Lipids- help me understand these results

[Rabble]

I’ve been tracking lipids for a few years using the Cardio IQ test. Started this just before I turned 50.
In addition to the standard lipid markers (hdl, ldl, tri, total) they break out particle size, etc.

I’ve done fairly well at keeping the high level makers in a decent range using ezetimibe 10mg eod, fairly consistent diet, and I do roughly 10 hours of cardio a week. I ride my bicycle as much as possible.

What concerns and confuses me are the detailed markers.
Here was my latest result.

I don’t know that there is anything I can do to get the high numbers in line, given the relative low cholesterol and triglycerides.

Any ideas?

 

[BP_6]

Your APO-B is good and your LDL is good as well. Those two are the most important. I wouldn't over concern myself with particle sizes.

 

[Rabble]

Your APO-B is good and your LDL is good as well. Those two are the most important. I wouldn't over concern myself with particle sizes.

Thx for the input. Yeah that’s what I’ve seen as the top level takeaway. I just can’t figure out what is up with particle size and quantity.

HDL has always been low, but has stayed around 40 since I started tracking.
These numbers are with 200mg test weekly.

 

[Kralteramon]

I also have low HDL, lowish LDL and very low trigs. No way to get HDL above 45, mostly below 40 (if cruising or not on cycle). ApoB is also optimal like in your case. Never understood this, but it has to be genetic. I have some SNP's that predict cardiovascular dissease too. Family occurance of especially atherosclerosis happens sometimes but only after 65 years of age (non steroid users). I'm planning to do periodic echocardiography and a coronary calcium scan after 40 years of age to stay safe.

 

[anon55]

Your APO-B is good and your LDL is good as well. Those two are the most important. I wouldn't over concern myself with particle sizes.

That's exactly what I thought. Everything else is bullshit.
Your Lp(a) is low too wich is great.
If you're blasting gear you might want your LDL-C/ApoB lower.

 

[egruberman]

Thx for the input. Yeah that’s what I’ve seen as the top level takeaway. I just can’t figure out what is up with particle size and quantity.

Particle size and quantity are a good surrogate for atherogenic burden. If you have smaller, more numerous LDL particle, that generally means that your atherogenic burden is greater.

That said, it is a surrogate. ApoB is a direct measurement of atherogenic burden. As such, if your ApoB is good, the particle size and number aren't relevant.

Probably, you shouldn't worry about it. ApoB and Lp(a) are what I'd be most concerned about and both of them are in a good range. My suggestion would be to do nothing unless you have a family history to be concerned about.

If you do have a family history and maybe just once for giggles around the age of 50, get a CT-CAC to check yoru calcium score. Based on your lipids, it would likely come back at zero or close to it, but there are cases where folks have relatively good lipids, but discover calcified plaque.

 

[Rabble]

That's exactly what I thought. Everything else is bullshit.
Your Lp(a) is low too wich is great.
If you're blasting gear you might want your LDL-C/ApoB lower.

I’m 53. My days of blasting were over a long time ago.

This draw was done having been off my TRT dose for around seven weeks.
Historically these won’t change much at 200/wk.

 

[Rabble]

Particle size and quantity are a good surrogate for atherogenic burden. If you have smaller, more numerous LDL particle, that generally means that your atherogenic burden is greater.

That said, it is a surrogate. ApoB is a direct measurement of atherogenic burden. As such, if your ApoB is good, the particle size and number aren't relevant.

Probably, you shouldn't worry about it. ApoB and Lp(a) are what I'd be most concerned about and both of them are in a good range. My suggestion would be to do nothing unless you have a family history to be concerned about.

If you do have a family history and maybe just once for giggles around the age of 50, get a CT-CAC to check yoru calcium score. Based on your lipids, it would likely come back at zero or close to it, but there are cases where folks have relatively good lipids, but discover calcified plaque.

Solid insight, thx. I did get that scan last July, and score was zero. They didn’t do contrast, which I’ll probably get soon- I’m seeing a cardiologist next month, because the other findings from that scan were enlarged descending and ascending aorta, and I’d like to understand if it’s simply enlarged as a result of training for decades, or if it’s something really concerning.
The size wasn’t particularly large, but still.

 

[oldgrey]

I know you are taking ezetimibe, but How high is your fiber intake and omega 3 intake? especially omega 3 to 6 ratio?

 

[Rabble]

I know you are taking ezetimibe, but How high is your fiber intake and omega 3 intake? especially omega 3 to 6 ratio?

I take a blend 3-6-9 as well as straight 3.

EPA- around 4g/day
DHA- around 1000mg/day

My understanding was that the EPA could have significant positive influence on lipids as well as other markers. It sure is expensive.

Fiber- celery and kale every day as well as metamucil.

I generally have one actual meal a day (dinner) along with a protein shake post-ride...so Im not eating an awful lot.

 

[oldgrey]

I take a blend 3-6-9 as well as straight 3.

