If You Want to Know Your Risk of Cardi... - Cholesterol Support

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If You Want to Know Your Risk of Cardiovascular Disease (CVD) Stop Focusing on LDL-C, Instead Focus on Apo B & Apo A1 - the ApoB/ApoA1 Ratio

sos007
sos007Ambassador
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"LDL-C has been the primary focus in lipid-lowering trials for more than two decades. A vast number of studies, both in primary and secondary prevention, have shown that there is a close relationship between LDL-C and CV event rates, the lower the LDL-C, the lower is the risk [163-165]. In several of these trials also apoB, apoA-I and the apo-ratio have been measured. When explaining the relationship of each lipid fraction and each apo-fraction to CV event reduction virtually all lipids as well as apoB and apoA-I and the apo-ratio are significantly related to outcome. However, LDL-C is much weaker predictor than apoB and any lipid ratio. The best relationship with CV risk reduction is the apo-ratio."

Source: intechopen.com/books/lipopr...

"...The apo-ratio, as shown in this paper, has commonly been shown to predict CV risk equally well or, in fact, more commonly even significantly better than conventional lipids in both prospective and treatment studies. So, which cut levels and targets of the apo-ratio should be recommended in the clinic to indicate CV risk before and after treatment? Since there is an almost linear increase (semi-log scale) in risk with increasing values of the apo-ratio from both AMORIS and the INTERHEART studies (Figure 10) it is clear that at values of the apo-ratio> 0.90(values should be given in two decimals in order not to lose important information) there is a considerable increase in risk, whereas values from 0.70 to about 0.90 are indicative of a moderate risk. Values for men < 0.70 and for fertile females < 0.60 can be more normal especially if no other risk factors are present.

The “ideal-biologically normal values” are rather < 0.50 as also documented in lipid-lowering trials in which CV events have been successfully reduced [176,177]. So the target values during therapy must focus on these levels, the lower the apo-ratio the better is the therapy."

Source: ibid (Same as above)

"IN CONCLUSION

with all the new knowledge presented in this paper about the strong relations between apoB, apoA-I, and the apo-ratio, and CV risk as well as other disease manifestations, it is proposed, as many researchers have already done, that these strong risk predictors/factors/markers are included in new guidelines. In many disease conditions and manifestations of atherosclerosis apolipoproteins are at least equally informative, and often better than LDL-C, non-HDL-C and lipid ratios in predicting risk. It is realized that there will be pedagogical hurdles, but it should be possible to educate physicians, patients and health providers to understand that these apolipoproteins are markers of normal and abnormal cholesterol metabolism. The apo-ratio simply reflects the “balance between the bad cholesterols and the good cholesterols” technically measured by apolipoproteins.

The apo-ratio is a valid cardiovascular risk index (CRI) that reflects the level of CV risk for virtually all patients with different lipid phenotypes, the higher the value of the apo-ratio, the higher is the risk.

Finally, targeting lower values (about 0.50) of the apo-ratio during therapy may more correctly identify who is at risk or not at risk, and how high is the risk? Does the risk depend on the atherogenic apoB, or the anti-atherogenic apoA-I or rather on the most informative value i.e. the apo-ratio which summarizes the level of risk in a simple way?

Since physicians usually only manage to effectively evaluate and trust one laboratory marker, the apo-ratio is such a valid marker.

By simply plotting the value for a given patient on the risk line you can easily follow improvement during therapy and also motivate the patient to improve values to normal levels (Figure 10). New guidelines should at least contain equally objective information (cut-values and target values) on how to use apoB, apoA-I, and the apo-ratio as on lipids so that physicians can choose whichever diagnostic marker of risk they prefer.

Gradually this new apolipoprotein-based risk classification with a focus on the apoB/apoA-I ratio may, or rather should be, introduced in clinical practice."

Source: ibid

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As many of my followers know, in 2015, I had bypass surgery followed by 2 angioplasty procedures that resulted in the insertion of 4 stents, due to the failure of the bypass surgery.

Although I started on a regimen of pharmaceuticals for ongoing treatment following these procedures, I had bad side-effects from the statin drug - Crestor (Rosuvastatin). As a result I made major changes to my dietary habits and lifestyle so that I could address the cause of my CVD.

In October 2016, I took my last pharmaceutical medications and in the spring of 2019 I took my last baby aspirin. My blood biomarkers are all in the normal range with most in the 'optimal' range. My LDL-C is in the normal range at 2.99 mmol/l, which is higher than traditional secondary prevention standards would recommend, however, my ApoB/ApoA1 ratio is just 0.43 which is in the optimal range according to the conclusions reached by the study documented above. Furthermore, my LDL-P as measured through the NMR Lipoprofile test, is also in the optimal range at <1,000.

For these reasons, I resist suggestions from my cardiologist to restart statin therapy. I just had another echocardiogram a couple of weeks ago and it confirms that my heart is operating optimally with no evidence of damage.

