Lipoprotein(a): The Inherited Cholesterol Risk Marker You Should Test

00:00:00: Lipoprotein R, you hear a lot about that lately.

00:00:05: An important predictor of heart disease.

00:00:07: so for heart health... It's

00:00:09: very important because it

00:00:11: is bad!

00:00:12: In Germany roughly ten to twenty percent people have elevated LpKlineR and thats something you actually only measure once in your life And then pretty much know exactly where you stand.

00:00:23: LDL & LPKline are independent on each other And both can cause a higher risk and if both are high then it multiplies.

00:00:33: Exactly, unfortunately its inherited very dominantly.

00:00:36: that's kind of the issue.

00:00:36: but well... It is not like death sentence either.

00:00:42: Hello & warm welcome to new episode of Beyond Lifespan.

00:00:46: Hey there Max!

00:00:48: Today we're talking about lipoprotein R. you hear alot alot about that lately.

00:00:55: why is that actually?

00:00:56: Yeah I think for long time It was originally a relatively controversial topic, I think twenty thirty years ago.

00:01:03: But now we know that LP Klein R is very important because it's a very-very-very Important predictor of heart disease.

00:01:10: so for hard health...

00:01:12: It's very important Because its' Very bad

00:01:14: Yeah!

00:01:14: Because Its' Very Bad

00:01:15: Summit up quickly.

00:01:16: So..It's very-Very Bad to have A high level.

00:01:18: We just Know That Cardiac Events Then Occure Significantly More Often Iortic Valve Synosis Occurs Significently more often And It's also Very widespread In our latitudes in Germany, roughly ten to twenty percent of people have elevated LP Klein R. And that's something you actually only have to measure once in your life and then you pretty much know exactly where the level is roughly whether it's elevated or not?

00:01:45: That's actually a big crux.

00:01:46: so the question you have to ask yourself... Is it elevated?

00:01:49: Yes!

00:01:50: Then I definitely need to manage myself better with medication if necessary.

00:01:56: If its not elevated well than i don't really do anything for now.

00:02:00: That's what today is about.

00:02:01: We want to do a bit of a comprehensive overview, What exactly it again?

00:02:06: How you interpret why exactly its important and how you also do diagnostics around if it is elevated And what should actually be done in the next steps.

00:02:16: I have elevated LPR Haven't really gotten any instructions from my doctor yet.

00:02:22: What are my next steps?

00:02:24: I think that we especially wanna share.

00:02:30: Let's go.

00:02:30: So basically lipoprotein R, maybe for a rough conceptual idea.

00:02:35: in the end most people probably know LDL and Lipoproutein R isn't actually that far off from LDL because it is also a lipid transporter.

00:02:46: And to put very simply its an LDL with small apolipoproutine R attached To It This small Apolipo protein R. so this process happens on the liver And this little extra makes this lipoprotein R or LPR.

00:03:04: It makes it stickier and less favorable for the vessels because...

00:03:09: Stickier to the vessel walls?

00:03:11: Exactly, exactly!

00:03:12: Because there are oxidized phospholipids in their and regardless of whether you know what that is its bad and That ultimately makes it Bad for the Vessels although it's probably okay to a certain extent that it's present.

00:03:29: It's just like with LDL, we need LDL We need this transport of cholesterol in the body and lipoprotein R serves this purpose too but its a very independent risk marker.

00:03:46: so you can have high LDL and low LPR ,it could be other way around.

00:03:51: both can be high But regardless of that So independent on eachother Its bad.

00:03:57: A high LDL is bad, and independent of that just a high LPA is also super-bad.

00:04:05: And specifically for everything related to cardiac events—for heart attack or stroke —and very particularly for calcification of the aortic valve.

00:04:16: The aortic valves are between the heart and the aorta so it's the large vessel which practically leads everywhere in your body.

00:04:24: If this valve is calcified Then you have a problem because this blood can't be pumped out as well.

00:04:31: It's a big strain on the heart and so one, and so forth.

00:04:35: That's bad And that's very specific to LPA.

00:04:41: Exactly!

00:04:41: That definitely is bad.

00:04:44: You're right No...and it just something that was actually mainly genetically inherited.

00:04:49: Yeah..you cant really do much about yourself but its usually already in family Especially if you might have already had some kind of cardiac events in the family.

00:05:00: know about that.

00:05:01: It's, of course all the more likely That there is a genetic variation Of it.

00:05:09: And what's interesting?

00:05:10: Is actually that I think i said this briefly at The beginning A really large part of the population has affected but especially In the african region its very common.

00:05:18: There Its over twenty percent in Some cases.

