TLDR: women who would otherwise be missed by current algorithms might be picked up by this inflammatory marker (hs-CRP)
Lp(a) is a largely distinct risk factor from “ordinary” cholesterol and cannot be changed by diet or exercise. Survey papers show practically no effective treatment (statins help all cause mortality in patients but do not lower lp(a)). There are two (iirc) ongoing trials for new, effective drugs. But those are not available yet and will probably be prohibitively expensive, going by the advertisements that the companies run.
So yeah, get an Lp(a) test once (it doesn’t vary too much over time) and reduce your other risk factors, but don’t put too much hope into an easy solution to this specific cause yet.
edit: found the two papers that were a good read:
Kamstrup, P. R. (2021). Lipoprotein(a) and Cardiovascular Disease. Clinical Chemistry, 67(1), 154–166. https://doi.org/10.1093/clinchem/hvaa247
Schwartz, G. G., & Ballantyne, C. M. (2022). Existing and emerging strategies to lower Lipoprotein(a). Atherosclerosis, 349, 110–122. https://doi.org/10.1016/j.atherosclerosis.2022.04.020
Burying the lede a little, here. The ACC has decided on a standard way to measure inflammation, which decades ago was a centerpiece of some very woo-woo "following the squizledoff diet will decrease your gomperblorp"-style health 'advice'. "Systemic inflammation" was a very tricky physiological parameter to nail down.
https://cancerblog.mayoclinic.org/2025/02/17/want-to-reduce-...
https://health.clevelandclinic.org/anti-inflammatory-diet
https://health.clevelandclinic.org/foods-that-can-cause-infl...
https://www.heartandstroke.ca/articles/the-anti-inflammatory...
https://health.osu.edu/health/general-health/how-fragrances-...
https://pmc.ncbi.nlm.nih.gov/articles/PMC9163252/
https://www.amjmed.com/article/S0002-9343(25)00549-2/abstrac...
> Grains (mainly whole grains): 7-8 servings > 1 slice bread
Who the heck is eating 7-8 slices of bread -- A DAY??? (or the equivalent)... Of a healthy bread that's about 900 calories just from breads...
That's like 2 bowls of cereal for breakfast, 2 sandwiches for lunch, and 2 servings of pasta for dinner, whoa.
I am 5 months into NSAID Gastritis. Would not recommend.
also they list a big list of drugs that are in various stages
I don't even know. But exercise is the god-tier reigning champion of all things health. You can count on it pretty reliably to show up as a positive effect source in any health study.
"Just exercise" should be a meme at this point.
To get a statin you have to go to the doctor, get a blood test, get a prescription for the statin, and start taking it, get blood retested, adjust dose (possibly), etc. Then you have to go to the pharmacy, pay for it and take it every single day.
To exercise you literally have to walk for 30 minutes. That's it.
It's only hard because we make it hard.
There's people that live even closer that drive their kids to school. One of them lives literally 19 houses down the street from it.
I also have a rule where if I can go somewhere within 20 minutes on a bike, I'm taking my bike. Most places I go fall under this rule, and I live in what most would call a suburban hellscape.
My wife used to drive to work. Driving took longer than walking. But she still drove.
I think it's less about easy vs hard and more about the culture around driving in the US.
[0] I heard this claim a long time ago, but according to Wikipedia (https://en.wikipedia.org/wiki/Plato#Life) it's apocryphal. The Talk page has a decent argument for it not being the case.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7498668/
What lowers oxidative stress is nutrition, specifically selenium, vitamin C, manganese, zinc, and copper.
https://www.derekthompson.org/p/why-does-it-seem-like-glp-1-... (Control-F "Theory 2: GLP-1 is a miraculous “moderation molecule,” and it has docking portals all throughout the body that reduce inflammation.")
https://www.health.harvard.edu/diseases-and-conditions/do-gl...
Not sitting a lot (more than 1 hour at a time), walking or cycling everywhere, not eating a kot of sugar/refined carbs..
https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...
> Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost-effective in primary prevention.
Lowering cholesterol lowers the amount of oxidized cholesterol that is caused from inflammation. The fact is is that in inflammation is the fundamental disorder, not high cholesterol on its own.
> Fourteen trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All‐cause mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was combined fatal and non‐fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined fatal and non‐fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined fatal and non‐fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen.
