Treating High Lp(a): A Risk Factor for Atherosclerosis

Treating High Lp(a): A Risk Factor for Atherosclerosis
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What is this lipoprotein(a) and what can we do about it?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

What could explain severe coronary disease in someone considered to be at low cardiovascular disease risk with a healthy lifestyle? A young man ends up in the ER with a heart attack; ultimately found to have severe coronary artery disease, yet given his age, blood pressure, and cholesterol, his 10-year risk of a heart attack should only be like 2 percent. But what he did have was a high lipoprotein(a) level, also known as Lp(a), markedly high at 80, which may help explain it. You can see the same thing in women. A 27-year old with a heart attack with a high Lp(a). What is this Lp(a), and what can we do about it?

Lp(a) is an underestimated cardiovascular risk factor. It causes coronary artery disease, heart attacks, strokes, peripheral arterial disease, calcified aortic valve disease, and heart failure. And these can occur even in people without high cholesterol, because it is cholesterol. It’s basically an LDL cholesterol molecule linked to another protein, which, like LDL, transfers cholesterol into the lining of our arteries, contributing to the inflammation in atherosclerotic plaques. But it has yet to gain recognition by practicing physicians.

The main reason for the limited clinical use of Lp(a) is the traditional lack of effective and specific therapies to lower it. Lp(a) concentrations are approximately 90 percent genetically determined, so the conventional thinking has been that you’re just kind of born with higher or lower levels, and there’s not much you can do about it. Even if that were the case, you still might want to know about it, since if it was high, that would be all the more reason to make sure all the other risk factors that you do have more control over are absolutely as good as possible––like maybe help you quit smoking, and do everything you can do lower your LDL cholesterol as much as possible.

Lp(a) levels in the blood can vary a 1,000-fold between individuals (from less than 0.1 mg/dL to a hundred or more). Here’s the graph of odds of heart disease at different levels. Less than 20 is probably optimal, with greater than 30-50 considered elevated. Even when the more conservative threshold of greater than 50 is used, that describes about 10-30 percent of the global population, an estimated 1.4 billion people. So, if we’re like the 1 in 5 people with elevated levels, what can we do about it?

The way we know that Lp(a) causes atherosclerosis is that we can put it to the ultimate test. There’s something called apheresis, which is basically like a dialysis machine where they can take out your blood, wash out some of the Lp(a), and then give your blood back to you. And when you do that, you can reverse the progress of disease. Atherosclerosis continues to get worse in the control group, but better in the apheresis group. This is great for proving the role of Lp(a), but has limited clinical application, given the cost, accessibility, and the time commitment required for biweekly sessions of two to four hours each. It causes a big drop in blood levels, but they quickly creep back up, so you have to keep going in, costing more than $50,000 a year. There has to be a better way. We’ll explore the role diet can play, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

What could explain severe coronary disease in someone considered to be at low cardiovascular disease risk with a healthy lifestyle? A young man ends up in the ER with a heart attack; ultimately found to have severe coronary artery disease, yet given his age, blood pressure, and cholesterol, his 10-year risk of a heart attack should only be like 2 percent. But what he did have was a high lipoprotein(a) level, also known as Lp(a), markedly high at 80, which may help explain it. You can see the same thing in women. A 27-year old with a heart attack with a high Lp(a). What is this Lp(a), and what can we do about it?

Lp(a) is an underestimated cardiovascular risk factor. It causes coronary artery disease, heart attacks, strokes, peripheral arterial disease, calcified aortic valve disease, and heart failure. And these can occur even in people without high cholesterol, because it is cholesterol. It’s basically an LDL cholesterol molecule linked to another protein, which, like LDL, transfers cholesterol into the lining of our arteries, contributing to the inflammation in atherosclerotic plaques. But it has yet to gain recognition by practicing physicians.

The main reason for the limited clinical use of Lp(a) is the traditional lack of effective and specific therapies to lower it. Lp(a) concentrations are approximately 90 percent genetically determined, so the conventional thinking has been that you’re just kind of born with higher or lower levels, and there’s not much you can do about it. Even if that were the case, you still might want to know about it, since if it was high, that would be all the more reason to make sure all the other risk factors that you do have more control over are absolutely as good as possible––like maybe help you quit smoking, and do everything you can do lower your LDL cholesterol as much as possible.

Lp(a) levels in the blood can vary a 1,000-fold between individuals (from less than 0.1 mg/dL to a hundred or more). Here’s the graph of odds of heart disease at different levels. Less than 20 is probably optimal, with greater than 30-50 considered elevated. Even when the more conservative threshold of greater than 50 is used, that describes about 10-30 percent of the global population, an estimated 1.4 billion people. So, if we’re like the 1 in 5 people with elevated levels, what can we do about it?