00:05:26: What's interesting is that it apparently used to be responsible for protecting against parasitic infections.

00:05:31: what exactly the mechanism Is there?

00:05:32: I don't know exactly?

00:05:33: To Be honest, i didn't research That further either.

00:05:35: It's not that important anyway.

00:05:37: What's important Is that it used to have a benefit and today it doesn't anymore.

00:05:41: Today it actually has absolutely no benefit at all.

00:05:44: We do need LDL yes but we Don't need this apolipoprotein A. with it we just don't Needed.

00:05:49: um it can be zero And it wouldn't kill us right.

00:05:52: that means we're Not hurting ourselves if we lower it somehow but we'll get to that later.

00:05:56: It's not that easy either, um... But that's why it's definitely not an advantage to have more of it.

00:06:01: and uh We want to somehow yeah Get rid of it.

00:06:06: Um..but before that Let's talk briefly about what are the limit values?

00:06:12: So how do I interpret this now?

00:06:14: Yeah exactly because we've been talking about How twenty percent Have high lipoprotein A And when we say High Lipo protein a We mean either fifty milligrams per deciliter or one hundred twenty-five nanomoles per liter.

00:06:33: And you have to be a bit careful there, the units have a certain catch to them.

00:06:38: The standard unit should actually be nano moles per liter.

00:06:42: That's preferred because this milligram per decilitre it has a minor weakness.

00:06:49: This lipoprotein A has particles of different weights.

00:06:53: So this little attachment, the apoA which we mentioned what happens in the liver.

00:06:57: This little apoA is attached to the LDL.

00:07:00: but this apoA can vary in size right?

00:07:03: It can be very large and heavy or it could be small and light.

00:07:10: And this milligram per deciliter measures exactly that mass.

00:07:15: That means you have a high milligram per desiliter value But the nanomole per liter value actually okay because for example you have a lipoprotein A that has very, very large apoA molecules.

00:07:30: It's a bit confusing with all the LP-apoA.

00:07:32: it is complex but this milligram per deciliter measures the mass.

00:07:39: But what are much more relevant and the number is measured by nanomoles per liter.

00:07:45: That´s the particle concentration.

00:07:47: So...that is much meaningful.

00:07:50: A lipoprotein-A with a large apo-a isn't necessarily worse than a lipop protein-A, but it distorts the milligram per deciliter value upwards.

00:08:01: And that's why you should always ask if you can get the nanomole per liter value from the lab where you get tested!

00:08:09: Back then for example I only got the milligrams per decilitre value.

00:08:13: mine was six.

00:08:15: now its so low.

00:08:16: It's more like milligram per deciliter gives a falsely high impression and not necessary.

00:08:23: I mean it can also be a falsly low value, sure but with such a low-value you wouldn't expect the nanomall per liter value to somehow shoot up or go through the roof.

00:08:36: When it comes to the assessment in general ideally should under thirty milligrams per deciliter, or let's say for simplicity sake we'll only talk about nanomolds per liter from now on.

00:08:47: You should be under seventy-five nanomolts per liter.

00:08:50: then there is a borderline range between seventy five and let us say one hundred twenty-five nano moles per litre.

00:08:58: And from one hundred Twenty-five Nanomolds Per Litre it's elevated.

00:09:05: in studies that are done, they always look at what from which threshold...from which limit is it?

00:09:11: That cardiac events become much more frequent.

00:09:14: And that was exactly this one hundred twenty-five nanomolds per liter or fifty milligrams per deciliter and very high is four hundred thirty nanomolts per litre Which already a multiple of one hundred eighty milligrams per desiliter who have a classic lipid problem within the family very fancy enormous.

00:09:40: Exactly,

00:09:42: so those are also not just people who have high lpna but they also have LDL values way beyond two hundred fifty to three hundred.

00:09:52: So you really have to make sure you treat that accordingly and get it down.

00:09:58: But always remember The unit is an important topic For other values, there's usually a fixed conversion factor for lipoprotein A not really because there is very wide range of how big this little attachment.

00:10:12: Is it heavy?

00:10:14: Very light.

00:10:15: and what's crucial above all the number of lipop protein A molecules overall.

00:10:23: right you already said testing once in a lifetime actually enough.

00:10:29: It isn't something that changes drastically over time.

00:10:32: I also read that some suggest you should probably get it checked every three years because of some minor dynamics.

00:10:39: It's a bit contradictory in the end,

00:10:41: yeah?

00:10:42: So so in most cases once is probably enough.

00:10:45: Of course there are phases and life where Theoretically it can change a bit especially during menopause.

00:10:50: That can sometimes go up a bit.

