Oops... Lowering Lp(a) has no effect on heart health

(Joey) #1

Newsflash: Lowering Lp(a) has zero effect on heart health outcomes.

The most straightforward explanation as to why lowering Lp(a) had zero effect on heart disease outcomes would seem to be because Lp(a) is not actually the cause of heart disease … it’s merely an associated symptom.

That Novartis has been pushing Lp(a) testing well before this distinction between cause and effect has been established would seem to be motivated by their expecting to have a “breakthrough” drug to market that lowers something they’ve helped raise anxiety about.

This is similar to so many erroneous beliefs that confuse cause and effect (viz. LDL?) :roll_eyes:

(Bob M) #2

Everyone simply believes that Lp(a) is evil.

The problem is that if there are people with super high Lp(a) who don’t have heart disease, then how can Lp(a) be an issue?

It MAY be that Lp(a) is more problematic if you have heart disease. Not the cause, but an “accelerant”. To me, this might be plausible. But it’s not the cause, just something like the fire trucks or ambulances that appear afterwards.

But since one of the studies used people with heart disease and the drug there cause near an 80% drop in Lp(a) levels while not helping heart disease, the “accelerant” idea is less plausible.

(Joey) #3

I suspect that Lp(a) - like LDL and other cholesterol components - are complex puzzle pieces of a number of metabolic sub-systems. As such, context is everything.

They could be a response to a disease or inflammation state. Or even perhaps the cause of other health issues. But again, context is everything.

If you’ve got a fever in response to an infection, the fever is a good thing. At the extreme, fevers can cause cellular damage and need to be controlled if possible.

Cutting out the carbs produces a context that can’t be ignored when comparing lipid profiles to someone eating a lot of SAD crap all the time.

I suspect Lp(a) is another example of a biomarker where context matters a great deal in determining if it’s an issue of concern or not.

(Bob M) #4

I’m 100% in agreement.

I like Malcolm Kendrick’s The Clot Thickens, as I think he has the best ideas when it comes to causation of heart disease. There are many causes, and LDL and Lp(a) aren’t one of them (though he seems ambivalent about Lp(a) possibly being an accelerant). I think his idea of protecting the endothelium, partly through nitric oxide production, is a good one.

I think viruses like covid can be particularly damaging:

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The endothelial damage is an issue, and if repair is >= damage, you should be okay. If repair < damage, that’s not good.

By the way, what drugs improve endothelial function? Statins. (See above.) This is probably one way statins ACTUALLY work, not through LDL reduction.