Managing patients with high Lp(a) | Peter Attia, M.D. & Benoît Arsenault, Ph.D.

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The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 40 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).

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The problem with statins is that they either do nothing to Lp(a) or increase it by up to 5%…

DrProfX
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Have to say I'm a bit shocked at the recommendation of taking Statins (with all the side affects) ... So far I've found zero proof statins do anything for Lp(a), even the American Heart Association says they don't do anything for Lp(a). And, just from my Personal experience, My dr wanted to put me on them too because my Lp(a) was high, I said no. He then said lets get a CT scan and then talk. So I did the CT scan and all clean ... so my dr said, well no calcium so no need to go on them then (and 5 years later did just another one and still clean). And trust me, if there was proof statins helped with Lp(a), I would take them, even with the potential side affects. Anyway, just offering a different view.

BeachLifeLove
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But what if you have high Lp(a) in your blood? Lp(a) is a modified LDL particle that has a "tail" protein attached to it. The tail has a sequence of atoms which interfere with the anti-clotting effect of plasminogen, so it promotes clotting. It is estimated that 20% of the world population has Lp(a) particles, which are genetically determined. Statins actually increase the amount of Lp(a), so they're no help with this. But 81mg aspirin counteracts the Lp(a) thrombogenic effect. The tricky thing is to get the aspirin dose and frequency correct for a particular concentration of Lp(a). Maybe a blood test, like the prothrombin time, could help the doctor titrate the aspirin dosage. Lp(a) is known to increase the risk of ischemic strokes and heart attacks, especially in elderly men, but doctors rarely test for it. You can find articles about this in PubMed.

stanleysokolow
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I am LP(a) null. I have the C>T mutation at rs41259144 (chr6:160601075) that substitutes Arginine for Glycine at that position, and causes the protein to truncate and stay immature and inactive. Less than 1 in 1, 000 people have this SNV. My blood tests confirm non-detectable LP(a). The drawback is that I have a tendency towards infection. But it doesn't seem to hurt much. 4 people in my family have lived to be over 100.

petercoderch
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I did a little self experiment. I get a blood test every two months and check hormones and cholesterol (including Lp(a)). My numbers were approaching the point where I would be put on cholesterol meds. I wanted to lose weight and went on a low carb diet - 60g carbs per day with no calorie restrictions - just eat as much of anything I want - just not carbs. I lost weight pretty rapidly(3lbs./week) but over seven months my Lp(a) went from 34 to 3 - sorry, I don't remember the units. Also, my hormone profile went from someone in the mid-50s to a 30 year old - not perfect but really good. I am sure there is a genetic component here but in my case it was a resounding success.

BossNerd
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Im on liberal keto diet my second LP (a) test was 9. On my first ever Lp(a)test it was 15. I was 62. With keto diet i want to lower my Insulin which is improving, but the biggest gain was my Lp(a).

margots.
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Can we get the SNPs for the LPA gene that are of concern?

JanZamani
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Why wait three months to test your cholesterol?

HyperResponders reacts on dietary intakes and can detect changes within 3-4 days.

Everyone that are concerned about their cholesterol levels should get a cholesterol tester.

I've tested all kinds of supplements that are said to lower cholesterol and also different diets.

I know it's individual but I can see changes within a week.

acke
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I’m so confused. So many people say a keto diet reduced all risks for heart disease. So many people say how bad statins are. I’m very confused. Been on a keto diet for months. Blood pressure went to perfect 110 over 77. My LDL 181, Hdl 56, tryg 102, vldl 18, waiting on Apo b results. I am 37 years old 6’2 188 pounds. Trying to do eveytning I can for optimal health. I don’t know which way to go though.

daviddelguercio
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I just saw another video that said that Statins do not help reduce Lp(a) but your guest suggests that it does. 🤷🏻‍♂️

antonioavila
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Niaspan dropped my Lpa from 55 to 26-30 range

would be great to have the new antisense agents when and if they become available

kram
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Every other cardiologist I hear says statins don’t touch lipo (a)

ChristinaRubinoMusic
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We know statins reduce ldl but does ldl unquestionably cause cholesterol? If so, what's the increase in life expectancy from all cause mortality vs the side effect risk. Are there confounding studies that question the cholesterol cvd hypothesis? And is LPa cuasitive or indictive?

snb
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I'm 55 years old, had an ischemic stroke 2 years ago and a stent placed in my left Coronary Artery for 75% blockage a month ago. I'm on blood pressure medication, baby l aspirin, 80mg statin and now blood thinners after the stent placement. My recent Aug 2023 lipid panel my LDL was 47 HDL 44 and triglycerides were 136 this is with use of the statin last 2 years. My cardiologist just had me do a LP(a) test which came back 160.
In the last 6 months I've even become more aggressive with my diet cutting out most meat and reduce alcohol to almost zero and lowered my sugar and salt intake. I lost 35 pounds from 215 to 180 in the last 6 months through this approach and through a new job where I walk about 35, 000 steps a day.
I've worked out with weights all my life but did not really pay much attention to cardio or diet eating junk food quite often.
Any thoughts on what else I can do to increase my chances with preventing further cardiovascular disease.

dsmill
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i am 22 and have hypothyroidsm. On a regular blood work my lipoprotein a was checked. It was 245 which shocked me. Currently I have heart burns that feel like a radio tgat is not working and is making the rough sounds. Could tgat be from lipoprotein a?

salyx
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What is high lpa a test read mine is 164

mallwilliams
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"Liberal with PCSK9" drugs... of course, he only has wealthy patients. The rest of us will just have to rely on luck.

JosephNJ
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Hi Sir.. I am 37 year old. Last year suffered Carotid Dissection twice. My LPa levels are very high around 160. Doctor has put me on statins, blood thinners and niacin tablets. These medicines are ruining my body. Please suggest what should i take to lower my Lpa Naturally.

richakhattar
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lowering lp(a) causes diabetes! what now?

milanpintar
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I lowered lp(a) by more than half (240 > 115) on testosterone therapy, kind of interesting.

Davidj-ilfk