00:10:53: Generally LDL often goes up a big than two.

00:10:56: You should just keep that in mind Um, but not like doubling or anything.

00:11:03: It's not huge either.

00:11:05: that means once is still probably enough because then you basically already know okay are you more on the high side?

00:11:10: Or More On The Low Side?

00:11:12: um Yeah I didn't find as much on That As You Did But um...you can do it every three years.

00:11:18: for all.

00:11:18: i care just to see.

00:11:19: Okay Do I Have Any Dynamics Going On?

00:11:21: Because There Are Ways Even Today To Lower At Least Slightly even If Only Slightly

00:11:27: yeah And I think the most important message we want to get across with this episode today is please know your lipoprotein A.

00:11:39: Such a small thing costs like fifteen euros, right?

00:11:43: You measure it once and you know okay... Is there risk for heart attacks or not?

00:11:50: because that's also extremely relevant.

00:11:53: If I have a significantly higher LPA, then i'm much more let's say stressed and look very closely at okay where is my LDL?

00:12:06: Where is my?

00:12:06: where's my upper B?

00:12:07: maybe as well.

00:12:09: And may be also have my heart looked at it bit more closely to see if there are any deposits.

00:12:13: right those are just small factors that... ...if I know my LPAs elevated.. ..I'll tackle them earlier than otherwise!

00:12:21: Right?!

00:12:22: And-and if necessary also tackle them a bit more thoroughly because its' just more likely that they're our deposits in your arteries?

00:12:28: That's just how it is.

00:12:30: Yeah, we've already touched on why it's actually important to know you're lipoprotein A. On the one hand of course because this increased risk Because We Know that The Higher The Lipoproutine A The Higher the Risk Of Ultimately Having a Heart Attack Getting Pluck Build Up Or Having a Stroke.

00:12:47: That Means It' An Addition To The Known Markers That We Already Look At.

00:12:51: Thats Also Very Very Important.

00:12:53: LDL and LPA Are Independent Of Each Other and both can cause a higher risk.

00:12:59: And if both are high, then it multiplies.

00:13:03: Then its not just higher but many times higher.

00:13:06: That's why you should know these values.

00:13:08: If also have high blood pressure or maybe smoke... ...then an exponentially higher risk than normal blood pressure.

00:13:18: don't smoke.

00:13:19: Maybe only have high lipoprotein A So always keep that in mind.

00:13:23: It multiplies overall.

00:13:26: Then as we already mentioned, aortic valve stenosis is an issue.

00:13:30: And that's mainly important because it leads to a lot of consequences.

00:13:37: I said at the beginning if you have iotic valve stenoses If its narrowed Because of calcification and these valves can't open well anymore then The heart is strained.

00:13:49: When the heart is strained, it backs up.

00:13:51: In this case, the blood comes from the lungs.

00:13:53: so first it goes into the lungs gets oxygenated and is then pumped back out of the heart to the body.

00:14:01: That means that the heart gets overwhelmed first.

00:14:03: It also backs a bit more in the lungs And people who have aortic valve stenosis eventually have problems with fluid in their legs and so on.

00:14:19: Like.

00:14:19: we are all

00:14:20: things that you've probably seen before I'd say in everyday life right?

00:14:23: Yeah, i mean.

00:14:24: Most people know someone without knowing what the reason is but many elderly have problems with fluid and their legs And usually something like this behind it.

00:14:33: You don't really want any of them as a huge longevity pain point In old age.

00:14:39: With thrombosis That's also another topic Venus, like a classic thrombosis in the venous system.

00:14:47: In the legs for example deep vein thromboses which is why it's called that.

00:14:50: lipoprotein A isn't really responsible for that.

00:14:54: But when?

00:14:55: so when it comes to an event like that It's more about The arteries.

00:14:59: That means the arteries are always where the blood goes away from the heart?

00:15:04: In the veins it flows back to the heart.

00:15:06: That's the oxygen poor blood and Lipo protein A Is more likely to cause a problem in the arteries if a plaque actually ruptures there.

00:15:17: If a deposit breaks loose in the blood vessel, The blood vessels get smaller and smaller And at some point... ...the particle that broke loose is just too big and blocks this artery.

00:15:28: Then you have an infarction Wherever it may be.

00:15:31: You can have cerebral infarctions or heart attack But also renal infarctions.

00:15:36: So depending on where this clot gets washed.. ..you'll have a blockage.

00:15:43: What do we do with this info now?

00:15:46: Yeah, yeah Or rather how can you actually make this visible?

00:15:51: whether whether you even I mean It's not necessarily the case that if you have high LPA.

