Take Control of Your Heart Health

[sos007]

I live in Canada and like most of the contributors to this forum who are in the U.K. we belong to a universal health care system. Our health care costs are paid through our burdensome tax system. As a result, people don't fully understand how much it costs to visit a doctor, have a blood test or to cover an Emergency Room visit. When there is no cost attached to a product or service, demand for that product or service approaches infinity. The result is bureaucratic rationalizing of services and long wait times.

Based on the comments in this forum it appears that the government-covered blood tests for cholesterol screening are being rationed and use 20 year-old standards. Total cholesterol has very limited value in assessing cardiac risk. Non-HDL has limited value as well, as do measures of LDL-C, which are calculated and not directly measured.

The most accurate measure of atherogenic lipids is the LDL-P (particle number). The blood test for this measure is not covered here in Canada and it appears it isn't covered in the U.K. either. This test (VAP) is also difficult to find.

The ApoB measure though is an excellent proxy for the LDL-P value. I believe this test is more widely available.

Some people on this forum have indicated they aren't prepared to spend the money if the government doesn't cover the cost. Does that make any sense? People routinely spend hundreds of pounds annually on mobile phones and other entertainment items, yet won't pay for a blood test that may help save their lives.

The PLAC test a.k.a. LP-PLA2 is a test that measures the amount of vulnerable plaque in your arteries that is subject to rupture. It is this unstable plaque in the arteries that causes heart attacks and stroke, not narrowed arteries (although they contribute to the process). Read the link below:

lifeextension.com/Magazine/...

Between the PLAC test and the measures of atherogenic particles via the Apo B test and the cardio-protective measure of ApoA-1, you can get a more complete picture of the state of your cardiac health.

Other useful tests include Fibrinogen (blood clotting protein) and Homocysteine (amino acid that can damage arterial walls).

Tests may cost some money, but what is more important than your health and your life?

[sandybrown]

There is WHO, then UK public health, the NHS. GPs have follow their guide lines.

What is in the system and the new research information available to us because of new technology the GPs are unable to respond!!!!

What do we do, wait till the cows come home?

[sos007 Ambassador in reply to sandybrown]

Consider using private test labs to get your more comprehensive blood tests. Interpreting the results is simple - the information is available on the internet.

[Bazza1234]

Agree with you - I have always wondered why people insist that their medical costs ( of living) should be free - while they are perfectly happy to pay through the nose to get their toilets unblocked.

Back to the subject though- let us say that a person was to get an LP-PLA2 test done . And let us say that it reveals a level which places them in the "high risk" category. I have already had a test which showed similar things - calcium score test revealed high risk - calcium hardened plaque is commonly associated with much greater amount of unstable plaque ( as found in autopsies) --- so the question then becomes - WHAT NEXT???? There are only 3 answers to that question - improved diet, exercise, drugs - or a combination of all three.

[Bazza1234 in reply to Bazza1234]

In fact, this article goes on to say that statins should be used to bring down LDL to 100 or 70mg/dL ( 2.5- less than 2.0 mmol/l) - this is exactly what my Doctor is doing as a result of my high calcium score test.

[sos007 Ambassador in reply to Bazza1234]

LDL-C may not be the optimal treatment target as it is not entirely comprised of atherogenic particles. This is what I was referring to when I said doctors are using 20-year old standards. Have your Apo B and ApoA-1 measured as well.

[DakCB-UK in reply to Bazza1234]

Well, there's two aspects of why people don't think they should pay for medical tests: firstly, ideological - is it supporting the idea that the rich should be able to buy better medical care? And secondly, pragmatic - does the refusal of the NHS to fund a test mean that it's generally a waste of money?

[sos007 Ambassador in reply to DakCB-UK]

The world is not divided into rich and poor, especially in advanced countries such as the U.K. Although there are some rich and some poor and you can debate the percentages, the vast majority of people are somewhere in between. Therefore, more than the rich can afford to pay for medical tests. Are you saying that those who can afford to do so should not be given the freedom of choice; that if the poorest people in society cannot afford a test, nobody else should be allowed to on ideological grounds?

Well, there are a few countries remaining who still subscribe to that ideology among them - Cuba, North Korea and Venezuela.

Bureaucratic rationing of public resources such as taxpayer-funded health care doesn't necessarily mean a test that isn't covered isn't worthwhile, it just means they cannot afford everything so government makes the choices on behalf of everyone. Individuals should make their own choices in life about what is affordable and what isn't, not the government.

[sandybrown in reply to sos007]

I am not sure on the first line. Rich & poor, North and south, and many more!