The way we know that Lp(a) causes atherosclerosis is that we can put it to the ultimate test. There’s something called apheresis, which is basically like a dialysis machine where they can take out your blood, wash out some of the Lp(a), and then give your blood back to you. And when you do that, you can reverse the progress of disease. Atherosclerosis continues to get worse in the control group, but better in the apheresis group. This is great for proving the role of Lp(a), but has limited clinical application, given the cost, accessibility, and the time commitment required for biweekly sessions of two to four hours each. It causes a big drop in blood levels, but they quickly creep back up, so you have to keep going in, costing more than $50,000 a year. There has to be a better way. We’ll explore the role diet can play, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

I’ve been wanting to do videos about Lp(a), but there just wasn’t much we could do about it…until now! Okay, so how do we lower Lp(a) with diet? Stay tuned for the thrilling conclusion in my next video.

What can we do in general to minimize heart disease risk? My video How Not to Die from Heart Disease is a good starting point.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

121 responses to “Treating High Lp(a): A Risk Factor for Atherosclerosis

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    1. Thank you for that reference– Daly had a strong influence on protein and cholesterol research, and helped promote awareness of cholesterol’s relation to heart disease.

      In the face of so much research on cardiovascular disease, the leading killer chronic disease in the US, we find so few articles that go into much depth and detail for the general public. That makes NutritionFacts.org an outstanding and exceptional resource.

      Belatedly, the medical profession only has begun to come to terms with the complex diagnostic and predictive markers of cardiovascular disease.

  1. I am looking forward to the next video.

    I have a neighbor who had none of the risk factors for the sudden heart attack she suffered at age 60 — except for high Lpa, which she discovered afterward. We’ve discussed diet, but I had very little evidence to offer her, since she believes that her condition is genetic, and there really isn’t anything she can do about it. It doesn’t make her happy, that’s for sure. And she and her husband do eat fairly well, but continue to eat meat, including fish and poultry, albeit moderately. (At least according to her; I’ve no idea what moderation means. I don’t ask.)

    I can send her links to both this and the following video — I hope.

    1. Here ya go Dr J. I found this while searching this morning. https://www.ncbi.nlm.nih.gov/pubmed/30014498
      The high Lp(a) is the same thing that Bob Harper had (has), and since his recovery from a heart attack that made the news, he has been doing well on a mediterranean diet recommended by his doctors.

      Anyway, thought you might enjoy taking a look at that study.

      1. Barb,

        Thanks for the link! I saw preliminary research results, which were presented as an abstract at a conference and published in abstract form, I think. Now it’s been published as a whole research article, so it’s been peer-reviewed.

        And we can read the article for free!! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/

        But, spoiler alert, from the abstract:

        “ Conclusions

        A defined, plant‐based diet has a favorable impact on Lp(a), inflammatory indicators, and other atherogenic lipoproteins and particles. Lp(a) concentration was previously thought to be only minimally altered by dietary interventions. In this protocol however, a defined plant‐based diet was shown to substantially reduce this biomarker. Further investigation is required to elucidate the specific mechanisms that contribute to the reductions in Lp(a) concentrations, which may include alterations in gene expression.”

        Though I actually shared the initial abstract with my neighbor, who was not impressed; she remained unpersuaded. Like many people I know, she says she eats “healthy.” But when I ask her what that means, she gets…insulted, I guess, because she doesn’t want to tell me. (People know I eat a whole plant foods diet.). She did say that she continues to eat meat, in accordance with recommendations by her doctors. And I am not a ”doctor;” merely a lowly PhD former plant biochemistry/physiology research scientist.

        1. PS to my comment above:

          When reading scientific research articles published in peer-reviewed journals, I typically read the Abstract first (to get a brief overview of the background, question researched, the methods used and the results observed, and the conclusions), then the Introduction (which describes the background of the question and the state of the science before undertaking the research as well as the rationale for doing the research), then the Discussion and Conclusion, which discusses the results found in terms of the background of the problem and what they might mean. Then, if interested, I look at the Results (especially tables, graphs, figures), and often last at the Methods.

          1. That seems a helpful rule-of-thumb for most published medical research. For me, the discussion portion is where the excitement lies, so, as often as I am able, I prefer to go directly into the discussion without the introduction. Then, follow with a more leisurely review of the introduction and a closer review of methods.

        2. This test is definitely on my radar now and I will be asking my doctor for it but I wonder what other tests we are not aware of that might be truly beneficial to know the results of if we want to get a full picture of our health beyond the basics that we are usually tested for. I for one am hampered by trusting that my doctor is aware of The full spectrum of tests that are available to get a more complete picture of our health prospectus.