00:15:57: Okay But is it one hundred percent the case That you actually have plaques in your Coronary arteries for example?

00:16:04: well statistically speaking The chance is already huge because i mean we're both young will already have.

00:16:10: We also have low LPA, but we'll still have plaques already.

00:16:13: Right?

00:16:13: That's even been found in seventeen these

00:16:15: fatty streaks.

00:16:15: They're called exactly.

00:16:17: it could well be that we have them yes and now It could be so that increases the probability But it doesn't Guarantee it right?

00:16:28: that means So it's not a reason to panic immediately, but it's actually a reason To take a closer look.

00:16:33: And then you have various options that you can use.

00:16:36: And first of all, there are super simple things like measuring the carotid intermediate thickness.

00:16:41: So that's basically just you look at okay You do an ultrasound on the neck and see how thick is this vessel?

00:16:47: There Is their other maybe already deposits right.

00:16:50: so that's definitely an indication which is super easy to Do via ultrasound.

00:16:55: But Of course That doesn't tell you anything about your heart.

00:16:57: First of All Right It Just Says Okay Maybe There'S Already Something There.

00:17:01: Then it's More Likely That There'S Also something in The Heart.

00:17:04: So if you want to look closely at the heart, there are two different options.

00:17:07: There's the CAC which is basically the calcium score, coronary artery-calcium score.

00:17:13: What actually happens there?

00:17:15: You do a simple low dose CT and just measure the amount of calcium de facto that's around the heart.

00:17:26: And the more there is, the worse because calcium deposits in the plaques but only in the plagues that are already relatively I'd say mature.

00:17:36: So if you have very early soft plaques then calcium hasn't really deposited yet and they won't be made visible there.

00:17:44: That means actually make plaques in later stages visible with this.

00:17:49: But it's already a good first step.

00:17:50: It's not that expensive, I think its around one hundred fifty euros if you get it and sometimes bit difficult to get in Germany.

00:17:56: Its'in the range where your already know.

00:17:57: okay do i have plaques meaning mature plaques could cause me problems or Do I Not Have Them Yet right?

00:18:06: If u wanna look even more closely And this is actually something That Is Sometimes Even Covered In Germany If You Have Risk Factors Like That Is A Coronary Is Basically Just An Angiography So A Coroner Angiography Of The Heart It's also via CT.

00:18:21: You need a bit more radiation dose, you also need contrast medium which is administered through the vein and with that you can see various plaques... ...you could really almost build kind of a three-D model at heart And it actually looks very impressive!

00:18:37: There are narrowings there are none.. ..you get clear picture but I think your looking like five hundred euros if u don't get covered.

00:18:46: But as I said, since this year it's partially covered if you have risk factors.

00:18:50: Whether LPI is enough for that we'd ask a cardiologist If they've managed to do so often or regularly.

00:18:57: In any case Risk factors are definitely enough Or symptoms anyway That's obvious.

00:19:01: So symptoms but don't want let them get too far Exactly!

00:19:07: You have these two options.

00:19:08: with CT This coronary angiography is much more accurate.

00:19:13: If just wanna basic overview This calcium score is also enough to just see, okay.

00:19:18: Do I already have a huge risk?

00:19:19: Right because that's actually what you want to know.

00:19:21: are there already A lot of plaques in my heart and my coronary arteries That could cause me trouble And lead To me suddenly lying In the hospital with a heart attack in a few months?

00:19:30: You really Want to avoid that at all costs and it's Really not that uncommon for people in their forties to Already Have something right especially With lpr.

00:19:39: It can still be that they don't notice anything until They're seventy but Things can also go badly and you get hit earlier.

00:19:47: And we know that you can reduce plaques, optimize them.

00:19:50: You can theoretically insert stents.

00:19:53: That means a lot to take precautions so nothing happens.

00:19:59: I'm a big fan of doing something like this.

00:20:01: if there are risk factors just on the safe side It doesn't necessarily have to be in your twenties.

00:20:11: You would defend a lot of amazing aliashile commands, instruments of happiness and you could mark them in the label from the baseline.

00:20:16: Don't I wish there was a prefix here?

00:20:18: Also we did it in critical print form in my netcom system after these earlier turns.

00:20:25: Mario!

00:20:42: Very high quality controls, high transparency with raw materials and innovative formulations all developed by doctors.

00:20:50: Can you think of anything else?

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00:20:52: if want to learn more why don't check out molecular.com?

00:20:58: In the end it's also always a certain risk-benefit assessment especially when dealing with radiation exposure.

00:21:06: That's why you'd probably start with a carotid intima media thickness.

00:21:10: So this classic ultrasound of the carotide artery here, where you then look at how thick the two innermost vessel layers are together.

