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Comment by brandonb

1 day ago

This is a nicely-designed study. For decades, we've known that inflammation is a risk factor for heart attacks.

In this study, the researchers designed a custom antibody that binds to oral bacteria. Then they used histological staining to identify specific biofilm structures inside the atherosclerotic tissue. Bacteria released from the biofilm were observed in heart attack cases, which gives us evidence that when the body's immune system responded to these bacteria, it triggered inflammation which ruptured cholesterol-laden plaque. So now we have more insight into the mechanism behind why inflammation is associated with heart attack risk.

The "pantheon" of risk factors for heart disease are:

* hs-CRP (inflammation): the mechanism studied by this research. High inflammation roughly doubles your risk of heart disease.

* ApoB - 20% of people with normal cholesterol will have abnormal ApoB, and be at risk of heart disease (ApoB is a structural protein in lipoproteins which cause arterial plaque).

* Lp(a) - the strongest hereditary risk factor for heart disease (Lp(a) acts as a multiplier on ApoB, since it camouflages cholesterol particles from your liver)

* HbA1c - insulin resistance /diabetes is a risk factor for just about everything.

* eGFR - estimates the volume of liquid your kidneys can filter, and is an input to the latest heart disease risk models (PREVENT).

All of these risk factors can be measured with a blood test + doctor review. Easy to order online: https://www.empirical.health/product/comprehensive-health-pa...

You should probably disclose that the order link at the end of your post goes to your own company.

Basic LDL cholesterol and triglycerides blood panels are still an essential part of heart disease bloodwork, too.

I would suggest most people start by asking your doctor for some of these tests at your next annual checkup, as many of them and the doctor visit are likely covered by insurance. The ACA has special handling for routine annual checkups, so don’t assume it’s going to be expensive until you’ve checked the cost with your insurance. A routine bloodwork panel will also include a number of other important measures that are routine and very cheap. It’s helpful to have all of these on your medical record so trends can be identified over time.

  • Fwiw, since it seems like a number of people on here have Kaiser, my experience asking my Kaiser pcp for these as a mid-30s otherwise healthy person:

    -lp(a) and apob were covered

    -ldl is computed on the standard panel, not an actual measurement

    -accidentally got lp(a) twice and it varied quite a bit, so they may use different labs that are calibrated differently

    -hs-crp is not offered

    -doctor didn’t seem particularly aware of the more “niche” tests but was open to putting them in during my yearly physical

  • Basic LDL cholesterol is often covered by insurance, but ApoB, Lp(a), and hs-CRP are unfortunately usually not. If insurance doesn't end up covering it, sometimes the fee is just ridiculous.

    For example, one person got billed $1,338 for just an ApoB test when insurance denied coverage: https://www.reddit.com/r/PeterAttia/comments/14a4an1/apob_te...

    Part of why we do cash pay (and pre-negotiated pricing with the labs) is that you avoid weird catastrophic scenarios like this. The price is upfront and transparent.

    (It's too late to edit the original post, but my affiliation is on my HN profile.)

IANAD, but

1) Isn't ApoB measurement pretty much in tandem with LDL, VLDL, and triglycerides? I realize it's being recognized now as the necessary factor for arterial dysfunction, but it seems like a lot of hoopla is being made as if it were some "silent" overlooked factor when for the vast, vast majority of people their ApoB levels are entirely explained by the other 3 lipid panel line items carrying it, and they have been in use for decades and are strongly targeted by the medical establishment

2) Isn't Lp(a) a separate lipoprotein altogether which is an independent risk factor for MACE? I've never heard of it "disguising" other cholesterol in testing.

  • 1) ApoB itself is more accurate than LDL and triglycerides. The latest evidence is that ApoB and Lp(a) together are more accurate than even LDL, VLDL, non-HDL, triglerycerides, etc combined: https://academic.oup.com/eurheartj/article-abstract/46/27/27...

