What is lipoprotein A/Lp(a)? Why could it put me at high risk for heart attack and stroke?

Lipoprotein A or Lp(a) is a subtype of LDL cholesterol. The BaleDoneen Method calls Lp(a) the "mass murderer" because elevated levels of Lp(a) triples your risk of heart attack and stroke. At the CureCenter, we call it the “worst” or “really bad” cholesterol. Think of it as “highly flammable” lipid.

Elevated Lp(a) affects around 30% of the population, yet it is not included in standard lipid testing. Why?

In the past, the test for Lp(a) was expensive. Today, it only costs about $10 and is becoming more common, yet still not routine. Change in practice tends to be slow, particularly in bureaucratic systems designed to keep revenue flowing through interventions. New drugs and associated revenue are on the horizon, potentially explaining a resurgence in interest.

What causes elevated Lp(a)?

Elevated Lp(a) is a genetically determined root cause with little impact from lifestyle or medications.

Genetics determines Lp(a) levels. You are much more likely to have elevated Lp(a) if you have a family history of high Lp(a).

Why does elevated Lp(a) increase risk for heart attack and stroke?

Lp(a) is made of cholesterol, protein, and fat. Elevated levels (>75 mg/dl) increase the likelihood of development of atherosclerosis, leading to heart attack and stroke. Elevated Lp(a) also increases the risk of calcific aortic stenosis, a valve disease that can lead to heart failure. Finally, it accelerates blood clotting. When atherosclerotic plaque ruptures, a blood clot forms more rapidly to occlude blood flow leading to a stroke or heart attack.

When combined with high levels of inflammation, elevated Lp(a) fuels that inflammation in the artery wall and leads to the formation of plaque.

Lp(a) is not included in standard lipid panels ordered by most doctors. It should be.

While its effect is often lost in the statistics of large population studies, Lipoprotein (a) can be dangerous for the minority with significantly elevated levels. For this reason, everyone should have it measured once, especially if you have:

• Family members who have had a heart attack or stroke at an early age

• Premature vascular disease in the absence of other usual risk factors

• Familial hypercholesterolemia

• Family history of elevated Lp(a)

If your Lp(a) is tested and at a normal level, you will not need a repeat test. Your levels will not rise. However, if it is very high, you and your relatives should know, as they could be at high risk as well. 

How are elevated levels of Lp(a) treated?

Niacin is the most effective supplement/drug to reduce levels of Lp(a). We have also witnessed response to Bergamot BPF, an effect we have not seen reported in the literature but have observed incidentally. In our experience Bergamot BPF has had a favorable effect that rivals or exceeds niacin in some cases, and it reduces insulin resistance,a highly prevalent root cause of atherosclerosis.

Lifestyle and statins tend to have very little effect on reducing high levels of Lp(a). They can, however reduce inflammation contribution to disease and cardiac events. Therefore, knowing about the increased risk from Lp(a) can motivate more proactive measures to control these other root causes more optimally.

Knowing about the presence of this "mass murderer" in your body will make healthy diet, exercise, and other risk reductions more imperative. Information is empowering. Become aware of Lp(a) - the “worst” or “really bad” cholesterol.

For further reading on Lipoprotein A, we recommend the BaleDoneen website.

Do your genes make you more susceptible to heart attack?

Genetics play a significant role in whether you will have a heart attack or stroke. However, though we cannot yet alter our genes, we can “hack” them.  Some genetic information can determine optimal treatment choices for you that may or may not be right for others, even those in the same family. 

Lifestyle choices and environmental exposure can change the way our genes are expressed (how the body uses information in our genes to create proteins and other molecules). This concept is called epigenetics.

Our genes are a blueprint for our bodies, but epigenetic changes can influence which genes are turned on or off. These changes can be passed down from one generation to the next, and can also be affected by our diet, exposure to toxins, and other factors. Studying epigenetics can help us understand how these changes occur, and how they may contribute to the development of diseases such as cancer and heart disease.

Genetic testing is becoming more affordable. Since it only needs to be done once, it can actually be quite cost-effective even if insurance plans don’t cover the costs.

What types of genes are analyzed during genetic testing at The CureCenter for Chronic Disease?

Here are some, but not all, genes that are analyzed during genetic testing that may indicate risk of heart attack:

• Haptoglobin Genotype:

  • Haptoglobin genotype 1-1

    • Lowest risk for vascular disease events

    • Vitamin E increases risk of vascular events

  • Haptoglobin genotype 1-2

    • Increases your risk by 200%

    • Vitamin E increases vascular event risk in this group as well.

    • Gluten increases chronic inflammation moderately. Gluten avoidance is optimal

  • Haptoglobin genotype 2-2

    • Increases risk of vascular events by 500%! 