00:21:19: The media is always the muscle.

00:21:20: every vessel has a bit of muscle and the Intima is very inner layer which blood ultimately has contact With.

00:21:26: that is cheap it quick to do And don't have any radiation exposure At all!

00:21:35: maybe especially at a young age.

00:21:38: And then it goes on to the calcium score, which isn't as widely available because you don't need contrast media yet and it's a bit less radiation exposure... ...and really expensive or in quotation marks really invasive is when you do the coronary CT When You Need Contrast Media?

00:21:55: When You Have Higher Radiation Exposure?

00:21:57: So On & so forth!

00:21:59: In the end there also your trusted doctor.

00:22:03: for that

00:22:04: You're a trusted cardiologist.

00:22:05: Cardiologist, exactly.

00:22:07: who then ultimately says yeah in your case this makes sense now or it doesn't make sense.

00:22:14: if you have a lipoprotein of thirty and you are twenty three probably nobody is going to recommend the coronary CT I hope at least because that's probably overkill right?

00:22:25: Then rather wanted yourself Right!

00:22:27: I think its probably over kill unless you really crazy high values.

00:22:31: I

00:22:32: was just going to say if you have very high values, very high family risk then that might also become an issue for public health insurance.

00:22:41: But otherwise no insurance in the world is going to cover that in the end.

00:22:46: Yeah private insurance of anything right?

00:22:48: Exactly yeah.

00:22:49: So in that respect yes That's so-to speak a look into the heart.

00:22:53: first You do a blood draw Then you look at how does it look with my LPA?

00:22:58: How Does It Look With My Other Blood Lipid Values?

00:23:01: And then you can venture this.

00:23:03: look into the heart if you actually have a reason to.

00:23:06: So high, they call it pretest probability but in the end It's just a high risk.

00:23:14: Now You've done all that and you Have A High LPI and You've Done A Calcium Score.

00:23:18: Let's Say That Also Didn't Look so Good.

00:23:21: What Do I do Then?

00:23:23: What Do i Do Than Right?

00:23:24: In That Case Not That Easy At All

00:23:27: But also not that Rare.

00:23:31: And then you have to say, okay.

00:23:33: You are definitely a risk patient To some extent right?

00:23:36: So you should really take things seriously and also go in a bit harder.

00:23:40: so you Should really aggressively lower LDL or apo B. That's also something where you don't need high levels of it.

00:23:47: Right?

00:23:48: that means you can uh...you Can lower very aggressively with various medications be its statins beat Be at fat binders so cholesterol binders like as a timi bee Uh..and so on.

00:23:59: There are various options.

00:24:00: You have to discuss that individually with your doctor, also see what you respond to and tolerate.

00:24:04: well but the gist is lowered

00:24:06: aggressively.".

00:24:08: That was also the statement back then from Brian Kennedy in Dubai.

00:24:12: he presented this study where they compared two groups.

00:24:16: one group actually healthy so had blood lipid values within range.

00:24:22: The other group were too high And in the end, the treated group had better outcome.

00:24:31: The actually sick but treated group have a better outcome than they're healthy groups.

00:24:36: That's again the problem of optimal and normal.

00:24:41: Normal is an LDL value such-and-such But Optimal is probably significantly lower.

00:24:47: Yeah you are sometimes still normal.

00:24:49: with over one hundred I would already say okay i don't want to be there

00:24:52: Probably like one hundred twenty five exactly.

00:24:54: If I remember correctly, on my last blood test it was normal.

00:24:57: But so with a hundred twenty four everything is fine.

00:25:00: probably not Everything's fine.

00:25:02: no So personally i would do something about that right exactly?

00:25:05: I

00:25:05: also want to go a bit lower

00:25:07: Exactly!

00:25:08: So definitely lowered aggressively.

00:25:10: That will have very weak effect on LP Lp little A but strong one on LDL.

00:25:16: You'll also the possibility of going deeper and say you're for PCSK-Nine inhibitors.

00:25:23: That's a bit of a newer class,

00:25:25: very expensive.

00:25:27: Exactly!

00:25:27: A bit more expensive definitely but... ...a newer class of drugs.

00:25:31: Interestingly the reduction in LPA towards thirty percent already works there.

00:25:35: But whether that actually has benefit we don't really know for sure right to be honest?

00:25:39: Whether it is even enough They are just very convenient because you inject sometimes I think once-a-week.

00:25:46: so super convenient.

00:25:49: they're well tolerated compared to statins again.

00:25:52: So again, significantly better tolerated.

