LPa Score 183. Cardio Disease Prone. Looking to master Inflammation, what Peps?

[lessthanhalf]

Just seconding the cardiologist advice, even after losing a lot of weight , just having been above 500 lbs puts you potentially in a very high risk category, even without otherwise bad numbers. I only found out I had already sustained some damage to my heart after losing the weight, and knowing this changes how aggressively things need to be treated, so some expert input is a good idea. Cardiology is just about the most research based specialty around, which is a good thing.

 

[Chucky]

lessthanhalf said:


The first thing done was a stress echo, as I had some odd symptoms of weird breathlessness while still very overweight, and it took forever to get it organised and I had already lost a lot of weight by the time it got done. No ischaemia was seen, but it showed an ejection fraction of 50% and mild left atrial and ventricular enlargement, so class b heart failure ( without symptoms but structural changes and mildly reduced ejection fraction, should have been 55%+ ) As best I can find out this has a risk of turning into symptomatic heart failure of 1-2% a year, assuming I take blockers and ace blockers and do not regain the 80 kilos I lost, overall this is probably a bigger risk than the risk of heart attacks from the high CAC, as reducing those risks with statins etc is easier. 10 year risk untreated 20-25% MACE , about half that with treatment , statin, ezetimibe, clopidogrel, assuming I do not regain weight, making the GLP drugs literally required to stay alive, as I would guess those risks would skyrocket with massive weight regain.

I have had an echo done every year since or 2 more with no significant changes which is hopefully a good sign. My reading of the science said the CAC and angiogram were probably not needed, but I deferred to my GP and cardiologist's advice. Angiogram showed 15% right coronary artery stenosis and 50% left anterior descending stenosis, so no fixable problems. ( mainly done to see if critical narrowings that could be fixed to prevent worsening heart failure, as the above comment explains I already qualified for maximal medical therapy for atherosclerosis, I was not sure the science supported getting it done, but not much point seeing specialists then ignoring their advice even if you have read the literature, clinical experience cannot be obtained by reading papers)

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Definately keep an eye on it. Nearly sent me to tte pine box last year. Fortunately I was at the gym at the time so there was a couple ER doctos and nurses working out at tye same time. My ejection fraction rate in the hospital was 39% so I got lucky. Triple bypass later and complete change on training, I'm sitting around 55% now.

 

[lessthanhalf]

Glad you did OK after that, it does not always work out so well. Mine was more quiet slow damage from years of obesity, ulcerative colitis and chronic inflammation and almost certainly leaky gut issues. Not much else to do other than slow the process down as much as possible by looking after my body a bit better and taking some pills, the GLP drugs make keeping the weight off long term a much more realistic prospect, which helps a lot, and was never possible before.

 

[Sector]

5mg rosuvastatin + 10mg ezetimibe will get your cholesterol markers cleaned up nicely—ldl,apob, hdl, triglycerides should all improve. Low dose rosuvastatin can also help with hs-CRP (inflammation) markers as well

You can get most of the benefits with a low dose, that’s why I’d also recommend combining a low dose with ezetimibe as the results are very synergistic and stack, and ezetimibe is essentially side free for most and very well tolerated.

Statins get a bad rep for a lot of people because usually they’ll show up to their doctor when there’s an issue that’s compounded over time, their doctor their puts them on a high dose statin, and with higher dose you’re likely to get much more side effects, for only a marginally (insignificant) reduction. The poison is in the dose.

Solution? Low dose statin + ezetimibe (effective for lowering, keeps sides minimal, and also improves bloodwork)

If you want to go really deep down the rabbit hole, this is a fantastic read for cardiovascular health




Cardiovascular disease is a solved problem – Total Health Optimization

totalhealthoptimization.com

 

[Habibibi]

lessthanhalf said:


CAC is not useful or used really in general to follow up changes, except to repeat it sometimes 5 or more years later if CAC is low. Statins do stabilise plaques, and that is an important function of them. CAC is mostly used to decide on the need for lipid lowering therapy if risk levels from normal assessments are intermediate.

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Yep, and that's my point, not really useful for prevention. And it's not really useful for determining use of lipid lowering therapy either, as apob is the gold standard, and when it comes to apob levels lower is better.