I exercise daily including a regimen of 12,000 to 15,000 steps during the fall/winter and 15,000 to 25,000 steps during the spring summer. I go to the gym 5 days per week (year-round) and incorporate both HIIT Cardio (High Intensity Interval Training) as well as resistance training (weight lifting). I play ice hockey once or twice per week.

I follow the Mediterranean Diet with my core foods being:

- legumes, nuts, nut-butter, berries, apples, leafy green and cruciferous vegetables (broccoli, arugula, rapini, kale, dandelions, etc...); Limited consumption of animal protein - 3-4 days per week focused mostly on fish (salmon, trout, arctic char), and limited quantities of fermented dairy such as plain Greek yogurt, goat and sheep cheese, and aged cheeses such as Gouda. I limit alcohol to 3-4 glasses of red wine per week (no more than 5 oz per drink).

I am currently 57 years of age, male 5'10" with a 31" waist, and 155 lbs.

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sandybrown

Very interesting report.

Confused!

"LDL Cholesterol is calculated using the Friedewald Formula as

follows (all measurements are in millimoles per litre):"

"LDL cholesterol = Total cholesterol – HDL cholesterol –

(Total triglyceride ÷ 2.19)"

I read below information in this report.

"2.1. Methodological problems for various lipids

The most commonly used method world-wide to measure LDL-C is based on the Friedewald formula [16]. However, errors are common and the methodological problems and shortcomings are not commonly recognized but have been discussed in many papers [17-25]. Thus, the formula (LDL-C = TC – HDL-C – TG/5) is not valid for blood samples having triglycerides (TG)above 3.5-4 mmol/L, for patients with type III hyperlipoproteinemia "

My understanding is USA unites TG is divided by 5. UK units TG is divided by 2.19.

Any comments?

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sos007
sos007Ambassador
in reply to sandybrown

I would not be worried about the Friedewald Formula. Yes there's a difference due to units of measurement being different - in the US mg/dl vs mmol/l in the rest of the world.

The point of the medical study which I have quoted at length here is that the traditional focus on LDL-C, is not the best biomarker of CVD risk, but rather the ApoB/ApoA1 ratio.

Eventually, the medical system will move to this more reliable biomarker but it will take a generation.

In the meantime when you get a blood test, insist on getting both ApoB and ApoA1 measured so you can calculate the ratio. If not covered through the system, then you can pay for it privately if you can afford it.

1 like
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sandybrown
sandybrown
in reply to sos007

Thank you.

New test parameters, good. I always read your post in full and take time to read the link reports.

My point!

Because I pay attention to detail not many people like it!!

How can a report get an incorrect formula without noticing and publish it?

In my working life when I asked questions, I get push down and the some one get the correction and credit.

By the way. There is a grandchild, one person is reinventing the method in making formula bottle because of new technology, hot tap!!. Hot tap do not boil water to 100 deg C. Only heat the water up to 83 deg C.

Milk powder has to be dissolved at 70 deg C hot water.

I have accepted this person's view, it is his child!!!

Reply
Markl60
Markl60
in reply to sos007

But first explain to your doctor what ApoA1 and ApoB are because there is a good chance he wont have a clue :)

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sandybrown
sandybrown
in reply to Markl60

I have my annual blood test appointment on Monday 25th Nov 9AM, I like to ask for fasting blood glucose, insulin test and ApoA and ApoB test. I am sure I will be told we do not do this under NHS!!

All I will have is the standard blood test.

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sos007
sos007Ambassador
in reply to sandybrown

From the NHS Dyslipidemia guidelines:

"Try to eat more:

-oily fish, like mackerel and salmon

-brown rice, bread and pasta

-???????????

-nuts and seeds

-fruits and vegetables"

Source: nhs.uk/conditions/high-chol...

How far behind the science are they that they are proponents of simple carbs - yes brown rice is a little better but bread and pasta??

Less, less, less of all of those 3 things. Where are the legumes? More legumes! How about green cruciferous leafy greens and vegetables?

So now you know NHS is a generation behind the science.

If you allow the NHS to dictate the direction of your healthcare will be doing yourself a disservice.

Canadian Cardiologists guidelines for testing:

"LDL-C as primary, non-HDL-C or apoB as alternative targets"

Note they have begun incorporating 'ApoB'.

Source: onlinecjc.ca/article/S0828-...

Be prepared to pay privately for your ApoB and ApoA1.

Good luck.

1 like
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Markl60
Markl60
in reply to sandybrown

You could pay for these privately. I have mine checked when I visit Portugal as they are much cheaper and they have blood analysis clinics on the High st

1 like
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CocoNutWater
CocoNutWater
in reply to sos007

I’d be happy to pay privately (within reason), but I don’t have much luck finding tests here in the UK. I’m not a fan of the test at home kits. Does anyone have any experience to share of private blood tests?

Reply
sos007
sos007Ambassador
in reply to CocoNutWater

I don't live in the UK but I looked this up to give you a start:

privatebloodtests.co.uk/pro...

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