00:25:54: Um so also another option that you could definitely look into but which in the end The doctor has to recommend and say okay In your case this makes sense because if You're doing well with statins Why should you mess?

00:26:07: With a running system And before we know whether PCSK nine inhibitors really have A real benefit for LPA as Well It's probably just thrown away money.

00:26:18: That is why it was super important which might seem a bit paradoxical, that you have high LPA and take medications who don't even lower the higher LPA.

00:26:26: But it's about this general risk reduction because... It is actually an independent risk factor.

00:26:33: As we already said in the end all gets multiplied together Your lifestyle plus your LDL plus your LPA.

00:26:39: And if you manage to make one value of this multiplication smaller The end result also smaller or the risk is lower, and that's what you're trying to achieve with it.

00:26:51: So as you already said statins are great.

00:26:54: PCSK nine is new expensive but also very potent.

00:27:01: But in the end I think only well its approved for LDL lowering.

00:27:07: theoretically also has primary LDL a PCSK nine inhibitor prescribed right away, but rather only if there's some kind of tolerability issue with statins.

00:27:22: Exactly exactly.

00:27:23: I think that at least the second

00:27:25: or third line

00:27:26: If money is no object then it might be different Right?

00:27:29: But um...exactly

00:27:31: yeah otherwise Yeah There's also benpedoic acid.

00:27:34: i actually hadn't heard of That very often before.

00:27:37: uh It's Also A class Of medication like so similar to Statins pcsk Nine Inhibitors.

00:27:43: Um its also Also approved to be given directly, but in practice it's often only prescribed when there are issues with statin tolerability Exactly.

00:27:52: Yeah what was also interesting?

00:27:54: We also looked up niacin.

00:27:55: It actually does lower LP LPA But in the studies where it was looked at they couldn't see any significant benefit.

00:28:01: At least that means yes, it was lowered, but it didn't really have a well In terms of survival probability or the probability of a cardiac event occurring.

00:28:13: Plus, you have the flushing side effects in higher doses.

00:28:19: So in the end that's probably why it is just not recommended because there are more suitable medications for it and apart from these standard medications we've already discussed For very high LPA values You can also do aphoresis

00:28:38: Exactly!

00:28:39: Basically try to filter out.

00:28:41: It actually isn't bad idea.

00:28:43: I think a lot of people do it in practice too, but of course.

00:28:47: It's something that is definitely not covered let's be honest.

00:28:50: So from my perspective at least i can't imagine it at all.

00:28:54: But maybe there are also special cases where?

00:28:56: That Is the case.

00:28:58: you have to shell out quite A bit yourself and i mean really Quite a Bit but The idea is okay.

00:29:05: You filter it Out And Then Make sure that over A certain period Of Time you first Have A phase Where you have Really low Levels and Really Physiologically Low Levels with few side effects without having to constantly take something.

00:29:18: Makes sense, to me?

00:29:20: You can do that!

00:29:22: It's definitely also something I would probably do now and then if i had a problem and were much older or more advanced... ...I might think about it then If the cash to spare.

00:29:33: But its not something that makes sense as first line.

00:29:36: Yeah And otherwise let us stay for these drug therapies.

00:29:42: There is actually a specific LPA therapy in development right now several of them.

00:29:48: In fact,

00:29:49: yeah Yeah

00:29:50: They are partly based on RNA technology where they develop special molecules That then target this lpa bind the lpa and make it quote-unquote harmless.

00:30:03: I think the one

00:30:05: Yeah

00:30:06: that Is closest to approval as far as i know is Pella Carson?

00:30:09: That's supposed To come to Germany As early as next year.

00:30:12: from what I've seen It has already received approval and the European Medical Regulatory Agency or medical agency is actually called the EMA.

00:30:23: They are currently reviewing it, I think.

00:30:25: And yeah then they'll decide in the end whether it gets approved or not.

00:30:29: But it also very often follows the FDA classification That will probably happen so that's pretty much bound to come anyway.

00:30:36: There are a few others A fewer ones Which are based on this RNA platform.

00:30:43: They achieve a massive reduction, so they eliminate up to ninety five percent of the LPA.

00:30:49: It's also usually an injection therapy similar to PCSK nine inhibitors once a quarter wants every six months.

00:30:58: So in terms of use actually very practical.

00:31:01: um...they have this depot effect and yeah In the end we have see what comes out these large trials What outcomes look like.

00:31:10: because it could be that you lower And in the end, but still

00:31:17: pretty good for some reason that nobody understands right?

00:31:20: Like with niacin.

00:31:21: In the end where you'd think okay a bit lower should somehow be better and Thirty percent is not that little either.

00:31:26: I mean twenty thirty percent reduction.

