Oxidized LDL (OxLDL) and Myeloperoxidase (MPO) test results

[TheBrain]

On 6/5/17, I had two blood tests for vascular inflammation and plaque formation. Labcorp did the blood draw, but Cleveland Heartlab ran the tests. I've attached my results, but the quality of the scanned fax is rather poor. I've included the PDF because it includes the text that discusses the reference intervals.

OxLDL: 39 U/L (reference interval <60)
MPO: 322 pmol/L (reference interval <470)

I'm pleased with my results, given that my coronary calcium score in August 2016 was 365 (in the 99th percentile for women my age).

I won't be able to travel to Boulder this year for a follow-up EBCT scan. I've poked around online trying to determine if an EBCT scan is available in my area, but I haven't come across anything. I haven't called around so I could still try that. I do know of a cardiologist in town who does heart scans using a regular CT scanner (with higher radiation exposure).

If you were me, what would you do? Would you forgo the follow-up coronary calcium scan, given these recent test results, or would you find some way to get a scan done, even if it's with a regular CT scanner?

On my 6/16/16 Quest Cardio IQ test results, my LP PLA2 (a marker for vascular inflammation) was in the moderate range at 216. Here are the ranges: Optimal <200; Moderate 200-235; High >235. I've attached the complete results at the end of this post. Note that my HS CRP was elevated because I had fallen and injured my knee. A follow-up test showed my HS CRP well below normal.

FYI, Life Extention explains the purpose of these two tests.

Thanks for any input!

MPO and OxLDL results - 6-5-2017.png

Quest Diagnostics 6-16-16 3 of 6.png

[Tincup]

In the Raggi paper, they tested after 3 years. So you may want to wait a bit to test. Also, what they were looking at was a change in volume - target less than 15% annual increase.

Gundry has us use perilla oil, which he says has the highest percentage of ALA (alpha linolenic acid). I believe there are studies showing that ALA will lower Lp PLA2. In some of the studies, a 2-3 grams a day was sufficient.

[SusanJ]

allyson I would wait. My hub's cardiologist said that a year doesn't give you any good information, and sometimes it looks worse because it takes time to turn the ship around. In fact, he never suggested another after my hubby got into treatment after the first.

The 3 year test is probably a good one to follow if you feel you need to monitor the progress.

[TheBrain]

Thank you, George and Susan. My mind has been eased greatly. I will wait. I wonder why I was advised by the woman at the imaging center to be retested in a year, given what you both have shared.

George, thank you for telling me about perilla oil. I will definitely look into adding that to my regimen.

[SusanJ]

Ok, on soap box. Money. They want to keep booking patients. Off soap box.

[Julie G]

And, this test is not without risk...grrrr. Radiation exposure is cumulative. George & Susan are spot on. Wait. Things are unlikely to have changed much. Congrats on your new biomarkers- nice! Did you ever check oxLDL before?

[Tincup]

Thank you, George and Susan. My mind has been eased greatly. I will wait. I wonder why I was advised by the woman at the imaging center to be retested in a year, given what you both have shared.

George, thank you for telling me about perilla oil. I will definitely look into adding that to my regimen.

Alysson,

Did your formal report have a retest period on it?

At one point, I had an email conversation with Dr. Blanchett in Boulder. I was asking the statistical question, "if the test shows > 15% volume difference/year, what is the probability this difference is real?" I never got a satisfactory answer. A year ago, I did look into repeat testing accuracy for EBCT scanners, and came up with some formulae. However I'd have to go back and reconstruct now.

[TheBrain]

I hear you, Susan. I appreciate your soap box comments.

Julie, this is the first time I've had my OxLDL tested. Of course, I wish I had it tested before!

George, here's what my formal report says about retesting: "Repeating the EBT heart scan, no sooner than 1 year after making appropriate modifications, will provide you with a measurement of the success of these treatments. It is important to note that only EBT calcium scoring technology has been shown to be precise enough to do serial imaging." (I didn't recall that I should only do EBT scans going forward. Hmm...)

And: "It is recommended to repeat the EBT scan in 1 year to determine if there has been a measurable increase in the coronary plaque disease."

I am taking the recommended dose of fish oil (at least 2,000 mg of omega-3 daily), and I'm following the recommended "relatively low carbohydrate intake." Of course, I've gone beyond that with a mildly ketogenic HFLC diet. I'm following other recommendations around exercise and other healthy lifestyle interventions.

However, I am not taking the recommended dose of aspirin (80 mg to 325 mg daily) because of my gut issues. Back in 2007, I had a bleeding colon ulcer at my ileocecal valve, and my gastroenterologist suspected it was caused by my use of NSAIDs during my monthly cycle. I stopped taking NSAIDs and have not had a recurrence.