        1. Marilyn Kaye,

          I agree, the diet does sound extreme. Plus, the study subjects were all overweight or obese: “all participants were registered new patients of a cardiovascular center and were hypertensive (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg), had elevated LDL‐C (≥100 mg/dL) and excess body weight (body mass index ≥25 kg/m2) at baseline.“ And there were several “exclusionary conditions.” Finally, it sounds like a re-analysis of a previous study: “ Secondary analysis of a previous trial was conducted, in which overweight and obese individuals (n = 31) with low‐density lipoprotein cholesterol concentrations >100 mg/dL consumed a defined, plant‐based diet for 4 weeks.” I don’t know what to think about all this. I haven’t read the paper in any detail, just skimmed parts of it.

          But I’m hoping that Dr. Greger will be providing additional and better information.

        2. Marilyn Kaye, you come up with the most interesting and helpful perspectives! I was thinking about Dr Jenkins fruit and veggie diet trial the past few days. https://www.ncbi.nlm.nih.gov/pubmed/11288049
          I mention it because I initially did a version of this when my doctors wanted my cholesterol down immediately lol.
          In less than 30 days it went to historic lows on the mostly raw (with some exceptions) diet. My doctors were so impressed! Interesting to see that in the Jenkins trial, the high fruit veggie diet beat out the diet with grains and legumes added, as well as the modern therapeutic low fat diet.
          After all these years experimenting, I had concluded I just
          could not eat starchy carbs, flour products, grains (or very limited) without a rise in overall cholesterol and ldl.
          I don’t follow the raw diet now really, (and my cholesterol is too high), but I do include daily spices in my morning ‘shot’.
          I’ll ask for the Lp(a) test next time.

    2. Thanks Ray for your thoughtful comment. I am very interested in receiving a copy of Dr.Thomas E. Levy’s book and I have emailed you my address. I have Coronary Artery Disease and recently had 2 stents placed, but prior to that I adopted a Whole Plant Based Food Diet and much to the amazement of my doctors, I lowered my total cholesterol from 309 to 152 in just lest than 4 months. I’m very encouraged by the diet and have become a totally committed advocate so much so that after a great deal of prodding by many people, including my doctors, I’m in the process of building a new blog around my success. Although it’s not published yet the address will be PlantFoodGourmet.com. There will be a wealth of information along will fabulous recipes that everyone will enjoy. If there’s any subject matter you think would be important to my potential new readers please get in touch. Plantfoodgourmet@gmail.com. Hope to see you on my site soon!.

    3. Levy is a notorious quack.

      Just poke around his website where he claims ‘oral infections are responsible for most heart attacks and breast cancers, as well as a majority of other chronic degenerative diseases’ and also that vitamin C is a ‘primal panacea’ capable of curing smallpox, anthrax, ebola, zika etc etc icluding every possible vital infection. Take that covid 19.

      Only suitable for people whose critical thinking faculty has been set to zero.

    4. Dr J, I would suppose her heart attack was “modest” since she only consumes a “modest” amount of animal.

      I am looking forward to the next video but in the meantime… I’m guessing that LDL cholesterol if elevated can only aggravate the issues. But TMA also is likely a huge issue as are AGEs and methylglyoxal and an inflammatory diet in general.. Controlling those might not change the Lp(a) but all those are likely to make it more lethal.

      And what else? We eagerly await.

  2. I can’t wait for the video on “Treating High Lp(a): A Risk Factor for Atherosclerosis”. My cardiologist, who has since retired noticed my high Lp(a) but my current GP and cardiologist don’t test and don’t care about my Lp(a). No matter, I just need some information on how to address it. I’m on 1 gram of niacin a day but it’s still high.

    1. Actually, I sometimes genuinely enjoy Dr. Greger’s facial expressions and personality showing.

      I still find the charts and graphs flying around behind him useless to me.

      I know that I should pause and re-watch at least to see what is going on in that part of the screen, but I do enjoy the videos.

      I even like that Dr. Greger has a favorite green shirt and I will like it even more if it is about avoiding decision-fatigue.

      And, if it is not about decision-fatigue, I will loop back around and like that he is quirky.

      Yes, it is all good.

      1. Merchandising of even solid research information has reached the point, most people are openly distrustful of the source, even if academic/scientific. That is why Dr. Greger’s “quirkiness”– unmarketable and unmistakable– is a well-established marker of authenticity. Good things (almost) always arrive in modest packages, without fanfare.

  3. Male 75 years old taking low dose of statin (10mg) just had my lp(a) taken was 41, had to fight to have test taken from my primary Dr. upon results he stated was ok the range, on plant base diet. Any advise? Thank You

    1. Hi Milton, The best dietary advice should be in the next video. One thing to consider is that even on a plant based diet, many vegans make the mistake of using a lot of oils that can raise LDL cholesterol – and likely lp(a) – such as coconut oil, palm oil and even too much olive oil.