 

[Tug Speedman]

Thanks for all the input you guys and girls. I was recently (2 days ago) placed on Pravastatin 20mg/day, and I've been on Ezetimibe for about 8 months now. I get my CAC scan done tomorrow. I started losing weight (on Reta) about 7 weeks ago. Started @ 265lbs and currently 240lbs. Goal weight is "skinny enough to make a difference for my health". Havent had anything fried in about 4 months, no liquid sugars, not much carbs (but a small amount daily). I only exercise about once a week but thats changing for the better as I get lighter on my feet. Honestly cant wait to start jogging again. And yes I may even risk muscle wasting again and circle back onto Rosuvastatin for the sake of "lets control what we can, for now". I may end up in a clinical trial, or Repatha + Statin + ezetimibe + etc. or maybe this Prava + Zetia im on plus coming down a total of 40-60lbs yields desired results. Time will tell.

Those of you suggesting a cardiologist, Thank you! But I agreed before the mentions. I meet mine tomorrow.

However it wasn't my question. Why? Well because most any cardiologist wanting to keep processing Insurace claims will say the same thing, "you cannot change high LPa, so the best thing to do is manage what we can". We know that is a true statement. But we also know that peptides can do amazing things. Take GLP1 for instance the reason we are ALL here. Has it saved many lives from CV death? , Probably. But a cardiologist dare not say it unless a full study over a long period of time is completed, approved for release and published in a medical journal somewhere. Right? So while I make acquaintance with the best that modern (FDA approved) medicine has to offer. I will still be curious about what I can do on my behalf to improve MY odds. Nothing wrong with that right?

I've read that NAD+ Injections is a big No due to oversaturation creating accelerated possible clogging due to something called "4Py", And I've also read similar warnings regarding Subq L-carnitine also (there goes the Lipo blends). Which is part of why I wanted to pose the question to begin with. If there are Peptides and even supplements that are a big NO. Then are there any that are a Maybe, or even a Yes. Such as, I was able to confirm NAC (the glutathione precursor) is a Yes!. Also my question was about Inflammation reducing support, particularly regarding the cardiovascular system. Thanks again everyone, ALL input is very much apprecited!

PS, did anyone else know that too much NAD+ and L-Carnitine can accelerate atherosclerosis? Has any ones cardiologist told them so? See, were learning in here!

 

[lessthanhalf]

I assume you are already on a GLP? They have been shown ( maybe not reta yet ) to reduce LDL triglycerides, HB1AC, and heart attacks, strokes and certain types of heart failure and are a worthwhile therapy to reduce cardiovascular risk especially in the context of being obese or even overweight.

I assume you have had renal and liver function tested? Urine protein? ( very common for this to not be normal in severe obesity, and can suggest more aggressive lipid lowering or antiplatelet agents are needed even if everything else is ok ) ) Metabolic syndrome can cause issues with kidneys and livers as well as the heart.

 

[Tug Speedman]

lessthanhalf said:


I assume you are already on a GLP? They have been shown ( maybe not reta yet ) to reduce LDL triglycerides, HB1AC, and heart attacks, strokes and certain types of heart failure and are a worthwhile therapy to reduce cardiovascular risk especially in the context of being obese or even overweight.

I assume you have had renal and liver function tested? Urine protein? ( very common for this to not be normal in severe obesity, and can suggest more aggressive lipid lowering or antiplatelet agents are needed even if everything else is ok ) ) Metabolic syndrome can cause issues with kidneys and livers as well as the heart.

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Thank you for taking the time lessthanhalf!

All 7 Liver parameters tested were in optimal range, Kidney parameters same, except for Anion Gap @ 13.0 which was a little high, something to do with un-measured Ketones. In-range, but just in the Yellow was EGFR @ 85. Im on low but not No carb, same for sugars. Urine was clear, yellow and Negative for protein, blood and nitrite.

By the way, I did have another parameter in a different category that did indicate insulin resistance. Ill try to find it. Found it. HOMA2-IR was Out of Range @ 1.6 . Ferritin also Out of Range @ 247 but i did eat a fat liver steak a week earlier, I need to revisit that test next round.

I somewhat would like to credit the decent Liver and Kidney results to the cycle of Glutathione I completed a few weeks prior to my blood draw. Eating pretty clean for the last 5-8 months, and for sure the Reta makes clean eating choices a breeze.

