LDLp or APOb and cost

#1

Had some great improvements on all my blood numbers including A1C as of last physical but my cardiologist only wanted me to drop my statins from 40 to 10. I have gone to zero statins with a retest slated for October.

Numbers were all fine with low vLDL, high HDL and low triglycerides. A1C went from HIGH prediabetes level to normal range. Total LDL still just over 100 and naturally they moaned and groanded and wanted to keep me on the statins.

My very minimal study suggests that either APOb or LDLP (total number of particles?) would be more informative. Are these tests more or less “either one will do”? if not, which is preferable? Any idea on typical costs as they are likely to no be covered.

(Eric - The patient needs to be patient!) #2

I don’t know which one is better. But If you live in the states direct labs has a web site and they have pricing for patient ordered tests.

https://www.directlabs.com/

My cardiologist actually uses them for lab work.

(Bob M) #3

Save your money and get a coronary arterial calcification (CAC) scan done. You may or may not need a doctor’s prescription (I called around and found 2 places requiring one and 1 place that did not, which is where I went). I paid $100. It tells you calcification in your arteries. The other markers are just markers. They don’t tell you anything.

NOTE: there is evidence that people who take statins have higher CAC scores. Whether the statins cause this or not is up to interpretation.

(Joey) #4

Holding @ctviggen’s advice aside for just a moment, first…

Lp(a) tests through Requestatest.com (available in most US states) cost half the price ($49) of an NMR Lipid Panel ($99), which provides info on LDL-Particles. But the Lp(a) reports just that single figure whereas the NMR report includes other data, such as the the rest of the typical lipid profile (HDL-C, HDL-P, Trig, etc) along with whether the lipid profile is Pattern A vs B, plus a measure of insulin sensitivity vs insulin resistance.

But Bob makes a fair point … Although I love data (and more is better) but if $$$ budget is tight, then a CAC x-ray will reveal actual calcification in the coronary arteries caught in the act, as opposed to blood work which can only reveal various “biomarkers” - about which there is still some ambiguity and a range of opinions about what to do if the results are less than satisfactory.

Of course, “what to do” if the results aren’t satisfactory is pretty much the same answer regardless of the test(s) you select… stay on keto :wink:

FWIW, my wife and I recently got his & hers CAC scans done for $69 each at a local hospital. No physician’s request/recommendation was required (although our internist subsequently said it was a grand idea). YMMV.

(Bob M) #5

I can give you an example. I have very high Lp(a), as in three times the “bad” limit. Yet I have a zero CAC score. 90% of the people in my age group (I’m 55) have higher CAC scores. What, then, do I do about the ridiculously high Lp(a)? Nothing.

The same could be said for LDL-p or ApoB. If you get a “high” score, what do you do? If your CAC score is zero, probably not much, as the “high” LDL-p isn’t affecting this metric. If your CAC score is higher, then something (though what to do is open to debate).

Now, is it possible that my high Lp(a) or another person’s high LDL-p or whatever, even with a zero CAC score, means there’s a higher probability of heart disease? That is, even though there is no or very little calcification of the arteries, could these affect you in some other way, such as coagulation? Maybe, maybe not. But you’d have to do more research.