      1. Thank You for your reply! Yes, I agree 100% with you I’m following the best I can the Dr. Dean Ornish program & have eliminated oils but I do nibble on raw nuts. Again thanks

      2. Hi Julian,
        Do you have a reference that addresses the fact that oils raise LDL cholesterol? I have that problem and want to make sure I can understand the limitations needed. Ground flaxseed doesn’t seem to be a problem. Nuts and avocado seem to not change the result, although it may have taken a long time to rise back up. I have been Whole Foods plant based for years while my LDL continued to rise. Finding that I am susceptible to oil of all things was a shock that I am still getting used to.

        1. Birtha, for me it was not only oil, but nuts and nut butters, eating too many calories in general, flour products of any kind, gaining, or just maintaining weight, plus declining estrogen after menopause that increases LDL. In order to lower LDL I have to be losing weight, and eating few heavy starchy foods.

      1. Dr. Matt Thank you for your reply, I do have Amla powder in my refrigerator but always forgot to use it. Now I will many thanks. Milton

  4. What I’m seeing in the chart at t=3:30, biweekly apheresis sessions might not be adequate to keep Lp(a) in check (assuming biweekly means every 14 days). Looks like weekly is what you’d need.

    I think I’d take a pass.

    1. Dr. Cobalt,

      I was thinking the same thing.

      Though, my cousin who goes to dialysis 4 times per week would call everybody wimps for thinking once a week was too much.

  5. The variation in nomenclature is a little annoying but I’m assuming that the “low density lipoprotein” listed on the blood test levels re. my latest checkup is LP(a). And if so yikes ! Mine was 149, though it said on the test that the “normal” range was 0-159 so I guess no automated triggers were set off. All my other numbers are good, I’m WFPB, and reasonably fit, but my Doc nonetheless was pushing statins. Her recommendation was primarily based on Kaiser’s algorithm given all of one’s numbers. When I asked her what were the dominant factors re. that recommendation she sort of shrugged and said mostly age and gender. I told her I’d get right on that ! I resisted the statin recommendation but now I’m wondering if the Lp(a) number was in fact a major contributor and that perhaps I should reconsider, as it seems like I’ve done all I can in terms of lifestyle. Anyway I anxiously await the next video…

    1. Karl,

      That is interesting that Kaiser gives an algorithm to doctors to help them decide whether to prescribe statins and the doctors can’t explain the factors clearly. It seems like if they could give a list of the information, they would be more likely to get people to listen to them.

      1. Deb,

        Yes that is weird. I generally appreciate Kaiser’s preventive approach, but I guess even they can’t resist combining that with pressure from the pharmaceutical companies. My doc knows that I’m pretty conservative re. meds so maybe she was required to provide that recommendation, and knowing that I’d probably ignore it, didn’t feel like she had to provide much explanation. But since I explicitly asked re. contributing factors you’d think she could have been more quantitative re. the contributing factors as per Kaiser’s algorithm. Oh well, I’m just a lowly physicist and trying to understand the medical industrial complex is far above my pay grade.

    2. Karl I think the number you refer to as Lp(a)
      Is actually LDL. They are not the same.
      Lp(a) must be tested on its own. Most MDs won’t prescribe it.

      1. Many thanks for the clarification; I was thinking that Kaiser’s automatic tests included Lp(a) and since I didn’t see it listed on my test results that it must be the same thing as LDL.

    1. Wade,

      You can change the playing speed.

      He does sound a little drunk at .75 but it does slow down the information for the laypeople.

  6. I wanted to raise a flag about the units your lab uses to measure lipoprotein (a). Some use mg/dl, others use nmol/L and they are dramatically different, so you really need to mention the units, not just the number in your posts.

    I have genetically elevated lp(a). 154 nmol/L despite a total cholesterol of 160, HDL of 60. I have eated a WFPB diet (whole grains, beans, soy, fermented foods, vegan) for the last 8 years and the only thing that has lowered lp(a)..(it was 176 nmol/L when first diagnosed) was prescription oral estrogen for menopause which I started three years ago. Oral estradiol is one well documented way to lower lp(a) via the first pass effect for menopausal women…..but I cannot take it forever. So very interested to hear if some magic food I am missing.

    1. Doubt if there is a magic food. I would love to be back on estradiol but just keeping my total LDL low with statins and diet and exercise is the best I can do for now.

    2. Mims,

      You brought a good point about the units used to measure LDL and Lp(a) blood levels.

      Here’s a general article discussing the different lipoprotein particles, which included this:

      “ Studies indicate that about one in five individuals have plasma levels above 50 mg/dL (80th percentile), and about one in four have plasma levels above 32 mg/dL (75th percentile). Lp(a) levels less than 30 mg/dL are considered normal.

      Here’s how Lp(a) lelevls are looked at in terms of risk:

      Desirable: < 14 mg/dL ( 50 mg/dL (> 125 nmol/l)”

      https://www.docsopinion.com/health-and-nutrition/lipids/lipoprotein-a/

      But the article also states: “ Lp(a) is mainly genetically determined and therefore refractory to lifestyle intervention.” Which I have read and heard many times before, and which I know is often not true.