EPA- around 4g/day
DHA- around 1000mg/day

My understanding was that the EPA could have significant positive influence on lipids as well as other markers. It sure is expensive.

Fiber- celery and kale every day as well as metamucil.

I generally have one actual meal a day (dinner) along with a protein shake post-ride...so Im not eating an awful lot.

Hmm, if you are supplementing O3's (not just epa / dha) unless you are doing carnivore or keto or something crazy your doing better than most people who get next to zero O3's daily in their diet with very high O6. You didn't really answer, but possibly You could look at improving your omega 3 to 6 ratio - but other wise for diet, not too too much I can add. you could look at getting some soluble fibre from your foods, items like chia seeds (good source of O3 also) but how much of a difference will the fibre specifically make if you are already supplementing?? - Who knows, but probably not a lot.

Not sure where you are located, Walmart in the US actually has some of the best priced highly concentrated fish oils around (but you have to compare price to epa & dha amount as they have like 10 variants and most aren't great), and costco isn't horrible either but you need membership.

 

[Rabble]

Hmm, if you are supplementing O3's (not just epa / dha) unless you are doing carnivore or keto or something crazy your doing better than most people who get next to zero O3's daily in their diet with very high O6. You didn't really answer, but possibly You could look at improving your omega 3 to 6 ratio - but other wise for diet, not too too much I can add. you could look at getting some soluble fibre from your foods, items like chia seeds (good source of O3 also) but how much of a difference will the fibre specifically make if you are already supplementing?? - Who knows, but probably not a lot.

Not sure where you are located, Walmart in the US actually has some of the best priced highly concentrated fish oils around (but you have to compare price to epa & dha amount as they have like 10 variants and most aren't great), and costco isn't horrible either but you need membership.

I mean more fiber would be better for sure at my age.

With EPA I'm using OmegaVia which seems to be the only EPA only product available in the US without a script.
I'm in the mid Atlantic area. I'm a Costco member so I'll have a look there also

 

[egruberman]

In

My understanding was that the EPA could have significant positive influence on lipids as well as other markers. It sure is expensive.

use Viva Naturals triple strength. That or Sports Research tends to have the lowest price per mg of EPA for IFOS certified fish oil.

 

[oldgrey]

I mean more fiber would be better for sure at my age.

With EPA I'm using OmegaVia which seems to be the only EPA only product available in the US without a script.
I'm in the mid Atlantic area. I'm a Costco member so I'll have a look there also

the ultra concentrated (not normal concentration or salmon oil etc) costo brand fish oils are solid price to epa / dha. Compare to the walmart ultra concentrated as well (yellow label not equate, i think they are called something like triple strength, and are lemon flavor so less fishy burps lol)

 

[egruberman]

As I mentioned, I tend to favor fish oil that is IFOS certified. It gets tested for heavy metals, which is common in fish oil. There’s also the fact that some of the cheaper fish oil is often sold rancid.

The re-esterified triglyceride form works best for me in terms of fish burps. Also, I keep mine in the freezer, which helps both preserve it and pass through the stomach more quickly.

 

[LGOP528]

Particle size and quantity are a good surrogate for atherogenic burden. If you have smaller, more numerous LDL particle, that generally means that your atherogenic burden is greater.

That said, it is a surrogate. ApoB is a direct measurement of atherogenic burden. As such, if your ApoB is good, the particle size and number aren't relevant.

Probably, you shouldn't worry about it. ApoB and Lp(a) are what I'd be most concerned about and both of them are in a good range. My suggestion would be to do nothing unless you have a family history to be concerned about.

If you do have a family history and maybe just once for giggles around the age of 50, get a CT-CAC to check yoru calcium score. Based on your lipids, it would likely come back at zero or close to it, but there are cases where folks have relatively good lipids, but discover calcified plaque.

Inflammation (h-CRP) is another marker to watch correct? The systemic inflammation is what causes the plaque to buildup because your body thinks it needs to repair the artery walls. Without inflammation, you should not have plaque buildup. Stan Efferding takes about this at length.

 

[anon55]

Inflammation (h-CRP) is another marker to watch correct? The systemic inflammation is what causes the plaque to buildup because your body thinks it needs to repair the artery walls. Without inflammation, you should not have plaque buildup. Stan Efferding takes about this at length.

That's a false statement. Without inflammation plaques buildup happen because of ApoB molecules entering the artery wall.

 

[LGOP528]

That's a false statement. Without inflammation plaques buildup happen because of ApoB molecules entering the artery wall.

Maybe I should have said systemic inflammation increases the rate of plaque buildup. Which creates a negative feedback loop because plaque buildup increases inflammation.

Inflammation is also what causes plaque to break free, causing a heart attack or stroke.


Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation.

The Role of Inflammation in Cardiovascular Disease - PubMed

Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment...

pubmed.ncbi.nlm.nih.gov