    2) The terminology is confusing, but each Lp(a) particle is "just" a cholesterol particle wrapped with an extra protein, apoprotein (a). So each Lp(a) particle includes one ApoB molecule (the structural protein in atherogenic cholesterol particles) and many cholesterol and triglyceride molecules, but the extra protein makes each Lp(a) particle about 6x more atherogenic than a typical cholesterol particle.

  • you're correct

    there's a small subset of people with more atherogenic triglycerides that ApoB picks up over and above just tracking with the LDL, but...you probably knew that just looking at them

Understanding this is a shameless plug, it's very cool this exists.

  • You don't need to use this specific blood test, by the way. Any lab near you will test these biomarkers for you.

    • I live in Canada, despite being free this would be way more complicated to get. I don't want to be political, but just paying for this would be very appealing.

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The standard risk model based on SCORE-2 and PREVENT like parameters are very poor as reported in the recently published paper on the their accuracy performance by the Swedish team [1].

>All of these risk factors can be measured with a blood test + doctor review

As all CVD risk stratification with cardiologist review, the most important accuracy is sensivity (avoiding false negative that will escape review) of SCORE-2 and PREVENT, 48% and 26%, respectively [1].

The paper alternative proposal increased the sensitivity to 58% by performing clustering instead of conventional regression models as practiced in the standard SCORE-2 (Europe) and PREVENT (US).

These type of models including the latest proposal performed very poorly as indicated by their otherwise excellent and intuitive display of graphical abstract results [1].

[1] Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models:

https://academic.oup.com/eurjpc/advance-article/doi/10.1093/...

For what it's worth, I did one of these sorts of heart health blood panels, which showed everything as fine except for hs-CRP which was something like 8x what it should be.

I took it to the doctor, doctor just shrugged it off and said it's probably fine and I might have just been fighting off a cold.

What's the recommendation for someone with a hilariously high Lp(a)? Just pin LDL as low as possible?

  • Currently yes. There are some really promising drugs in the pipeline that are doing well in trials, though.

For lipids, besides the named tests, HDL, LDL, and triglyceride tests are older but shouldn't be overlooked.

For measuring inflammation, besides hs-CRP, additional tests are relevant and overlooked: regular CRP, ESR, and homocysteine.

Additionally, a heart attack can result from parasite induced inflammation too, e.g. in chagas disease, which is becoming increasingly common in the US while being very undetected without explicit testing. It is also very difficult to treat, but the gist 4196f31d12a43a95756e792500ff516f has some info on treating it. Lyme disease too can harm the heart permanently. In both cases a pacemaker could help as applicable.

  • Can you expand more on why you'd want regular CRP over hs-CRP (specifically for cardiovascular risk)?

    For homocysteine, one proxy is B12 or folate (which are more cost-effective to test). To my knowledge, ESR is used in certain rheumatologic conditions, and was used more often in the past, but isn't currently used for heart disease.

    • It is true that hs-CRP is relevant for cardiovascular risk. CRP and ESR are more for broader inflammatory risk, for acute and chronic values respectively.

What do you do next if one is high? See your Doctor?

  • Yeah. If you don't have obvious symptoms, they'd likely prescribe you a statin, metformin, or some sort of dietary intervention. But you'd want to discuss it with your doctor in any case...

  • This particular panel includes a consult with a doctor (who can advise on next steps, prescribe medication, and so on). Or you can take the results to your doctor.

Is the fat rapture because the body wants fat to release vitamins and other stuff to help power itself to fight off the bacteria?

Do you happen to know how much that test costs? (Clicking a link to try to find out brought me to a page that asks for my zip code.)

are you a cardiologist? Excellent points, thanks

  • Not a cardiologist, but adjacent to this type of research. I'm an MLE but have published research in cardiology.

    • TIL MLE = Machine Language Engineer. It wasn't listed in Google's AI overview, although I did get

      Major League Eating (MLE): a professional organization focused on competitive eating contests.

      Mister Leather Europe (MLE): an event within the European leather subculture.

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