00:31:28: That's really not Not Little For no impact actually something super cheap Right.

00:31:33: so

00:31:33: yeah Yeah would definitely very cheap

00:31:35: Very easy to get.

00:31:38: So yeah Actually ashamed.

00:31:39: But oh well

00:31:42: If, if it at least also brings a benefit for this valve calcification.

00:31:46: It probably also depends on how long you've had this high LP Klein R. they'll probably also be a dose effect?

00:31:53: If you've headed hi four twenty thirty forty years maybe the Calcification is already so far advanced that its not immediately noticeable.

00:32:01: but little bit of calcifications still happens anyway right.

00:32:04: So Also quite

00:32:05: quiet I mean especially if their soft They can At Least Be Reversed Better.

00:32:09: So better Better Broken Down Again Right If they're hard, that's obviously much tougher.

00:32:15: The probability is high that after a few decades it's already calcified.

00:32:21: but yeah those would theoretically be the drug options.

00:32:24: you have either act quite classically on this LDL issue.

00:32:29: there are many drugs.

00:32:30: work is now also being done on having special drugs

00:32:34: Yes exactly

00:32:35: coming very soon.

00:32:36: like I said i read That will already Be the case next year.

00:32:39: so Yeah let's see what else.

00:32:43: But now lifestyle is actually also very, very relevant because we said earlier in the equation.

00:32:48: In the end it's LDL.

00:32:49: you have LP Klinah but also blood pressure and smoking which still feed very heavily into this equation.

00:32:56: If you can eliminate that then You've already made a big contribution to being symptom free I

00:33:05: think so too And above all To an early Unpleasantly quick death.

00:33:12: Yes, exactly and that's where the very classic principles apply again right?

00:33:16: You shouldn't smoke at all.

00:33:17: you should make sure you maintain a normal blood pressure.

00:33:21: And so if that can be achieved with lifestyle measures then Sometimes it's also a very very sensible consideration to resort to medication Also regardless of age.

00:33:32: yeah I think you have to be honest with yourself there too

00:33:34: bad and Exactly!

00:33:37: You should maybe get a blood pressure monitor.

00:33:42: You don't have to buy one, but you can borrow one.

00:33:44: most grandparents Have won by now and then you do that for a week two three times a day.

00:33:50: Then you get an overview Calculate on average And everything is probably fine or not?

00:33:56: That's also important information.

00:34:00: It's just not good if you dont' have this information.

00:34:02: So If u have no assessment at all and think Yeah But Everything Is Fine With My Blood Pressure Anyway Because U Can Have High Blood Pressures At Thirty Not Just At Sixty.

00:34:11: Otherwise, yeah.

00:34:12: You should exercise you should eat healthily Uh, you should watch your weight.

00:34:16: what's your sleep?

00:34:17: What's your stress management?

00:34:18: I think that's all Not um particularly new or even complex.

00:34:24: That applies to lpr but it also applies to blood sugar and It also applies too All other metabolic pathways.

00:34:30: you can make a big contribution with your lifestyle Yes But the LPR won't change much because of that.

00:34:38: having such a cardiac event in the future will change.

00:34:42: And that is already worth very, very

00:34:44: lot.".

00:34:45: Yes!

00:34:47: Now I'm sitting at home and i've listened to this episode.

00:34:50: what should take away from it now?

00:34:52: Yeah exactly so first of all you have to measure it.

00:34:54: So if haven't measured yet get on it.

00:34:56: Get it measured right way.

00:34:57: It's not expensive.

00:35:00: Everyone just has it on their radar.

00:35:02: Just how it is The probability is At least one-in-ten.

00:35:06: That its case for you.

00:35:10: Yeah, just measure it first.

00:35:12: Also ask around in the family does anyone of you have high LPA?

00:35:16: If everyone says I don't know then please take Everyone to the doctor right away and have a determined.

00:35:22: And if they say okay Yes It's High Then The Probability is unfortunately also very high that its also Elevated for You Exactly.

00:35:30: Unfortunately Its Inherited Very Dominantly.

00:35:32: That'S A Bit Of The Issue.

00:35:33: But Well ITS NOT LIKE A DEATH SENTENCE EITHER.

00:35:35: THAT ALSO NEEDS TO BE SAID.

00:35:37: I MEAN WE JUST SAID

00:35:37: NO NOT AT ALL.

00:35:38: IN THE END IT'S ABOUT

00:35:39: KNOWING.

00:35:41: you can work against it so well that makes no difference at all, and in the end exactly what is important.

00:35:46: That's why measure as early as possible?

00:35:48: Yes!

00:35:49: Exactly.

