lp(a)

Unlock the hidden mysteries of advanced lipid profiles with our insightful guest, Al Lopez, DO a respected internist with a special interest in lipids. Journey with us as we explore the sophisticated world of lipid profiles, dig into the data sets impacting heart and vascular disease, and reveal unseen risk factors that could be lurking in your health journey. Get an in-depth look at the intriguing bond between Geri Garcia and advanced lipid profiles, and learn about the vital role of the ApoB protein. Discover the silent dyslipidemias hiding among those who are overweight, diabetic, or resistant.

We take it up a notch as we steer our conversation towards oxidized LDL and its profound health implications. With 20 years of experience in measuring oxidized LDLs under his belt, Dr. Lopez, DO enlightens us on their potential peril in the vascular bed and the formation of plaque. Gain exclusive knowledge on where these LDLs may be embedding themselves and the impact of lipoprotein A on our overall wellbeing. This episode is indeed a goldmine for all those keen to enhance their understanding of advanced lipid profiles and their bearing on our health.

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Thank you for joinging me today! We are going to deep dive into the 4 big killers, starting first with Cardiovascular disease. The do's and don'ts of prevention and catching the signs early. 

4 big killers

• Cardiovascular disease and cerebral vascular disease
• Cancer
• Neurodegenerative disease - Alzheimer’s, dementia, Parkinson’s etc
• Metabolic disease

Cardiovascular disease -

Leading cause of death globally (17.9 millions people die from this every year)

My father passed when I was 8, he was 42, and so I know it’s in my family. So what do you do?

Takes 20 - 30 years for it to build up in arteries.

Cardiovascular disease - top 2 heart attack and stroke, but there are many more

Top risk factors -

physical inactivity

Bad diet

Tabacco and alcohol use

Most show up as overweight and obesity - -high blood pressure - high blood glucose - high blood lipids - diabetes

They all have interplay, they are not separate

Men usually get cardiovascular problems midlife, women on the other hand are less at risk mid life because they are premenopausal and still have estrogen, which protect that

Right now - men have 2 to 5 times more complications than women

After menopause, women will level out the playing field with cardiovascular disease

Untreated celiac disease can have an effect (treatment is gluten free diet)

If you are sleeping less than 7 hours a night, that is a risk factor that increases 10-30%

How do you screen for this?

I like to look at the ratio between HDL and Triglycerides - this gives us a better view of your situation

You want triglycerides to be less than 100

Insulin hormones stores fat, so if your insulin is high, your fat goes to visceral fat, it gores to organ fat, and and subcutaneous fat (some you can see on the body and some you can’t)

Fatty liver, big problem!

Usually found in people that drink a lot of alcohol.

Finding that younger people are developing this, but non alcohol related. Spiking insulin

If the liver is fatty, not working so well, the pancreas will create more insulin, which turns into prostate problems, cancer, dementia, and much more

What causes fatty liver? Sugar and carbs, ultra processed foods

Homa IR - insulin sensitivity

APO B - (APO B is a protein that develops around the bad LDL

This will read how the LDL is doing in the body,

apoB - Higher apoB shortens lifespan, increases risks of heart disease and stroke, and in multivariable analyses that account for LDL cholesterol, increases risk of diabetes 

Lp(a) - take this test once, it will test for levels of bad LDL in the body. If it is low, it will always be low (genetics). If it is high, you and your family need to take preventative measures and drop that LDL count.

Pre-diabetics - insulin resistant - pre diabetic, a lot of people in this range. You are at high risk!

App B is just the tip of the iceberg, we need to continually dive deeper and test more than traditional physicians would because we now know it takes 20-30 years before we see symptoms of the bigger problems.

The silver lining… 90% of all that we talked about today is preventable.

Body fat composition, diet, keep the sugars, carbs, and processed foods down

Full Study Link

Dr. Michael Koren and Dr. Dennis Leahy wrap up the MedEvidence Lipoprotein A series by exploring Lp(a) clinical trial treatments. Dr. Leahy shares his personal clinical research experience and platform for encouraging everyone to have their LP(a) blood work drawn. Tune in to learn more about this lesser-known condition, possible treatment options, and the future of Lp(a).

Learn More:

• Nature Magazine, Targeting Lipoprotein(a) with siRNA
• Medscape: Universal Testing for Lp(a)
• Get Your Lp(a) Tested

Related MedEvidence Episodes:

• Two Heart Docs Talk Lp(a) Part 1
• Two Heart Docs Talk Lp(a) Part 2
• Two Heart Docs Talk Lp(a) Part 3
• Heart Health Research and Lp(a)
• Cholesterol, Heart Disease, Statins & Evidence-Based Medicine
• Lipoprotein the Really, Really, Really, Really Bad Cholesterol
• New Treatments for Lipoprotein(a) on the Horizon
• Lipoprotein(a) The Evil Twin of the LDL Cholesterol

Dr. Dennis Leahy is a retired interventional cardiologist living in San Diego. He received his education from Princeton University and Columbia University and his residency at the University of California. In addition to enjoying the opportunity to surf and golf, he has maintained a personal and professional interest in Lipoprotein A research and treatment.

Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.

He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. 

Dr. Koren has served as an Investigator in over 2,000 trials and as the international lead investigator for many multi-centered trials including ALLIANCE, ROLE, TREAT to TARGET, OSLER, and MENDEL studies. He has written and co-authored over 100 peer-reviewed articles and been published in the most prestigious medical journals. Dr. Koren has also designed a research training course for physicians now in

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