      The article continues: “ At present, serum Lp(a) concentration does not appear to be significantly altered by realistic dietary changes. Standard dietary intervention such as a low-fat diet has little effect on serum Lp(a) levels.” Note the use of the phrase “REALISTIC DIETARY CHANGES.” So, hang onto your hats: eating a whole plant food diet is apparently UNREALISTIC. OK, so WOW!! Then how are we able to do it? But more importantly, does it improve Lp(a) levels? We must wait and see…Though we can already guess the answer. And I’ve seen some preliminary research results, presented at a conference last year or so. We will not be surprised.

      1. I am always wary of statements made on low carbers’ websites like the one you link to.

        As a low carber, the owner of that website would automatically consider WFPB diets both unrealistic and unhealthy

    3. 1 mg/dL value equivalent in µmol/L = 0.0357. Not good at math? Here it is in a chart.
      mg/dL mg/dL value to µmol/L mg/dL vs µmol/L
      150 150*0.0357 5.355
      240 240*0.0357 8.568
      310 310*0.0357 11.067
      450 450*0.0357 16.065
      510 510*0.0357 18.207
      630 630*0.0357 22.491
      720 720*0.0357 25.704
      810 810*0.0357 28.917
      900 900*0.0357 32.13
      1050 1050*0.0357 37.485
      1100 1100*0.0357 39.27
      1200 1200*0.0357 42.84
      1320 1320*0.0357 47.124
      1410 1410*0.0357 50.337
      1502 1502*0.0357 53.6214
      1609 1609*0.0357 57.4413
      1760 1760*0.0357 62.832
      1808 1808*0.0357 64.5456
      1900 1900*0.0357 67.83
      2405 2405*0.0357 85.68

  7. waiting for AKCEA-APO(a)-LRx to become available. I’m 70 with CVD (sub clinical) and hoping this drug comes available soon. Any thoughts on this?

  8. Thank you! Thank you! Thank you! I’ve been wanting to see a video on LP(a) for a long time. Think about it: 20 out of 100 people have high LP(a) and could be heart attack victims, even though they have low cholesterol and their doctor says they are in good health. Shouldn’t people be made aware that there could be a snake lurking in the weeds? It’s regrettable that LP(a) testing is not considered when assessing risk for coronary artery disease!

  9. When is the next video coming about what to do about it? I’ve been following a WFPB diet without fail for 5 years and still can’t get my number to budge. I even tried high doses of Niacin for six months but it didn’t help.

  10. Yes I have been waiting too. Lp(a) testing is a battle. I was fortunate in my pharm repping days to rep a drug called Niaspan targeting Lp(a). I called on one Internist who had certifications in lipidology and was highly motivated. He ordered a test based on family history and my number was 300 nmol/L !!

  11. I am looking forward to the next video!!

    I survived a heart attack at age 48, almost 6 years ago.

    I have been highly proactive in relation to lifestyle changes to improve my longevity: I have been whole foods/plant based for 5 years (and Daily ‘Dozening’ for 3), I walk or hike 7.5km per day, my work/life balance is good and my LDL is 1.30.

    I have just learned that my LPa is at 1100, and have been told by my Cardiologist that this is a hereditary marker and that there are no interventions at this time.

    If there is any way to improve my LPa number, I would love to hear about it!
    <3 CINDY

  12. I’ve been anxiously awaiting these episodes and am on the edge of my seat for the next video. Have been looking for an Lp(a) strategy for more than a decade…the good news there is that I’m “not quite dead yet” with an Lp(a) shifting slightly from 136 mg/dL in 2007 to 123 mg/dL now. When I first leaned about it I recall the phrase “frighteningly high” being bantered about. And while I’ve been mostly vegetarian for 30 years, I continue to refine my now WFPB diet as new information becomes available (that was a great Food Revolution Summit, thanks Dr. Greger). My current cardiologist will prescribe an Lp(a) test if I ask but since we already know the answer, I agree that it is pointless if you know it is high. I had the other lifestyle issues dialed in before I learned of my high Lp(a), which was when my mother died of heart attack. I’ve also been told by cardiologists and lipid specialists that it is genetic and there are no more diet or lifestyle changes to be made. I’m taking a statin and I don’t like it, so I’m looking for some useful information other than to keep my affairs in order.

        1. Sorry. There was someone who posted multiple comments praising a Doctor Thomas Levy who has a reputation for making absurd false claims about the causes and cures of all diseases. I posted a warning under each of those posts. Since then, the posts have been deleted possibly because they were considered ‘spam’
          .

  13. People can get the test ordered through online sites if their doctors don’t want to order it. It costs about $49 at a few sites and some of them do a 10% discount for first trial of their service. There are sales throughout the year, but $49 is what I saw at a few sites.