[DakCB-UK in reply to sos007]

Please don't twist my words. Of course I'm not saying "that if the poorest people in society cannot afford a test, nobody else should be allowed to on ideological grounds" - I'm saying that the state should pay for worthwhile tests. If the test is worthwhile but currently unaffordable, then we need nobody to buy it in order to reduce demand for that test and the price will drop.

I think it's frankly insulting to all the medics and patients giving their time to national public health decisions to deride their work as "bureaucratic rationing". It's very trite to say "Individuals should make their own choices" but it's a massive duplication of effort for every individual to evaluate every possible procedure, some people simply aren't going to have enough time to evaluate everything in sufficient depth, and it clearly should be better for us to work together, cooperate and trust each other to some degree on these evaluations and decisions, shouldn't it?

[sylvc54]

Thanks for your detailed reply. I have already booked to have the PLAC test privately together with a full bloods test and health screen not provided by our NHS.

I will now look at the other tests you have suggested and see if they are available in UK.

I appreciate your advice and agree that without your health you have no quality of life and it is so important to be proactive in your own healthcare.

[sandybrown in reply to sylvc54]

Would it be possible for you to give the cost of private blood test?

[Cassiejo]

I had a health check in April last year with 'bluecrest'. I bought it on Groupon virtually half price. But I paid £70 extra for the PLAC test. The full lipid profile didn't offer the Apo B or ApoA-1 that is mentioned previously. May of changed of course in the past year.

[sandybrown in reply to Cassiejo]

Thanks, reaching for Apo B and Apo A-1 blood testing and it is looking over £200.00.

I am sure when the time comes and if it is necessary GP can order this test.

[sos007 Ambassador in reply to sandybrown]

The GP won't order this test because they are focused on the standard LIPID PANEL which measures TC, TG, LDL-C, HDL-C, and NON-HDL. As noted in my post, individuals must take control of their heart health and not rely on the medical establishment which is using 20-year old science.

[DakCB-UK in reply to sos007]

My hospital consultant ordered me Apo* and LP* tests at my recent appointment, so it seems to be possible on the NHS. Blood was drawn immediately after the appointment and I await the results with interest.

[lynsreid in reply to Cassiejo]

I have been looking at the bluecrest plac test - what I wanted to check was would the results of this be accurate if you are already taking a statin? Did you find the results provided were easy to understand? I am basically wanting to get an indication of damage done to date as i have just been diagnosed with FH at age 41. I show no symptoms I am aware of for cardiovascular damage. I have been referred for a treadmill test but not convinced this will reveal anything if. I'm not symptomatic anyway.

[sos007 Ambassador in reply to lynsreid]

The PLAC test indicates the level of the enzyme lipoprotein phospholipase A2 (Lp-PLA2). The higher your level, the more vulnerable plaque that has accumulated in your arteries. The result should be < or =75 nmol/min/mL. If it is higher, then you have more vulnerable plaque than is optimal.

In order for the rupture to occur it requires a catalyst - that catalyst is 'inflammation'. Inflammation in the body is caused by excessive consumption of sugar and simple carbohydrates such as products made from refined white flour - bread, pizza dough, pasta; as well as white rice and white potatoes. Inflammation is also caused by a lack of exercise. You should be elevating your heart rate above 120 bpm for at least 30 minutes each day. This requires a brisk walk. If you are capable of cardiovascular activity beyond walking, then even better.

The fibrinogen test will tell you how sticky your blood platelets are, and therefore likely clot too easily.

It is blood clots and plaque ruptures that result in heart attacks and strokes, not plaque accumulation per se, although the more plaque accumulation you have the more likely a rupture or a clot can cause the blockage that triggers the heart attack and stroke.

The degree of accumulated plaque can also be measured indirectly through the MPO test (blood test) and the brachial artery responsiveness test (this is not a blood test and requires a special device called 'angiodefender'.

MPO is shows the level of oxidation in the blood stream. The higher the level, the more oxidized LDL-C that exists which is atherogenic (creates the plaque).

Once you have this information you will know how advanced your condition is. In either case, it means more exercise and a major reduction, if not elimination, of simple carbohydrates in your routine diet.

[Cassiejo in reply to lynsreid]

I found the results of the PLAC test with bluecrest very easy reading. The readings were different to sos007 low risk < = 151 med risk 152 - 194 high risk > = 195. I wouldn't have thought statins made a difference to results but to be honest don't know. Good luck there is a lot of well researched information on this site.

[lynsreid in reply to Cassiejo]

Thank you!!!

