Plus a risk Factor you may not have heard of “LP little a“
Eighty percent of heart attacks would be avoided if we all adopted a healthy lifestyle.
Unfortunately, that still leaves twenty percent of the commonest cause of death worldwide, that is unavoidable.
Ageing is by far the commonest risk factor for cardiovascular disease (heart attack, stroke, sudden death worldwide.) This is a fact of life that we cannot alter. Smoking, an Ultra-processed food diet and Inactivity are three of the major risk factors that we could control but overall,don’t. This also predisposes us to the other metabolic pandemics of Obesity, Type 2 Diabetes, Dementia, Fatty liver disease etc, etc, etc.
The story of my heart attack (a lucky chump!)
In early September 2021 I was out on my usual hilly cycle when I noticed an odd sensation at the top of my chest which lasted for a few seconds as I crested a hill only to reoccur on the next steep hill. However, a further downhill stretch of about eight miles was fine & the return journey up a long gradual incline was without any problems. I spent a normal afternoon working in the garden had a bodyweight exercise session followed by a strenuous swim in a counter-current pool and slept like a “baby.”
When working in the NHS I had run a Rapid Access Chest Pain Clinic where my mantra had been
“any discomfort between the nose and the belly button was heart related until proven otherwise”.
I ignored this sensible thought as I was evangelical regarding healthy living and practiced what I preached so it couldn’t be my heart!
The next day’s cycle was identical (an awareness with very heavy exertion lasting only seconds.) The third day was slightly different as my chest awareness returned on a slight incline about half a mile from home but again lasted only seconds. The following morning a Saturday (I don’t cycle at weekends) I became aware of the same chest feeling when simply walking and spilt the beans to my wife, a retired GP who on discussion with my daughter a current GP both decided that it must be my heart and I was an idiot to have ignored it.
Within an hour I was in the Accident & Emergency department of my local Hospital where I had been a Consultant Physician with my ECG showing severe strain and irritability with runs of tachycardia (a rapid heart rate). I was advised transfer to the local Cardiac Intervention Centre fifty miles away in Exeter for observation. About twenty minutes prior to arrival in Wonford my symptoms returned, and the monitor showing an acute STEMI (ST Elevated Myocardial Infarct) a heart attack! I was taken directly to the Catheter Lab where my blocked major artery was reopened, stented and two further critical narrowing’s in a second artery similarly sorted.
Prior to discharge two days later an echocardiogram (heart scan) showed that my pumping chambers were working well but my Aortic valve was a little narrowed which was a surprise. The fats in my blood confirmed my healthy living with the “so-called” good Cholesterol being extremely good & the bad Cholesterol at an acceptable level so it must be my age or was there another risk factor?
LP Little a
A private blood test (not eligible for testing on the NHS due to my age 75+) unfortunately revealed my level of LPa to be around five times higher than normal, tripling my already high risk of a recurrent heart attack but also stroke and Aortic valve narrowing – happy days!
What is it & why it is a risk factor that’s time is coming?
Discovered nearly sixty years ago LPa has not hit the headlines in Cardiovascular disease as it is a genetic trait that cannot be altered by lifestyle. Significantly raised in around 15% of the world’s population, being highest in blacks and Southern Asians.
Nerdy stuff (Mainly for Medics)
LPa is produced by the liver and can be regarded as bad cholesterol with a “Velcro” like attachment sticking to the walls of blood vessels and allowing increased penetration of the inflammatory fat. The molecule also reduces the breakdown of blood clots, the combination unfortunately predisposing to heart attack, stroke and the progression of Aortic valve narrowing.
Fun stuff not for the nerds!
What has Danish Pastries to do with heart disease? Apart from causing weight gain.
Clue! A Kringle is a traditional Danish Pastry characterised by its looped appearance. This name is also used to describe the looped chains of amino acids that are seen in the LPa molecule
The good news is that a current drug trial is underway which hopefully will show that a manufactured anti-sense oligonucleotide** will radically reduce (hopefully by over 80%) the production of LPa by the recipient.
** A short length of modified messenger RNA that prevents a specific protein from being manufactured
A progress report : –
A plant rich Mediterranean type diet without ultra-processed food remains my staple eating pattern (Unfortunately my brief stay in Coronary care was a desert as far as heart-healthy eating!)
I returned to cycling after two weeks of brisk walking, fortunately without any discomfort and bodyweight strengthening exercise and vigorous swimming are now back on my regular agenda.
A cocktail of drugs that will further reduce my “bad “Cholesterol although unfortunately not affecting my LPa (Some Statin drugs do appear to raise it!)The medications that help keep my stents clear of blood clots should hopefully further protect me from increased risk in the future.
It is likely that in future Cardiovascular Risk Assessment in the U.K. will include a one off LPa measurement so that high risk individuals and their families can be identified, and disease progression hopefully avoided.
Fingers & toes crossed for the future!!!
Dr. Andy Latham