#CHOLESTEROL Health Scare - Emperor has high Lp(a) !! "El pee little a"

Update 26th April: Nice article from the great William Davis: http://www.cureality.com/blog/post/2012/08/08/i-wish-i-had-lipoproteina.html

UPDATE 23rd April:  Ok I've come in with Lp(a) of ~160nMol/L. But more study and it looks like my Lp(a) top quintile only matters for ultra-high LDLc peeps (!) - Below from 2004 Physicians' Health Study looking at Lp(a) - I'm in the nice, comfy green oval:

...and another very comprehensive study - my Framingham risk is 3% - look where that puts me while being in the top tertile of Lp(a) - pretty damn good, eh? Lp(a) high for ancestral peeps means they must not invite disater with high carb / high BP / low HDL dyslipidemia. See below:

Original Post:

Ooops - got my Lp(a) for first time today - this is a resilient genetically-determined risk factor for CHD death, resistant to statins and/or dietary intervention - and it was high at 160nmol/L, or 60mg/dL (not sure of this conversion - need check). Should ideally be <30mg/dL. Bah Humbug indeed  :-(     

So what am I going to do?  Well, a bit of research - that's what! I had looked this up before - and there is some really interesting theory around Lp(a) having come down through hunter-gatherer genetic lines; I recalled that the only dietary things that helped with it (and also helped oxidized LDL) were LCHF and w3 supplementation - these are perfectly in tune with the ancestral origins, as usual.

But there's more - the Lp(a) link to Heart Disease is a noisy associative one, so gotta be careful here: just like LDLp, you gotta look at it in the context of all the other variables. Synergy and interaction abounds - always. My suspicion was that high Lp(a) would link to poor outcomes particularly for high-carb / low-HDL types (those misguided folks who break the ancestral rules, in other words). So let's see what we found, shall we? Note that the research & pharma world hates seeing high HDL being a universally good thing - because it don't shift pills. The high carb guideline goons HATE high HDL being good - because it undermines their carby anti-science. One finds that there are great papers available from the 90's, but oxLDL became less popular after then...

Here is a paper from 1997 where they tripped onto something:

Modulation of Lipoprotein(a) Atherogenicity by HDL Levels in Middle-Aged Men...

What they found was that the Lp(a) was a significant risk factor....for the low HDL men! The significance collapsed for high HDL men:

Btw, 'hypoalphalipoproteinemia' means 'low HDL' basically - even back then they didn't like crediting HDL in words :-)

Now let's get right up to date with a 2009 study, combining a massive amount of data from Lp(a) trials - the last word if you will. Here they wouldn't acknowledge high HDL as being important AT ALL - so I had to get the truth from their raw data - who the hell are these guys? Are they that influenced by dogma? Or by the 'thou shalt not threaten high carb guidelines and drug profits by mentioning high HDL importance'? Who knows; anyway, here's the paper - it doesn't even have the data tables, but they can be got online:

2009 Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease...

And the salient data, extracted for your pleasure:

As can be seen, Lp(a) from a massive compilation of decades-long research came in with a broadly linear association, with approximately an extra 15% risk for having a 3.5x higher value (1 full SD). (In fairness at my value of Lp(a) the association would be more like 50% higher risk, but don't have raw data on the HDL and the higher Lp(a) values - would love to see it).

But look at the peeps above 55mg/dL HDL - no longer significant risk from Lp(a) for a 3.5x higher value;

And what about LCHF peeps like you or me who are at 75mg/dL HDL due to our ancestral high fat diets? Well I haven't the full dataset (why don't any of theses studies provide raw data), but I'd guess our risk from Lp(a) is at the left hand side of that little bar, or just about....zero percent.

For a 'Big Picture' View, get a load of this - apparently acts in synergy with Insulin - so better keep yer Insulin down, if you wanna play with this particular puppy - Lp(a) as healing force, but keep carb low / fat high or it'll bite you? Also following is the incredible Hyperlipid - Peter has multiple erudite posts on this elusive Lipoprotein, read 'em all!

http://qjmed.oxfordjournals.org/content/qjmed/93/2/75.full.pdf

http://high-fat-nutrition.blogspot.ie/search/label/Lipoprotein%28a%29%20a%20prickly%20subject  (please do see all the related posts at Hyperlipid...)

(Here's an earlier post of mine on Lp(a) - need look this one up some more, time permitting... http://www.thefatemperor.com/blog/2014/11/20/asked-about-lpa-more-later-but-heres-a-taster

For Chris M here's a 2007 Study that crossed Lp(a) with Lp-PLA2, and a diagram showing interaction:  2007 Lp-PLA2