So the evidence base is a collection of studies where most of the participants had at least one prior indicator of CVD or diabetes, and their outcome is a relatively weak benefit to all-cause mortality, CVD, CHD and stroke. For primary prevention, what you really want is a strong outcome in a study of people without any prior indication of disease.
I think the article posted by parent is exaggerating, but even the Cochrane review is pulling its punches here, saying specifically "cost-effective in primary prevention", instead of the stronger claim. Common jokes about putting statins in the water supply aside, there's not a ton of evidence for giving them to, say, otherwise healthy 20-somethings.
Extraordinary claims require extraordinary evidence. The cholesterol to heart disease link is one of the best attested in medical science [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]
And yet when making this very extraordinary claim, the author fails to cite any quantitative data for or against. He does not even attempt to build a qualitative argument by proposing a mechanistic theory of why cholesterol is unlikely to be causative of heart disease. Then he goes on to claim that doctors don't have hard evidence to show that statins reduce the incidence heart disease, despite the fact that such evidence exists [5]. The post is just 10 paragraphs of fluff that boil down to 'don't trust the medico-industrial complex'
Honestly, I think that blog post is a litmus test on scientific literacy - What convinces you more, data and numbers and charts and tests of statistical significance, or rail-against-the-machine rhetoric and a few scary sounding quotes provided without the associated context?
[1] https://jamanetwork.com/journals/jama/article-abstract/19216...
[2] https://pubmed.ncbi.nlm.nih.gov/25815993/
[3] https://jamanetwork.com/journals/jamacardiology/article-abst...
[4] https://www.ahajournals.org/doi/abs/10.1161/01.CIR.67.4.730
[5] https://jamanetwork.com/journals/jama/fullarticle/2678614
[6] https://pubmed.ncbi.nlm.nih.gov/32507339/
[7] https://www.tandfonline.com/doi/abs/10.1080/07315724.2008.10...
[8] https://pubmed.ncbi.nlm.nih.gov/18061058/
[9] https://www.jacc.org/doi/abs/10.1016/j.jacc.2022.03.384
[10] https://www.nature.com/articles/s41598-021-00020-3
[11] https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030496
[12] https://www.nature.com/articles/s41467-024-46686-x
[13] https://www.sciencedirect.com/science/article/pii/S002191502...
[14] https://link.springer.com/article/10.1186/s12872-021-01971-1
[15] https://www.jstage.jst.go.jp/article/jat/31/3/31_64369/_arti...
Your comment is an appeal to authority. While I have my problems with characterizing statins as dangerous drugs, the article is not particularly spicy. In particular, this part:
> Because the link between excessive LDL cholesterol and cardiovascular disease has been so widely accepted, the Food and Drug Administration generally has not required drug companies to prove that cholesterol medicines (such as statins) actually reduce heart attacks before approval. So drug companies have not had to track whether episodes like heart attacks are reduced.
...is true, and controversial only amongst people who don't know the evidence. Which, unfortunately, is many doctors and "experts".
In general, saying any variation on "experts disagree" is not a rebuttal to a question of medical evidence. You would perhaps be surprised to know how many practicing physicians have no idea what level of evidence backs the drugs that they prescribe.
I for one appreciated the clarification that it was not mainstream, since sneaking a random controversial take into a comment thread as if it was fact without noting that it's contentious is disingenuous.
No, they don't. If you don't know enough to argue on the merits, don't argue. A count of opinions is not an argument.
> sneaking a random controversial take into a comment thread as if it was fact without noting that it's contentious is disingenuous.
And again, you're justifying your judgment and dismissal based on hearsay. Saying "I refuse to believe it because experts disagree" is fine if you're unable or unwilling to look into an issue yourself, but in that case you have to realize you're basically ignorant.
I realize that we all go through life taking most things on faith, but that also means that you should not cling to the opinions of others as a substitute for thought.
You're asserting that a extremely well-known logical fallacy is not a fallacy. It's not an HN rule, it's argumentation 101.
The fallacy is where you use an authority in place of evidence. It is not fallacious to refer to consensus or experts.
Else, you end up basically in the "Do your own research"/vaccine denier/climate deniers/flat earth territory. Appeals to experts is not a logical fallacy. It's actually smart, because you get to leverage agreed facts (the earth is round) even though you've never actually been to space to see it for yourself.