00:35:49: And if turns out we then have various options.

00:35:52: We've actually already talked a very lot about elevated level.

00:35:55: What do u do then?

00:35:57: First of all maybe if the levels are low Then first there's nothing further to do.

00:36:02: You don't have any separately elevated probability.

00:36:07: Yeah, you calcify coronary arteries.

00:36:09: The coronary artery is calcified or you get strokes at least not from that right?

00:36:14: As long as your LDL which might also measure every now and then... ...as long as it's in normal ranges.

00:36:20: You don't need to do much more.

00:36:21: there can stay super non-invasive There.

00:36:24: the topic only becomes interesting if actually have an elevated level.

00:36:30: we just said okay go To a doctor talk them really intensively about.

00:36:35: Ideally a cardiologist who also deals with the topic Who?

00:36:39: Also says that it makes sense to intervene early Because that's just how the study situation is right now.

00:36:46: That's just the truth.

00:36:47: That means you go in aggressively.

00:36:49: You lower Apple B and LDL, we can do that with various medications.

00:36:52: We've already listed a few.

00:36:55: We're definitely not prescribing anything here.

00:36:58: And then the question is okay if the overall risk profile doesn't look so good you should definitely also go in the direction of a CT, have a calcium score calculated or maybe do this coronary angiography just to get clarity about how hard I really need it now.

00:37:16: What else can I additionally do?

00:37:18: Maybe reverse plaque formation so that is something we could achieve today.

00:37:28: uh, lowering through statins.

00:37:32: You should then also use that exactly.

00:37:35: and then yeah what many also frequently add is an aspirin.

00:37:39: if you bring a very high risk um And If That Also Fits The Patient Well Because It Also Increases The Bleeding Risk.

00:37:47: So Aspirin Can Also Be Useful There But Would Probably Be Somewhat Unnecessary.

00:37:51: For The Basic Therapy Yeah

00:37:52: And Above All You Don't Take the Classic Aspirine That You Take for Headaches but It's a lower dose, and if you've already had a heart attack then most people know that you take it permanently.

00:38:04: That is called secondary prevention right?

00:38:06: And as primary prevention its actually not done THAT often!

00:38:10: So If You Haven't Had An Event Yet... ...it Is Quite Rare & Now Also Very Outdated.

00:38:17: To Start With Aspirin Anyway Because In These Very Large Studies They Didn't Really Find Any Survival Benefit Then Maybe Its Just Not Worth The Bleeding Risk.

00:38:27: It is outdated.

00:38:27: Exactly, especially in older people then exactly yeah Yeah and like Mari already said absolutely of course Especially if it occurs in yourself urgently measure the parents And so on as well.

00:38:36: If they don't know anything about it um...It just changes The individual risk profile enormously uh..And that's why you should have taken care Of it once.

00:38:46: Um....it's not a drastic point In your own life but it Just means okay You Have to pay more attention To it and if necessary Take one mini pill More A day Right?

00:38:56: And I'd rather know that and be able to do something about it than grope in the dark.

00:39:23: And that's why measure and take the family with you to measure, check how things look there.

00:39:31: Exactly!

00:39:32: Lower it massively.

00:39:34: Even if you can't lower the LP much yet You CAN lower the risk.

00:39:36: That is actually a crucial thing Yeah...that' s why measure.

00:39:40: Take your family with me To measure and check how everything looks There.

00:39:43: Lower it massivly.

00:39:45: It´s like riding a bike without a helmet If u don't know right?

00:39:49: So its also such an unnecessary reason to die.

00:39:52: Thats true.

00:39:53: Well ok fits Um, yeah.

00:39:56: And then I mean very high we've also already said right?

00:39:57: So if it's naturally enormously high than It's a very likely that you genetically have familial hypercholesterolemia.

00:40:03: That's not common But you should have it on your radar.

00:40:06: and then of course the individual risk profile is shifted completely completely differently.

00:40:09: but really every medical professional who sees that once knows that.

00:40:13: um i wouldn't worry about.

00:40:14: that means just measuring.

00:40:15: it Is definitely The first step.

00:40:17: Yeah, I think the message has arrived should measure, so absolutely make an appointment right away and see how things look for yourself.

00:40:26: Otherwise yeah we've actually discussed everything.

00:40:28: uh we set out to do for today.

00:40:31: if there are any questions from your side then feel free to get in touch at podcastatbeyondlifespan.de or on Spotify Apple Podcast YouTube just comment!

00:40:38: We look at all of that don't forget to subscribe to the Beyond Lifespan newsletter.

00:40:42: you can find the link.

00:40:43: I had a lot of

00:40:52: fun.