[sylvc54]

I too have booked with bluecrest. The health check is £179 and the PLAC test £70 but I was quoted £199 for both. Haven't checked out the other tests suggested yet

[sos007 Ambassador]

Very good point. From what I've read hypothyroidism it is often an issue related to post-menopausal women.

When getting blood tests, adding the thyroid tests makes sense.

[Bazza1234]

At the end of the day - what are these tests good for??? My calcium score test was good because it gives me a visual pic of the calcium hardening of my heart arteries - and the medicos know ( from post mortems) that the presence of hardened calcium in the heart is always accompanied by a much larger amount of soft unstable plaque. It is also good to have a test like these done because - high levels of cholesterol do not necessarily result in plaque and low levels of cholesterol do not necessarily guarantee that you won't have a heart attack - hence these visual pics tell you whether you need to reduce cholesterol or not. High cholesterol in the blood but with no sign of plaque buildup in an older person means you don't need to take statins. However , you may have low cholesterol readings - but have plaque buildup. Then you will have to take statins regardless of your low cholesterol readings.

My question really is - AFTER having these kind of tests ( whether they test for hardened calcium ALA calcium score test) or for soft unstable plaque ALA the PLAC test - what then????? These tests wil categorically show you/tell you what your heart condition is like - whereas simple lipid tests will not - BUT , IF you find that you have soft unstable plaque , what do you do then????? It is the soft unstable plaque that is the present danger - the hardened plaque "may" slowly kill you in time ( it cannot be reduced - once can only slow down it's progress) - but the soft plaque will kill you unexpectedly and suddenly and happens all the time to fit healthy people who suddenly drop dead!!!

[sos007 Ambassador in reply to Bazza1234]

You make valid points - I think the issue of 'what then' always relates back to lifestyle adjustments - diet and exercise.

Once again though, dietary cholesterol consumption may not be the villain in absolute terms but rather in relative terms. Animal fats are calorie dense so in our Western society, eating animal fats, daily, likely provides us with more calories than our daily activity requires.

As a runner, you know that exercise increases your nitric oxide production which is a vasodilator and therefore provides a wider lane of traffic for your blood flow. It also likely makes your vascular system more elastic so that plaque accumulation may not be as disastrous to you as for sedentary people. Spinach and arugula are the best vegetables for nitric oxide production, but other vegetables contribute positively as well.

Sugar and simple carbohydrates also are calorie dense and contribute to fat accumulation and to the process of inflammation.

Excess calories leads to fat accumulation throughout the body which also triggers an inflammatory response by the body which then results in plaque accumulation of both kinds.

Therefore knowing your risks and understanding how a balanced nutritious diet coupled with regular exercise, can improve your blood flow sufficiently to minimize the rupturing of the unstable plaques - is of great value. It basically tells you that you have to modify your lifestyle.

A balanced diet and regular exercise will also likely result in fat loss. If everybody weighed according to their bone structure, they would not bring on the many diseases caused by excess weight, including heart disease.

Even though I wasn't happy with my cardiologist initially putting me on statins, my determination to get off of them allowed me to learn much more about heart disease and statin drugs. More importantly the best thing he did for me is to tell me that my bypass surgery did not 'cure' my heart disease - I had to change my lifestyle. As a result of my lifestyle change, I'm off of all drugs, have my blood chemistry under control and feel better than ever.

I believe information generated by various tests provides more pieces, each with its own portion of the big picture for this large medical puzzle we call heart disease. Therefore, the more information we have, the better decisions we can make about our lifestyle and any medical treatment.

[Bazza1234 in reply to sos007]

But you never really commented on this part of your original link -- "Although Lp-PLA2 is not a primary target of therapy, the expert consensus panel7 recognizes that patients with high Lp-PLA2 have evidence of vascular inflammation and should therefore be treated more intensively with preventive therapy to lower risk of a cardiovascular event. The panel recommends that patients with high Lp-PLA2 levels be upgraded from moderate risk to high risk, or from high risk to very high risk. In these patients, a suitable goal is to lower LDL to 100 mg/dL in high-risk patients and to 70 mg/dL in very high-risk patients.7"

Hence why I raised the "what to do after" - exercise - yes!- change of diet - yes!!! - but also statins!!!!!

[sos007 Ambassador in reply to Bazza1234]

If you read the article in the link I provided,

texasheart.org/HIC/Topics/C...

the way to address vulnerable plaque is through a reduction in inflammation. PLAC measures how much vulnerable plaque you have but doesn't indicate whether or not it will actually rupture. Inflammation is the actual catalyst. Statins do in fact lower inflammation, but so does exercise and a diet low in sugar and simple carbohydrates.