There are conflicting incentives here, and as usual we don't care about someone else's p value, we care about argmaxing our own utility functions.
> Statins can be beneficial in patients who have already suffered heart attacks. Cholesterol lowering is not the reason for the benefit of statins. If it was, lowering cholesterol via any means should have produced the same benefit, but it doesn’t.
What a blatant lie! Ppcsk9 inhibitors have produced excellent results, even better than statins.
Do you have any?
Can you expand on this? I don't understand.
Weight lifting causes short bursts of inflammation right after training, which is part of the repair process. But in general it is considered very beneficial.
High levels of CRP are associated with high levels of oxidative stress.
https://pubmed.ncbi.nlm.nih.gov/15585208/
Inflammation is a synonym for high levels of oxidative stress. Keep your oxidative stress low and you will not get heart disease.
I think we should always be careful when we speak in absolutes. The conclusion from the article:
> This result suggests that oxidative stress may be a determinant of [C-reactive protein] levels and promote pro-atherosclerotic inflammatory processes at the earliest stages of [coronary heart disease] development.
I'm not saying the result is wrong, but I am saying "if you A you will not get B" is over-promising.
if you take this advice literally, you should stop exercising
I've been mostly on a keto diet since 2014, and it is probably the most important health choice I've ever made. At the time I worked in Neurology at a Children's hospital, and a keto diet is one of the treatment options for epilepsy. I talked with the clinical dietician at the time, and asked if these kids were having heart attacks in their 20s. On the contrary, much of the department was on the diet, or a low glycemic diet, as was much of the oncology dept. Obviously, this is an N of 1, and I'm not an MD, but every single aspect of my physiological and mental health has improved over the last 10+ years.
“Dietary Intervention to Reverse Carotid Atherosclerosis” (Circulation, 2010) — participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets; carotid arteries were imaged with 3-D ultrasound cross-sections at baseline and follow-up. After 2 years there was a ~5% regression in carotid vessel-wall volume, with similar regression across all diets (i.e., including the low-carb arm). [1]
Volek et al., 2009 (Metabolism) — 12-week very-low-carb vs low-fat trial; ultrasound of the brachial artery showed improved post-prandial flow-mediated dilation (a marker of endothelial function/inflammation) in the low-carb group. Not carotid 3-D slices, but still vascular imaging with before/after comparisons. [2]
[1] https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.1...
[2] https://lowcarbaction.org/wp-content/uploads/2019/12/Volek-e...
Inflammation broadly refers to destructive immune activity (or sometimes any immune activity). If you get a cut, immune cells show up, they kill germs, sometimes they kill somatic cells too. Different cells show up to heal and close the wound. That's all immune activity.
When you need it, it's a net good, but you don't want any of that going on when you don't need it. Increasingly people seem to have more immune activity than they should and it causes cumulative low grade damage. That's the "systemic inflammation" that you've probably heard about.
hs-CRP (high sensitivity C-reactive protein) is a test which seems to be a good biomarker for systemic inflammation, although CRP is just one chemical involved in immune activity.
This article is advocating for using that particular biomarker (related to systemic inflammation) to predict heart disease.
This article might be truthful, it might not. But it is absolutely trying to sell you something.
Unknown editor
No journal? Committee? Conference?
Ew.
brandonb•1h ago
The American College of Cardiology just started recommending that everyone measure hs-CRP, a blood test for inflammation. Why? Because inflammation now predicts cardiovascular events more accurately than cholesterol — especially in people already on statins or those without traditional risk factors.
In some ways, cholesterol has become a victim of its own success. With routine screening and statins, most heart attack patients now have artificially lowered cholesterol. That leaves the remaining risk hidden in non-traditional biomarkers — beyond the usual SMuRFs (standard modifiable risk factors).
Night_Thastus•1h ago
brandonb•1h ago
Night_Thastus•1h ago
I think there's supposed to be some kind of green highlight for comments by the poster but that's missing as well.
Mea culpa.
CleverLikeAnOx•1h ago
Night_Thastus•57m ago
pinkmuffinere•1h ago
brandonb•1h ago
(There are some people who dispute whether cholesterol is causative, but most cardiologists believe LDL cholesterol, or ApoB, causes heart attacks and strokes --based on both mechanistic evidence and randomized control trials.)
SpicyUme•1h ago
brandonb•1h ago
SpicyUme•51m ago