    Speaking of testing, this study says that saliva may be more accurate for COVID testing than throat swab. They did tests both ways and there were cases where the throat test came back negative while the saliva test came back positive.

    https://www.medrxiv.org/content/10.1101/2020.04.16.20067835v1

  14. So, with the mathematic people saying that we can open everything up and not have lockdown and places like Israel going from total lockdown to nothing, I am wondering what Dr. Greger is going to say in the Webinar.

  15. I already know that my father already feels like he is right that he didn’t need a mask and didn’t need to socially distance and shouldn’t have had to stop his activities and going to restaurants.

    And, I guess, if places open and nothing happens, I will put my attitude down and concede, but it just seems like more people are going to die.

    Hearing Israel tell kids to go visit their grandparents, maybe they know something that I don’t know and I am going to wait and see.

    I am not comfortable with it.

  16. How many children are going to cause their grandparents to die over this next month?

    The logic for masks, for social distancing and for lockdown is being removed and I feel like it is in the states that shut down so early that they didn’t see the same thing we are seeing.

  17. Very good introduction into Lp(a)
    I have known for the last 38 years that I have a very high Lp(a) as well as a bad general lipid profile. Tried niacin in the past and could not tolerate it. All I have done was taken Metformin 500mg 3x per day (I am not a diabetic) for the last 33 years and high dose Vit C (2,000 to 3,000 mg/day).
    My arteries are clean on angiogram and coronary artery scanning. I am in my seventies. I have a high egg, meat diet and animal fat diet and have avoided plant seed oils as much as I can. My sister (lower Lp(a) than mine) already had a triple bypass at age 47 and was a vegetarian since she was 21 years old. My cardiologists are surprised.
    The genetics and Lp(a) seems to be related to scurvy. See the following useful link:
    https://www.youtube.com/watch?feature=player_detailpage&v=O0lEmXJD7p4

      1. Thanks. But taken that “harmful doses” for nearly 40 I must be an exception. Don’t think so – I know quite a lot of folks who have done it and it just fine.

  18. I was looking at the data again for the study on Vitamin D and COVID and the counter-intuitive levels of Vitamin D where the sunny places maybe thought they were getting enough from the sun were interesting beyond COVID-19.

    https://scitechdaily.com/vitamin-d-determines-severity-in-covid-19-researchers-urge-government-to-change-advice/

    Countries at lower latitude and typically sunny countries, such as Spain and Northern Italy, had low concentrations of vitamin D and high rates of vitamin D deficiency, and, also experienced the highest infection and death rates in Europe.

    The northern latitude countries of Norway, Finland, and Sweden, have higher vitamin D levels from supplementation and fortification of foods and they had lower COVID-19 infection and death rates. The correlation between low vitamin D levels and death from COVID-19 is statistically significant.

    I was noticing that they were also less likely to get the infection (or possibly they were asymptomatic enough to not know?)

    But if it is less likely to get it and less likely to die, both of those are excellent outcomes. Worth supplementing.

  19. This interests me a lot as my mother died of stroke at 82 from atherosclerosis and my father died of heart disease at 72, my present age. I’m doing what I can with my diet and can’t wait to see your next video to see if I can do more. Thank you for all the great work you do.

  20. There are drugs available that specifically lower LP(a) levels – a LOT. Rapetha is one that is fairly inexpensive now – you can sign up at their website and the cost is about $5/month. I wonder what Dr. Greger thinks of the drugs…

  21. OH. I forgot to add that I had a heart attack last year after being whole-foods plant-based for the past 4 years. I did perhaps eat too many avocadoes and nuts that I have reduced now to almost zero. Yes I have LP(a).

  22. So how dangerous is my cholesterol, really? It’s around 350 & the good one is just under 40, triglycerides a little over 300. Do these numbers always mean something bad is coming my way? I’ve loved every recipe I have tried in your book but the prep time is the big bugaboo. I am willing to make changes, but only if the numbers represent something real. Thanks. :)

    1. Yes. Something good will happen if you radically change your diet. If you dont then you are opening yourself up to extreme, and risky surgery.
      500,000 Americans die every year of heart disease. The first symptom for about half of those: sudden death.

      So, knowing that, you can decide if you wanna die of heart disease or make a big change to your diet. Don’t believe me? Check out Dr. Esselstyn from Cleveland Clinic.

      I hope you make the change for your own health. You are a grown-up now, you can decide to make this change for yourself.

    2. You’re level of total cholesterol does put you at significantly increased risk for premature death. Recipe? Hassle? What could be more hassle free than pouring yourself a bowl of fresh or frozen fruit or simply peeling a banana? Recipes or for those that enjoying doing that. I’m with you: recipes are too much hassle. So I keep it simple and just eat fruit or boil some lentils with spinach and then cover with fresh diced onions and tomato. Sometimes I’ll pour a bunch of curry powder in with the lentils. Eat what you like and what fits your lifestyle. You have millions of hassle free WFPB choices that don’t involve more than about 15 seconds of prep time.