Also, I'm no longer taking the flushing niacin (which was mentioned in the report as a possible intervention, but it didn't end up in the list of recommendations for me). At a dose of 500 mg, I was having terrible, full-body flushing at unpredictable times, sometimes in public, sometimes waking me up in the middle of the night and lasting up to an hour. But frankly, I don't need to lower my triglycerides or LDL. Nor do I need to increase my HDL. So perhaps the niacin is not important in my case. I could tolerate 250 mg well enough, but my understanding is that this low dose is not therapeutic.

[Tincup]

(I didn't recall that I should only do EBT scans going forward. Hmm...)

This may be the pitch from them, and I think it had validity some years ago. A friend has done 6 scans, including 3 EBT's on the same scanner you used. He's a NASA engineer. Here are his comments:

The attached spreadsheet summarizes my CAC scores from April 2013 to February 2017. These data were gathered from 4 separate scanners at two different clinics. Five annual scans would cover 4 years, but I got an extra one just because I’m trying to understand both random and systematic errors. Besides, I’m my favorite test subject!

The spreadsheet tallies all the data available from each scan, as reported by the radiologist, namely the Agatston-Janowitz (AJ-130) and Volume-130 (Vol-130) scores for each coronary artery. I also average the AJ-130 and Vol-130 scores since they are both based on the same raw images.

I plot everything in the attached spreadsheet, but I think the takeaway is that my total score is fully consistent with no change over 4 years. The embedded plot shows my total AJ-130 scores vs. time compared to the exponential growth rate that’s expected without any treatment. I think I can rule out even 20% annual growth (red), but clearly 40% growth (black) is utterly inconsistent with my results (green). I reach a similar conclusion using AJ-130, Vol-130, or their average.


Proponents of certain scanners argue that results from different devices cannot be mixed, but I do not see that in my results. I see as much consistency between different scanners as I do with the same machine. Note that the 2nd, 4th, and 6th data point were obtained with the same Imatron C150 at Front Range Preventive Imaging, yet those images show more apparent change than the others. Is the change real? There’s no way I can know for sure, at least not yet, but I suspect the measured changes are not real.

My LAD (left anterior descending = the widow maker) scores are also consistent with no change, at worst, but it’s hard to know the true errors. Did my Vol-130 really go from 19 to 52 and back to 19 in 16 months? I doubt it. I’m encouraged that my latest measurement is at the lowest end of the distribution.

My RCA (right coronary artery) history seems stable for ~3 years, with the first point being the only outlier. The last 5 measurements are steady at 20 +/- 2.5. Could it be that I had soft plaque that calcified and thereafter was stable? If true, that is a good story, and even Dr. Nissen would agree! Or could the first scan have actually missed some calcium? Of course I can’t go back in time to check.

My LCX (circumflex) scores are interesting. The first 5 epochs show an intriguing steady decline that I once thought was likely to be real, yet my latest image shows a higher score. Was this a false trend, or could some re-calcification have really occurred? We all know that small samples can yield misleading results.

To wit, suppose I was more radiation averse and had fewer scans. Would I reach the same conclusion? If I use just the 2nd and 6th scans on the same “gold standard” system ~3 years apart, most scores are either essentially constant or lower with time. Only the RCA values go up, marginally, and much less so for the Vol-130 algorithm. That evolution would have left me very happy, yet comparing just the 4th and 6th scans resulted in a warning just last week from Dr. Blanchet that my 26% per year calcium growth rate should cause me to reconsider my prevention strategy. Those are very different conclusions pulled from the same dataset!

Dr. Budoff’s research says I should be quite pleased with what I think are stable scores, but I am interested in any counter arguments. In any case I’m not abandoning LCHF for at least another year, despite my most recent TC of 380. I anticipate waiting nearly 2 more years before getting another scan, and perhaps it will be my 61st birthday present in November 2018. However, I haven’t decided what scanner to use.

In this graph, from the left, points 2, 4 & 6 are EBT's

Calcium Volume.png

Here is all the data:

Coronary_Calcium_History_2013-2017.xlsx

[Gilgamesh]

I am taking the recommended dose of fish oil (at least 2,000 mg of omega-3 daily), and I'm following the recommended "relatively low carbohydrate intake." Of course, I've gone beyond that with a mildly ketogenic HFLC diet. I'm following other recommendations around exercise and other healthy lifestyle interventions.

Hey Alysson. What else was recommended?

I just saw "minimal aortoiliac calcification" on my scan report for the kidney stone. Not sure what "minimal" means, but after all my years of careful lifestyle choices, I'm stunned it's not zero. (But there were periods of breaks from CR, and maybe my current high fat diet isn't working for me.) So now I have another thing to think about.