Initial lab results coming in. Had a urine analysis, CMP, CBC, lipids, PSA, cystatin-c, and CA19-9. So far, everything but the cystatin-c and CA19-9 is in.
The only issue so far is the urine Albumin/ Creatinine ratio was a little high, 40 ug/mg. High end of normal is 30. However, blood creatinine was where it always is 1.2 mg/dL, providing a calculated GFR of 66.57.
The lipid panel.
I had this big dissertation on making the case for a CCTA scan, and making a decision on taking statins or Repatha... and after living on Kind Bars on my boat for 4 days, I was thinking this lipid panel would be bad. It wasn't. I didn't prepare for this test with an excessive fast or a change in diet.
Fasting glucose - 85 mg/dLTotal Cholesterol - 166LDL - 112Trig - 119HDL - 40ratio - 4.19
Any cardiologist would look at these numbers, a zero CAC 2 yrs ago, and probably not recommend a CCTA, or even statins. This was a better than usual lipid panel for me.
The only other thing was my liver enzymes, ALT/AST. Usually in the high teens low 20s, this time 32 and 31, higher but still normal.
Everything still not optimal, but not particularly dangerous. My biggest risk remains the organ cysts. My PSA was ok 1.2, hoping for a good CA19-9 and cystatin-c.
Did hard work today removing a fallen tree, cutting, stacking, and splitting wood. Real hard on the hands. I got attacked by yellow jackets, stung 3 times. My truck must have run over the nest. After a while, I went back and started my truck, it was unreal. They attacked one side of the truck, sounded like it was raining, must be a huge nest. I was trapped inside for more than 10 min. Got to find that nest.
Holding steady at ~143 lbs. Fat scale says 12.2% body fat.
Amazing weather, was 83º today, flowers still flourishing. No frost in the forecast.
“ Any cardiologist would look at these numbers, a zero CAC 2 yrs ago, and probably not recommend a CCTA, or even statins.” False. Dr. Alo and Dr. Richman would recommend statins. Cardiologists who stay current on research pay no attention to CAC and just focus on LDL, Apo B and Lp(a). And family history. Apparently the ratios are now considered meaningless. There is clear data from trials that LDL over 60 and you are laying plaque. Elevated UACR is the most concerning thing here as it indicates your kidneys are starting to leak proteins. This, combined with already marginal eGFR portends increased risk of future decay. Also it is an independent CVD risk factor. Recheck periodically. Maybe there was a lab error.
ReplyDelete"There is clear data from trials that LDL over 60 and you are laying plaque." Not that simple. Many other factors. With values of virtually zero for Lp(a), IL-6, and hsCRP, these play in my favor. The CKD as you said increases risk.
DeleteClaude: "Where the claim goes wrong
DeleteThere’s no threshold at 60. The researchers found a linear relationship between lower LDL-C and less plaque progression, across the range from 110 down to 20 mg/dL. That is a dose-response curve with no cliff at 60.
Plaque didn’t grow in the comparison group. The statin-only patients averaged about 93 mg/dL, and they had neither progression nor regression. That’s stable plaque, not active plaque accumulation at LDL above 60.
ccjm
Who was studied matters. Everyone in GLAGOV already had coronary disease. It doesn’t establish that a healthy person with LDL of 80 is building plaque, or how fast.
Plaque volume isn’t the same as heart attacks. GLAGOV measured an imaging endpoint. Clinical-outcome trials are a separate body of evidence.
What’s fair to say
The data support this: lower LDL-C is associated with less plaque progression, and benefit continued at levels far below what was once considered a normal target. That fits the guideline direction toward lower LDL goals in high-risk patients. It doesn’t support a specific number where plaque starts forming for everyone. How much lower matters depends on a person’s baseline risk, existing disease, and other factors."
I stand corrected on the claim “above 60 laying plaque”.
DeleteTrust Dr. Alo https://www.dralo.net/blog/ldl-60
ReplyDeleteStill thinking about getting a CCTA / Cleerly or Heartflow evaluation.
DeleteGemini says: “ Murfreesboro:
DeleteAscension Saint Thomas Rutherford provides self-pay CCTA scans for $598. [1]”
It should be easier to get a physician to write a prescription for a self pay - they would have to fight with insurance and likely lose. I’ve read the guidelines for CCTA, quite restrictive.
Deletehttps://www.dralo.net/blog/ldl-60
ReplyDeleteThat link won’t open for me from your blog. If it gives a 404 it will work if you paste it into a new window
ReplyDelete