      1. If total cholesterol levels put you significantly at risk and you can show a well structured study that proves when TC is high but Trigs are low you are at significant risk then go ahead and claim the 5,000 dollar reward that one guy has put up to anyone coming forward. Why are we still touting this nonsense about TC

  23. I agree, there has to be a better way. I suspect it has something to do with eating style. My eyes get wider when reading some of the posts here where people have Lp(a) and are eating WFPB–and having heart attacks.

  24. So just wondering the impact of LP little b. My LP little a level is nine but my LP little b level is in the very high range. I have a diet which is mainly fruits and vegetables with some fish and chicken ; gluten free dairy free and organic. I’ve been following Dr. Gregor for years and I listen to his suggestions.. my cholesterol hovers between 220 and 250. We have heart attacks in the family. I’m trying to be smart about what I’m doing but have not heard much about LP little b

  25. Niacin in large therapeutic doses dramatically reduces LPa You can look it up. Questions are” is it worth the potential liver damage and does reduced lab values decrease cardiac events and damage?

  26. I was a seemingly healthy, active guy who had the “Widow Maker” attack at the age of 47. I’d been getting annual check-ups and was told everything was fine. After the attack, I was treated by two cardiologists who never mentioned Lipoprotein (a). I began having my blood tested on my own and the tests I bought included Lp(a). Mine was off the chart! My current cardiologist told me it (high Lp(a)) is my biggest problem. We’ve attacked it using REPATHA twice per month for about one year. The number has dropped by around 50%. I have been living a Whole Food Plant-Based life for almost four years, lost a lot of weight and I use my treadmill daily.

  27. Dr. Greger, thanks for all of your great work at helping us learn about the factors we can control in optimizing our health. But why do you do this: tell all about the little known factor you just described that contributes to heart disease and ask question “and what can we do about it”? And then say ” I’ll tell you NEXT !” What next ? Where is it ? Please don’t play that “tune in next week to learn how this soap opera crisis turned out ” If you must separate the videos then at least lean right into the next one you leave us on the cliff waiting for. May be a good marketing tactic on television to be sure you “tune in next time”. But come on, we’re loyal listeners and these are serious health issues. So WHERE IS THE “NEXT” video you said would contain the answer to the all important question of “what can we do about it”. Please and respectfully ” less drama and show us where the answer is” ! thanks

  28. Maybe Dr. G. feels he can’t get all the data on one video because of the time allowed in only one. So therefore he arries over the rest of his “new findings” onto another video. (I just read the transcripts.)

    Plus, he likes to show off his green shirt and tie……video after video after video. :-/

    https://www.youtube.com/watch?v=rRZ-IxZ46ng

    1. YR,

      I like that Dr. Greger is who he is.

      He is brave to become a public figure on the internet and even braver to be evidence-based when so much of his audience is vegan or plant-based. I respect that. Johnny Cash already took black and black would be the wrong message from a man who wants everybody to eat their greens.

    2. Honestly, I would have not had him used his green shirt with that background, but it has become charming to me.

      Most of my friends were creative people and they all had their own “voice” and in entertainment that can backfire or it can make you a legend.

  29. I saw something interesting about COVID. A researcher now believes that using the current mutation rate and knowing that they have found an “A” virus, which is earlier than the “B” in most of the Wuhan cases that there is a 95% chance that the original successful spread of the virus may have started as far back as Sept. 13, 2019.

    I am interested in that.

    The winter was so crazy for my family and I have relatives who travel for work and friends who went on cruises.

    We will never know, but I will always wonder.

  30. A few years back in comments to a video I asked if Dr. Gregor would sometime get around to doing something on lipoprotein (a). I’m glad it is finally happening! The only suggestion I got in the comments was to perhaps eat a few more almonds. So I am very much looking forward to what Dr. Gregor has to say in the next video, although I am not optimistic. I am hoping it is more than “eat plant-based, whole foods” encouragement. Lipoprotein (a) for years has been portrayed as being a particularly harmful lipoprotein, although its total contribution to or role in heart disease was not entirely understood. So I’m somewhat surprised to hear lipoprotein (a) now presented as a definitive substantial contribution to heart disease. (So much for the proposition that cholesterol is everything and keeping your total cholesterol below 150 mg/dl protects you from heart disease–I know, lipoprotein (a) is cholesterol–but some past videos presented levels of cholesterol below 150 mg/dl as being too low to trigger arterial plaque buildup.) I am a type 1 diabetic and have been on statins for two decades and have had very low cholesterol, total cholesterol around 100 mg/dl and ldl in the range of 60 mg/dl. However, along with type 1 diabetes, I have had Lipoprotein (a) levels of between 60-95 mg/dl. I fully understand that diabetes and high lipoprotein (a) levels are two major strikes against my heart health. I was able to get below 30 mg/dl by taking 3 grams of niaspan (the max dose) for a year or two a long time ago, but the levels eventually climbed back up (and I stopped taking niaspan). It was later in 2017, experiencing what might be mild angina, I did a coronary calcium scan and was shocked to get a high score (around 150). I immediately adopted full Esselstyn/Ornish-type diets. My lipoprotein (a) scores have not improved but have worsened. 2016: 78; 2017: 89; 2019: 98. So I am anxious to hear what Dr. Gregor says, but I am not optimistic that he will have something that will prove useful for me as far as lowering lipoprotein (a) levels.

