Big heart scan scores drop

High heart scan scores of, say, greater than 1000 are more difficult to reduce than lower scores.

I learned this lesson early in the experience of trying to drop scores. In the first few years of trying to drop scores, I saw relatively modest scores of 20, 50, or 100 drop readily, even when the usual targets were not fully achieved, and even before the incorporation of some of the more exciting recent additions to the Track Your Plaque program, like vitamin D.

But big scores of 1000, 2000, or 3000 are a tougher nut to crack. In the first few years, what I usually saw was a slowing , or "deceleration," of growth from the expected rate of annual score increase of 30% that would continue for a year or two, followed by zero change. In the first year of effort, for example, a score increase of 18% was common. 10% was common in year two, then finally zero change in year three. Somehow, the more plaque you begin with, the more "momentum" in growth is present and the longer it takes to stop it. Kind of like stopping a compact car versus stopping a freight train.

But more recently, I'm seeing faster drops. Today, Charlie came to the office to discuss his second heart scan. 18 months earlier, Charlie's first scan showed a score of 3,112, high by anybody's standard.

His repeat score: 3,048. While the drop is relatively small on a percentage basis and may even fall within the expected rate of error for heart scans (which tends to be <2% at this high a score), I told Charlie that it still represented a huge success. Not only did he not increase his score by the expected 30% per year, he also brought a charging locomotive to a rapid stop.

Next year, Charlie is targeting a big drop. Given the tools he now has available, I'm optimistic that he will succeed.

Watch for the Track Your Plaque May, 2007 Newsletter in which we will detail Charlie's story further.
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Lipoprotein(a): Surprising Poll Results

Lipoprotein(a): Surprising Poll Results

No doubt, our little informal poll asking readers whether they have lipoprotein(a), is skewed towards people inclined to respond because they have this genetic trait.

Nonetheless, the response is telling. Of 82 respondents:

--40 (48%) said they did have Lp(a)

--16 (19%) said that they did not have Lp(a)

--26 (31%) said that they did not know whether or not they had Lp(a)


Though admittedly an informal analysis, I'd draw several conclusions from this simple "experiment".

One, while the proportion of people responding that they have Lp(a) may not be accurate, it is a prevalent genetic risk factor that, according to formal studies, is present in 17% of people with coronary or vascular disease, 11% of the broader population. This number may be even higher if the newer particle number assays (measurements) are used (with results expressed in nmol/L), since an occasional person with a "normal" Lp(a) in mg/dl (weight-based) will prove to have increased Lp(a) by nmol/L (particle number-based). (The reason for this phenomenon is not clear. It may be consequent to variation in apo(a) size, with larger apo(a) varieties of Lp(a) occasionally escaping detection .) As our little poll shows, plenty of people have Lp(a).

Two, readers of this blog tend to be highly motivated, sophisticated, and knowledgeable about health and heart disease. Yet a substantial portion--31%--did not know whether they have this crucial risk factor. That shouldn't be. The unnecessary difficulty of getting this simple blood test performed has been driven home to me repeatedly when I identify this factor in someone and then suggest that their grown children and parents, each of whom have a 50% chance of having Lp(a), be tested. It's not uncommon for a 35-year old son, for instance, to say that his doctor refused, claiming it is an unproven risk marker, or to simply say that he/she doesn't know what it is.

No doubt, just knowing whether you have Lp(a) or not is not the end of the story. Reducing Lp(a) and its associated co-factors is no easy matter. With several hundred patients in my practice with Lp(a), it occupies much of my time and energy. Sometimes it leads to enormous successes , but it can also pose a real challenge.

There should no longer be any doubt that Lp(a) is associated with significantly increased risk of cardiovascular disease. This has been demonstrated conclusively across dozens of studies. Risk from Lp(a) is over and above that posed by other risk factors; it also amplifies the risk posed by other factors, e.g., small LDL, inflammatory phenemena, homocysteine, total LDL, low HDL.

In the world of Lp(a), our two most desperate needs for the future are:

1) Better education of physicians and the public, and

2) More effective treatment options.

Thus, our reasons to form The Lipoprotein(a) Research Foundation. Steps to gain tax-exempt status are being pursued as we speak.

I can't help but wonder whether, like vitamin D, a solution is right beneath our noses. An investment in research to fund the trials to better explore both basic science as well as practical treatment options might yield an answer more readily than we think. Wouldn't that be great?

Comments (5) -

  • mike V

    5/6/2008 3:53:00 PM |

    Thanks for your work in achieving these goals.

    I am one of the naieve do not know my Lp(a)score.
    As I have mentioned in the past, I am fortunate to have no detectable plaque by recent CTA.
    What tests do you advocate for your patients in this circumstance?
    (I have long followed preventive nutrition similar to your advice.)
    Is age a factor? I am 72.
    Thanks again.
    mikeV

  • Ross

    5/6/2008 7:33:00 PM |

    Well, I didn't answer the poll because my Lp(a) was 16mg/dL in November and is now 12mg/dL.  So it was borderline and is heading down.

    So, do I "have" Lp(a)?  Yes.  There is Lp(a) in my blood.  But not so much that I'm worried about it.  And I do know what my Lp(a) is, so the "don't know" response isn't right.

    None of the responses seemed to fit me.  So I didn't respond.

  • Anonymous

    5/7/2008 3:17:00 AM |

    Similar for me too.  My lp(a) was 6 mg/dl in the first test, 7 mg/dl in the second and 11 mg/dl in the third.  Not quite sure what to make of this so I answered the poll "don't know."

  • Bad_CRC

    5/7/2008 3:08:00 PM |

    Ross,

    Dr. D has said that Lp(a) is not one of the markers where a normal value is 0.  In the TYP book and online library, he says that a desirable score is <30 mg/dL (again, with the caveat about mass vs. particle size).  Superko's book puts the threshold at 20, and the VAP score sheet puts it at 10.  Mine was 7 by VAP, and I took this to mean that I don't "have" Lp(a).  Sounds like you're in the same boat.  See Dr. D's response to me under "Red flags for lipoprotein(a)."

    I didn't respond to the poll simply because I didn't notice it until it was closed.

    Dr. D, out of curiosity (if you have time to respond), what percent of the population scores zero for Lp(a)?

  • Dr. William Davis

    5/8/2008 2:37:00 AM |

    bad_crc--

    Curiously, a Lp(a) of zero is rare.

    Perhaps this provides some insight, though I'm not sure precisely what.

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