In my own case, I've been measuring CRP on a regular basis for the last year and it is extremely low. This gives me a good base line from which to assess my risk. My first PLAC measure was Feb. 21st (10 days ago) and was 79 nmol/min/mL, which is slightly above the 75 nmol/min/mL cut-off point.

To determine how much risk I was facing, I did a search on PLAC studies. Not many to be found but what I did find was those at greatest risk had measures well over 100. At my level, I was in the lowest quintile in the study's risk stratification. Although I'm not satisfied with my PLAC result, knowing my CRP is very low, I don't think I need to over-react.

Given it was my first PLAC measure, I don't know if this is a substantial reduction from 6 months ago, a higher level, or a similar level. Without a baseline measure I cannot assess the merits of the measure other than knowing I need to get it lowered.

In my case, I don't think statins are necessary for their anti-inflammatory benefits given that I'm doing all else to reduce inflammation and have achieved a very low CRP (<0.3 mg/L).

As for getting LDL below 70 mg/dl (1.81 mmol/l), I'm not convinced that is necessary.

First it is based on studies of groups of high risk individuals who already have CVD in the form of a bypass (which I have had), heart attack (I have not had MI) or stroke (I have not had an IA). According to my cardiologist and GP, the lifestyle change I have undergone since my surgery makes me one in a million, I'm not the typical person evaluated in these group studies. The vast majority of people make very few lifestyle changes in the belief that the medications will protect them.

Secondly, I'm not convinced 'lower is better' in the whole discussion about LDL-C cholesterol. There is some discussion out there about excess suppression of cholesterol potentially increasing the risk of cancer. Nothing proven to date, but it makes sense since cholesterol is a necessary substance in the human body for repairing damaged cells.

I think the medical community is living in a box with blinkers on and will not consider anything outside the orthodoxy taught in medical school. When the only tool in your tool box is a hammer, every problem looks like a nail.

I don't wish to tell anybody else about statin use, but given my blood chemistry and my current lifestyle, I don't feel the need to use them.

[Bazza1234 in reply to sos007]

Please don't think I am "having a go at you" in any way --- and I believe that you are absolutely correct regarding the degree of change of lifestyle and exercise required ( my Doctor seems to enjoy my visits to him because he tells me that I am his only patient who has any kind of understanding of what he talks about . He also says I am his fittest healthiest heart patient!!

But the problem is that there is a LOT of contention in these matters - so personally I am a person who does not like to put his eggs all in one basket - so the answer for me personally covers the bases of exercise, diet, low dose statin and small aspirin. My biggest problem is that future calcium score tests will only tell me whether my calcification has stopped progressing or not. I don't have any definitive assessment of unstable plaque - so I will discuss this PLAC test with my Doctor next time I see him.

[sos007 Ambassador in reply to Bazza1234]

No offense taken Bazza. It is important that we are challenged in our views because it allows us to better understand our own intellectual process in arriving at decisions.

My cardiologist told me I'm the only patient he's had in the last 25 years that actually took his advice on lifestyle change. However he doesn't like the fact that I'm off the drugs because their recommendations are based on protocols from their medical association.

Here's why I like to challenge the medical establishment:

sites.middlebury.edu/smokin...

[Bazza1234 in reply to sos007]

- but they would not be the only ones to ignore their own advice I recently changed doctors - my old Doctor looked like he was about to die of exhaustion - I know the hours he works!!!!

[sos007 Ambassador in reply to Bazza1234]

One thing I neglected to mention previously, the need for testing is to track your progress. You can therefore determine how dietary or exercise modifications affect your health.

[sos007 Ambassador in reply to Bazza1234]

Bazza, I thought you might find this research piece interesting:

ncbi.nlm.nih.gov/pmc/articl...

[sos007 Ambassador in reply to Bazza1234]

You might find this of interest on vulnerable plaque:

texasheart.org/HIC/Topics/C...

[kasibarndoor in reply to Bazza1234]

The Lipitor advert says in the small print "in a large clinical study 1% of patients taking a sugar pill or placebo had a heart attack compared to 2% taking Lipitor" This small effect is unlikely to be related to its cholesterol lowering properties, otherwise there would be a reduction of deaths from CVD directly related to the number of statin prescriptions. Statins are treating 20 year out of date theory, the standard lipid profile blood test does not tells us a lot, it may tell us that we are eating too many carbs or that our tc/hdl ratio is too high >5 but that is about it, what we need to know is the particle size as it the small dense LDL that is the problem as it is not reabsorbed by the liver and remains in your blood stream to become oxidised or glycated.

[sandybrown in reply to kasibarndoor]

Glycated and oxidized protein degradation products are indicators of fasting and postprandial hyperglycemia in diabetes.