The charts say im Morbidly Obese and my scale tells me my BMI is 31 (in the Red), but at 6'2" 240lbs looks alot better on me than 265 did almost 2 months ago. Its when I get down into the 215-220 area that people will start asking me if im sick. Still the "charts" say im supposed to be 190lbs. I may go down near there but we'll see, I still need to throw around 100lb buckets of chemical at work all day so I cant just shrink away.

 

[Sector]

Tug Speedman said:


PS, did anyone else know that too much NAD+ and L-Carnitine can accelerate atherosclerosis? Has any ones cardiologist told them so? See, we’re learning in here!

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This statement is extremely misleading, to the point of being false. Your cardiologist told you this?! If so I’d be deeply concerned and probably find a better cardiologist, maybe even a sports cardiologist

So on l carnitine:

Certain gut bacteria can convert L-carnitine into TMA, which the liver converts into TMAO. Higher TMAO levels have been associated with an increased risk of cardiovascular disease in some studies. However, association doesn’t prove causation, and the amount of TMAO produced varies a lot from person to person based on their gut microbiome. To date, there isn’t definitive evidence that typical L-carnitine supplementation directly accelerates atherosclerosis in humans.

^^ the key thing here is how your gut microbiome affects TMAO levels

Nad + has an even better safety profile:

The evidence here is much weaker. Most of the research has actually looked at NAD+ as potentially beneficial for mitochondrial function and metabolic health. There is currently no convincing human evidence that NAD+ supplementation accelerates atherosclerosis.

 

[Tug Speedman]

Sector said:


This statement is extremely misleading, to the point of being false. Your cardiologist told you this?! If so I’d be deeply concerned and probably find a better cardiologist, maybe even a sports cardiologist

So on l carnitine:

Certain gut bacteria can convert L-carnitine into TMA, which the liver converts into TMAO. Higher TMAO levels have been associated with an increased risk of cardiovascular disease in some studies. However, association doesn’t prove causation, and the amount of TMAO produced varies a lot from person to person based on their gut microbiome. To date, there isn’t definitive evidence that typical L-carnitine supplementation directly accelerates atherosclerosis in humans.

^^ the key thing here is how your gut microbiome affects TMAO levels

Nad + has an even better safety profile:

The evidence here is much weaker. Most of the research has actually looked at NAD+ as potentially beneficial for mitochondrial function and metabolic health. There is currently no convincing human evidence that NAD+ supplementation accelerates atherosclerosis.

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No no. My cardiologist didn't tell me this. Google did . I haven't been able to get a conversation with my cardiologist honestly. So this (forum and google) will have to do while i wait . They took my CAC scan 3 days ago, said the results would be ready in 2 days. Now they wont give me the results until they are available by appointment. Even though it was me that initiated the request for the CAC and it was me that paid on site for it out of my pocket. And I've got at least maybe 2 or 3 internet based Cardiologist/Influencer types waiting for my results.

So when I post the statement into Google "L carnitine supplementation and CVD" ""The result? L-carnitine supplementation has complex, mixed effects on cardiovascular disease (CVD). While it supports cardiac energy metabolism, high doses can be metabolized by gut bacteria into TMAO, a compound linked to atherosclerosis and heart attacks""

I know you said assoc. doesnt prove causation, however TMAO is high in people with a bad gut microbiome. Do you know what google told me about how many people have that? 50%-66% of people in the US. Thats more than Half of everyone in the US. For UK, one article I found states gut disbyosis occurs in 7 of 10 adults. Thats ALOT of TMAO walking around in York. https://wecovr.com/guides/uk-2026-shock-new-data-reveals-over-7-in-10-britons-battle-a-gut/

Then when I post the statement into Google "NAD+ supplementation and CVD" The result? ""Preclinical data suggests that NAD+ and its precursors (NR, NMN) can support heart health. However, ground-breaking 2024 research reveals a major caveat: excess doses lead to the buildup of a metabolite (4PY) that directly triggers vascular inflammation and is linked to a higher risk of heart attacks and strokes""

After having read the results of both of these searches, would you feel comfortable injecting high doses of either, based on "Association doesn't prove causation"??? I wouldn't think so. Probably easier to move on to other options no?

Given this information, one could in theory, safely take these two. But in the case of L-carnitine, I would suggest looking into inflammation markers and a good cycle of high quality probiotic and diet improvement before risking a heart attack taking L-carnitine. Same for NAD+, theres a test to see how saturated you are. How many people do this test in the middle of their Nad cycle? Anyone.???.......Anyone.???........