    • Vitamin E mixed tocopherols reduces cardiovascular risk! Now that is cool to know! 

    • Gluten also provokes a significant increase in inflammation in the gut for this genotype. Therefore, gluten should be avoided by individuals with this genotype. Gluten avoidance is also important for those who are haptoglobin 1-2 because they are very prone to gluten triggered inflammation.

• ApoE Genotype:  ApoE 4 genes increases risk of Alzheimer’s Disease and arterial disease. It can predict better outcomes with a very low fat diet and no alcohol. If you are willing to modify these choices based on the result, let’s get it. Howver, if other dietary priorities, like reducing carbs due to insulin resistance, are a priority, maybe it won’t matter. ApoE 2 or 3 genes are lower risk for arterial disease and dementia, and generally do well with a low carbohydrate diet with more liberal fat.

• KIF-6 Genotype: KIF-6 genotype determines whether atorvastatin and pravastatin are effective or ineffective at reducing heart attack and stroke frequency. However, if we use rosuvastatin or lovastatin as our preferred statin, it doesn’t matter.  Again, it is useful in a limited set of circumstances. 

• 9p21 Genotype is the Heart Attack Gene. It is the one to beat, as the title of Dr. Bale and Dr. Doneen’s book suggests.  However, there is no specific treatment for this gene. Its presence could motivate someone sitting on the fence about some treatments, but for the most part, we rarely order it since our program is based upon measurable disease, not risk. 

Awareness of higher risk can provoke more proactive efforts on controllable factors. However, if you already have a disease, being “low risk” doesn’t change your plan. You need to act on the disease to put it into remission.

There are other genes that determine how you metabolize medications. This can be important if you are on multiple medications that can interact with one another or require metabolism for elimination or activation. When inquiring about genetic testing, ask your doctor about these genes. Be wary of commercial panels of an array of genetic tests that can add more “noise” than “signal.” 23 and Me offers little useful information for testing that really matters.

Knowing your genetics allows The CureCenter to individualize and personalize your care to lower your risk of having a heart attack or stroke. We offer genetic testing for all and encourage it especially for those who have had a heart attack, stroke, TIA, stent, bypass or signs of dementia to optimize treatment. For others, it enables the best possible choices to personalize your care.  

Our general rule is to order genetic tests that will determine a specific change in choices or prescriptions.

For recommendations on genetic testing, request your complimentary Discovery Zoom Call with Dr. Backs and take the first step toward ensuring a long and healthy life.

Stroke or heart attack: What really happens?

This video will change your understanding of stroke and heart attack events. They happen in a suddenly accelerated phase of a chronic progressive inflammatory process. Similar to acne, inflammation creates plaque (pimple) that can heal (calcification/scar) or rupture/crack. Plaque doesn’t “break off.” It is the clot/thrombus that interrupts blood flow leading to stroke or heart attack. Watch this video.

There are three phases of arterial health depicted in the video featured in this message:

1. Normal Artery

2. Vulnerable/Unstable Homogeneous Plaque

3. Stable (Fibrous) Heterogeneous Plaque

4. Healed Calcified Plaque

A normal artery refers to the stage before atherosclerotic plaque forms in the artery wall. This stage is typical of younger individuals. Atherosclerosis is more common with age, but it is not normal “aging.”

Stable calcified plaque is like a scar that forms after an injury. It is the latest and most stable stage of the process. It won’t disappear altogether, but it also won’t cause sudden harm. Calcified and fibrotic connective tissue wall off the plaque from the lumen of the artery where the blood flows. This is like a healed scar from a prior injury, an event that could have but did not happen. The lumen through which blood flows is diminished in size, but the situation is stable. However, it reveals increased risk of forming more plaque in the future because it has done so in the past, especially if the root causes are still active. 

Vulnerable/unstable homogeneous new plaque is the real danger. It is actually newly-formed plaque. When plaque forms due to inflammation or injury to the artery wall, there are two potential outcomes: (1) it can heal without causing harm, becoming stable plaque, or (2) it can rupture or erode and trigger formation of a blood clot in the lumen. This blocks blood flow through the artery. That flow interruption kills heart muscle or brain tissue.

Arterial disease is silent, deadly, progressive but preventable and reversible. At the CureCenter, we work with our patients to prevent the formation of new plaque and heal plaque that has already formed. We identify and minimize the common and uncommon root causes with a Personalized CurePlan based on better choices, targeted supplements, safe and effective medications and genetic tests that determine individualized therapy.

Are your arteries healthy? If they are sicker and older than you believe, we can make them healthier and younger again.

Take the first step toward preventing arterial disease, heart attack, and stroke. Request a complimentary Discovery Zoom Call with the CureCenter today.