[kasibarndoor in reply to sandybrown]

If we have a high carb diet non Diabetics can also have glycated LDL, which the liver doesn't accept for recycling.

[sos007 Ambassador]

...I did say 'often' and not exclusively...

[sos007 Ambassador]

I hear you...one of the consequences of government-run healthcare...

[sos007 Ambassador]

Have you heard about Brazil Nuts and selenium?

mindbodygreen.com/0-10681/w...

organicfacts.net/health-ben...

No more than 2 per day. Eating more than that may cause toxicity and unpleasant side-effects.

[Cassiejo]

What an interesting 'civilised' debate! Not often seen these days.

[Ewig]

I think that's because the participants are informed. I've done as much reading as I can. It's been a journey from the Big Fat Suprise through many others to Cholesterol Clarity. I would struggle to articulate what I've learned. It's very complex (our bodies and their functioning is). I asked the doc for a breakdown of my ldl but was told they don't do that. I'm waiting for my HbA1C to think what to do next to get an idea of state of play with insulin resistance. My family have issues with high blood pressure and T2 diabetes. My lipid consultant told me my cholesterol was ' spectacularly high (total 11.6, ldl 8.6) but my tri/hdl ratio is low at 0.6. I've come off the statins because of the risk of diabetes and the lack of efficacy in women. I also understand that high cholesterol can be a protective factor in older women and in men too against other conditions. I was thinking about the calcium heart scan to see what damage is done already. I already low carb but still struggle with cravings for chocolate which I indulge in if I'm honest. It's been an interesting journey. I know no-one gets out alive but I enjoy life and I don't want to go spark out at any point soon! ☺

[sandybrown in reply to Ewig]

Hi, food and drinks intake control, watching out for free and hidden sugar, regular exercise can help towards a healthy life. There are free medical courses on future learn, given by universities to get undergraduates. At the moment there is a course on diabetic. I have followed many courses over the last three years and learned a lot.

The course content is from medically qualified people and I learned a lot from questions from others on the course.

When it comes to blood cholesterol and blood glucose, I have a lot of documentation saved from the courses. Channel 5 has a programme GP behind closed doors, another learning place for me.

[sos007 Ambassador]

The problem with the WHO and government in general is that they are large bureaucratic organizations. Large organizations have to consider the input of many different individuals and groups. The result is that decisions and conclusions take a very long time to be arrived at, and those conclusions tend to be influenced by vested interests. This is especially so in publicly funded organizations like government and supra-national organizations such as the WHO.

The sooner that individuals realize the limitations and flaws of government guidelines, the more quickly people can start searching for answers in other directions.

In the end, rather than delegating the responsibility of research to the government, individuals must accept that responsibility on their own if they expect to find the truth.

[ITYFIALMCTT]

Interesting Radio 4 programme a while ago discussed the PLAC test: bbc.co.uk/programmes/b04xp4x7

They seemed to agree that it's a valid test but that it probably doesn't add much more useful information to what is already known and the diet, lifestyle, and possibly medication decisions that people might wish to consider.

[sandybrown in reply to ITYFIALMCTT]

The later part of discussion is very interesting.

[DakCB-UK]

Oh come on. I've no idea what those tests are nor what the results mean, so how the heck am I going to request them?

It's been some time since I had a thyroid test and I've no idea where the results are. I'll dig back into my file when I get a round tuit. I did look them up at the time and they seemed unremarkable.

They are rerunning full lipid profile and liver function along with the LP and Apo tests - I guess they're now routine and fairly cheap, as I seem to have had those every time I can remember except one.

[DakCB-UK]

Does anyone else reading this discussion think that post contained useful information? It seemed to call me and others "totally idiotic", contain a sequence of cryptic letters/numbers, tell us to join yet another HealthUnlocked group (that is probably also infested with people brainlessly reposting Daily Fail and quack website links like this one is now) and basically implied that I should have asked for a repeat of another test without any reasons why. So yes, I responded with some exasperation!

[DakCB-UK]

I think you'll find people are here in an attempt to find USEFUL advice. Not to be ordered around without reason or explanation and called idiotic. We've had quite enough of that from poor doctors, thank you!

I don't think I posted any sarcasm but damn right I'm not grateful to be called an idiot by you again.

[DakCB-UK]

Rude possibly, but that's not sarcastic.

I still don't think you've provided reason why anyone should suspect their condition is a thyroid problem rather than a diagnosed liver problem, nor what those test results would signify. If you want an example of a helpful and useful post giving reasons, see the explanation of the Apo tests in the OP, or search for many of the posts from the user with something like sunhillow in their name.