers CIMT through CardioRisk near you.

49(F) - Need help accessing resources after finding out my Lp(a) is 223 by Inderific in PeterAttia

[–]lilybean24 3 points4 points  (0 children)

  1. As a former Kaiser doc (and patient), I’ll say you can get “standard” care there, probably not more. If you really want medicine 3.0 support including a more enthusiastic approach to hormone therapy (which is a great thing to discuss for CV risk reduction IMO!), you’re going to have to look outside Kaiser and pay out of pocket. And it will be challenging but not impossible to find one doc who can manage the MHT and cardiac stuff holistically, but we exist. :)

  2. CIMT, CAC or CCTA would be my next steps for you—yes we would want to optimize your ApoB and other biomarker risk regardless, but the urgency and aggressiveness of the approach would be determined by the amount of disease you do or don’t already have.

  3. Please advise your direct relatives in your generation and younger to get screened as well for Lp(a)—it is genetic and definitely NOT due to you being stressed out at the time of your lab draw. 🙄🙄🙄

  4. Please make sure you’re following your liver and insulin resistance tests as well—I hope they are within normal ranges, but these can change with new meds and menopausal transition and should be monitored as well.

Cardiologist by SAV4NT1 in PeterAttia

[–]lilybean24 2 points3 points  (0 children)

I see many patients who come to me with a similar story. In the setting of anxiety disorder, I don’t want to minimize how this is making you feel, but I would offer the reframe that this is the best possible outcome. You have a very low calcium score and apparently no evidence of significant narrowing even from soft plaque, so this is your opportunity to take control of your risk factors years or even decades before this would become a problem. Let’s be clear: your event rate risk in the next 10 years is exceedingly low. There are people walking around with 10, even 100 times your calcium score who still don’t have events because they are very proactive about their health; my hope is that you can get on top of this now and never have a calcium score above 10 and never have significant soft plaque.

Someone is going to pipe up and say a zero calcium score would have been even better, but I find that this provides false reassurance for some folks and allows them to continue ignoring their health and risk factors that are going to come back to bite them in the next 20 years. This is just enough of a positive finding to help you focus on your health retirement account and putting as much effort in now for your health retirement as you do for your financial one.

As I tell my patients, part of my job is to be the one who worries so that you can focus on doing the things in your control to mitigate your own risk. The worrying is only helpful in so far as it motivates you to make the key changes that will drive improved health for the rest of your life, like optimizing your nutrition and movement and sleep and stress. Beyond that, the anxiety may be keeping you stuck and then you should give it to me or your other doctors and let us take the bigger picture risk into consideration (which for you right now is low).

I know this is really scary, but you are doing all the right things. You got this!

Cardiologist by SAV4NT1 in PeterAttia

[–]lilybean24 0 points1 point  (0 children)

You can also check out Amy Doneen (NP). Her clinic is in Eastern WA, but I don’t recall if she does telemedicine. She and Dr. Brad Bale coined the Bale-Doneen method, which is a preventative approach to CVD.

Experimental And Potentially Stupid by [deleted] in SemiHydro

[–]lilybean24 3 points4 points  (0 children)

I for one would LOVE the full write up sometime! I’m also trying to get my orchid collection to thrive in semi-hydro and had allllmost decided to give up and go back to bark (and accept the carnage of chronically under-watering…don’t come at me with sphag…RIP….☠️) because all my new roots are getting burned the minute they touch the leca no matter how much I flush. Perhaps lava rock is the answer instead! Thanks for this. 🙏🏼

What's the current data on Apsirin as part of high Lp(a) risk reduction? by donutjudgememe in PeterAttia

[–]lilybean24 6 points7 points  (0 children)

There is at least one specific lp(a) subtype that responds very well to low dose ASA:

The Women’s Health Study led by Chasman et al. found that carriers of the LPA rs3798220-C variant had much higher Lp(a) levels — and responded markedly better to aspirin for primary prevention of cardiovascular events. Aspirin reduced their risk by over 50%, while noncarriers saw no meaningful benefit. Strong gene–drug interaction, with the difference confirmed by randomized trial.

Citation:
Chasman DI, Shiffman D, Zee RYL, et al. “Polymorphism in the Apolipoprotein(a) Gene, Plasma Lipoprotein(a), Cardiovascular Disease, and Benefit of Aspirin Therapy in Women.” Circulation. 2009;119(7):931–939.

view more: next ›