Lipoprotein(a) in atrial fibrillation

[Carew]

The other day I fell across a paper:

The role of lipoprotein(a) in atrial fibrillation: a systematic review.

europepmc.org/article/MED/3...

Within that paper, I specifically noticed in their reference 28:

Conclusion

Low circulating Lp(a) levels were associated with AF, especially in the female Han population, suggesting that Lp(a) may be useful for risk stratification of AF in female individuals.

Jiang L, Yang X, Tao J, Qiu Q, Gao F, Chen W, Hu L, Xu Y, Yi Y. Low lipoprotein(a) concentration is associated with higher atrial fibrillation risk: A large retrospective cohort study. Research Square; 2022. doi: 10.21203/rs.3.rs-1692867/v1. PPR:PPR498747.

europepmc.org/article/MED/3...

I ignored the "female" and "Han" aspects. And just considered my own lipid results:

Apolipoprotein A1 (1.04 - 2.02) 1.32 g/L

Apolipoprotein B (0.66 - 1.33) 0.71 g/L

Cholesterol General: (0 - 5.0) 3.57 mmol/L

HDL (1 - 10) 1 mmol/L

LDL (<3) 1.9 mmol/L

Lipoprotein (a) < General: <75 7 nmol/L

Triglycerides (Fasting triglyceride (10-14 hours) should be below 1.7mmol/L.) 1.5 mmol/L

I have long had 100% permanent afib.

Comments? Thoughts?

[Cliff_G]

Well, my Lp(a) is monster high, 205 mg/dl ("of concern" level is above 30), and was only found 2 years after my aortic dissection and 25 years after I first started AF. Mine is probably familial.

So I don't know how my personal n=1 study fits with their data...

Normally, high Lp(a) is associated with cardiovascular risk. Mine almost certainly led to my aortic penetrating atherosclerotic ulcer which probably inititated my dissection.

[Cliff_G in reply to Cliff_G]

p.s., the first study you linked says "Mendelian randomization studies advocate a causal association between high Lp(a) and AF" and that studies are conflicting. One I'd put in the deeper recesses of my brain in case something pops up later. But there is also no current treatment for high Lp(a).

[Carew in reply to Cliff_G]

Yes - it does!

205 is an even higher high than 7 is a low low. IYSWM.

I've actually had a reply from the author of the first paper confirming my interpretation - that low LP(a) was seen as a factor in that one paper.

With my lipid results - which have been in the same general direction forever - I get absolutely frustrated that it is so difficult to even search for low Lp(a), low total cholesterol, low LDL, etc!

And, if cholesterol is low, what would be the advantage in having a high HDL to return the non-existent cholesterol to the liver?

[Autumn_Leaves]

As someone with naturally low cholesterol, I get your frustration with the lack of information about low cholesterol. I am so weary of all these gloom-and-doom scare mongerers who don’t seem to realise that people with naturally low cholesterol actually exist! They all seem to love to post some graph that “proves” that if you have low cholesterol you are doomed and death is imminent! It drives me round the bend. I blame my parents for my low cholesterol (and my hereditary high iron levels, haha). It’s not down to anything I’ve done. Otherwise I’m the consummate goody-goody. Of course.

[Ppiman]

My feelings are that heritable health conditions, diet, exercise, weight (as well as, drinking, drug use and smoking) over life and especially adult life are likely to be better predictors of inflammatory conditions, such as AF and a whole range of others, rather than specific tests - especially if taken later in life.

Body fat (i.e. lipids, lipoproteins, etc.), especially that which becomes vascular and grows around major organs, seems to be a feature of age, genetics and lifestyle, as well as of inflammation and ill health.

Inflammation, per se, is a kind of tilt in the balance of natural processes, not an illness in itself. The illnesses it “causes” result from the imbalance (and age).

Overall, I have come to believe that we need to keep our children active, slim and away from toxins.

Steve

[Carew in reply to Ppiman]

I've had low cholesterol for as far back as it has been tested. (Afraid I can't remember how long ago my first test. I'd guess at least thirty years.)

Along with that, I have had dry skin - spent much of my life feeling that hand-cream is an absolute essential.

But I have plenty of excess body fat!

[Ppiman in reply to Carew]

I think AF is likely from genetic pre-disposition in the main. But, we should be fitter and slimmer throughout our life - and be born with healthy genes! I can’t think other than that.

More than anything, we should raise fit and slim children.

Steve

[Autumn_Leaves in reply to Carew]

My serum cholesterol levels have always been low, but my skin has been oily, becoming drier post menopause so I’d put that down to hormone levels. Your gut microbiome plays a role in skin health too although I don’t think much is known about it. There’s also the skin biome and probably the worst thing for it is too harsh skincare regimes which disrupt the balance of microbes. Definitely use moisturiser if your skin needs it. Central heating has a terrible drying effect.

As for the body fat, I’m a lifelong skinny type but I’d say that’s a combination of genetics and dietary preferences. I don’t ever think the low cholesterol even comes into it. It seems there are no known health risks associated with having naturally low cholesterol. The number of years of exposure to high LDL appears to be a significant factor in CVD risk, but at the same time it doesn’t give us a free pass to stuff ourselves with unhealthy food!

[Autumn_Leaves in reply to Ppiman]

I know it’s a cliche but when I was a kid, overweight kids were very unusual. There was more playing outdoors, more street games and playground games at school. Within 10 years or so all those games had mostly disappeared. I can’t really figure out how that shift happened. I’m talking about the difference between the 70s and the 80s, not some pre-war fictional idyll. We were pretty much expected to get ourselves to school and home again. The phenomenon of “the school run” didn’t exist. I’m not one of these “on my day it was better” types but there are certainly changes that have occurred. There were no computer games but there were many adults at the time thinking that children were watching too much TV and concern about what kids were watching, and all of that. Even the Clangers was criticised for fear of little kids not learning to speak properly! But certainly big differences in play, and also the sheer amount of fast food and takeaway shops that didn’t exist. On the other hand we have access to a lot more healthier foods now too, but the cost of the healthy options has risen disproportionate to the cost of the less healthy options, so that’s another factor. The net effect on the population hasn’t been positive.

[Ppiman]

My original reply seems to have floated away onto cyberspace. All you say makes complete sense. I suspect overall we simply eat more and more frequently these days, and eat foods processed to make them moreish. Sadly many parents feed their children so much that childhood obesity is now a towering issue that bodes badly for those kids' futures.

It's all so sad.

Steve