      1. Thank you for posting again! that would translate to keeping ldl levels below 61 mg/l, and levels have been in the 50s through the past two decades, but have been 35-49 since going plant based.

  31. How to print Dr. G’s transcript of this Lp(a) article for my file only—and not for publication, and to remember to ask my PCP for a Lp(a) blood test for my annual wellness exam. I made a copy of Brent’s comment on pg 44 in case a cc is not available. Thank you. Tom

    1. Hi Thomas, you can go to the Transcript option and then copy and paste into Word. Hope that helps!

  32. Any chance of going back to videos without Dr Gregor in them. The studies are one of the best and most credible parts of his videos, and now with them smaller to accommodate him gyrating and gesticulating, they can hardly be seen. Plus his physical presence distracts from the points being made. I rarely watch anymore, unless it is topic I can’t find info about, anywhere else.

  33. I have an Lp(a) of 180. I’m female, 52 years old, have always been slim and fit, I’ve eaten a low fat, no oil WFPB diet for 10 years. I had my total cholesterol down to 157 but it has crept back up to 200 with decreasing estrogen.

  34. You hit on one of the key factors in your elevation, lower estrogen levels. From a therapeutic perspective niacin and l‐carnitine are two of the few effective impactful ways to lower Lp(a), along with estrogen. https://www.ahajournals.org/doi/10.1161/JAHA.116.003597

    If you’re also looking at the rest of the field, from a phama approach a new set of medications, only for those with extremely high levels is called antisense ( in phase 3 studies ) or the use of PCSK-9’s. https://www.heartuk.org.uk/genetic-conditions/high-lipoproteina. Key take away is that these are not first line approaches.

    Dr. G should be addressing your question shortly with a new video. In the meantime…. how about some increases in your intake of phytoestrogens, say soy products or consider an addition of some actual bio-identical estrogen and/or l‐carnitine or niacin ? Keep in mind that you’ll want to read a bit before the niacin experiment:

    Dr. Alan Kadish moderator for Dr. Greger <a href

    1. Hi,

      Thank you for your reply.
      I do eat a lot of soy and other phytoestrogens. I’m not sure about taking bio-identical estrogen as it may promote cancer and heart disease. I’m high risk for both. I’m not interested in taking medications, not yet. I’m hoping I can make some further dietary adjustments. A raw diet? Amla?

      Kind regards, Meg

    2. Dr. Greger recommends against carnitine: “… taking a carnitine supplement—certain gut bacteria metabolize the carnitine to a toxic substance called trimethylamine, which then gets oxidized in our liver to TMAO (trimethylamine-n-oxide), which then circulates throughout our bloodstream… take carnitine supplements, or lecithin supplements, which contain choline, presumably you’d foster and maintain those same kinds of TMAO-producing bacteria in your gut, and increase your risk of heart disease and, perhaps, cancer.”

  35. There was a paper on Vit C for lowering Lp(a). Personally I found that Vit C supp’ lowered mine from 31 to 21. Whilst away for 3 months I stopped supplementing and on retest it was back at 30 but after resumption dropped again to 20. There is no down side so try it but test before and after

  36. is it possible to deal with FH (23 and me indicates that I have a variant on my APOB gene – found out yesterday ) *without* statins. I am vegan since 2011. Age 50. At least 150 min of exercise per week. Never smoked.
    I have not seen my doc nor had blood work done in *years*. I plan to visit our GP soon — But wondering about options in case she recommends/px a statin.
    Thank you.
    a Holistic Holiday at Sea Alum

  37. Hi, Jean Wiser! I am assuming FH stands for family history. To paraphrase Dr. Greger, cardiovascular diseases do run in families, but so do lousy diets. If you haven’t already seen them, you might be interested in these videos:
    https://nutritionfacts.org/video/how-to-lower-lpa-with-diet/
    https://nutritionfacts.org/video/eliminating-the-1-cause-of-death/
    You can find everything on this site related to statins here: https://nutritionfacts.org/topics/statins/
    I hope that helps!

    1. Hi and thank you so much for the resources. FH is Familial Hypercholesterolemia. To be clear, I don’t have the diagnosis. I have the result of a variant on the APOB gene. Noted that my diet is very different from my relatives’; however, diet & lifestyle doesn’t appear to be enough when FH is in the picture.

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