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This is a nicely-designed study. For decades, we've known that inflammation is a risk factor for heart attacks.

In this study, the researchers designed a custom antibody that binds to oral bacteria. Then they used histological staining to identify specific biofilm structures inside the atherosclerotic tissue. Bacteria released from the biofilm were observed in heart attack cases, which gives us evidence that when the body's immune system responded to these bacteria, it triggered inflammation which ruptured cholesterol-laden plaque. So now we have more insight into the mechanism behind why inflammation is associated with heart attack risk.

The "pantheon" of risk factors for heart disease are:

* hs-CRP (inflammation): the mechanism studied by this research. High inflammation roughly doubles your risk of heart disease.

* ApoB - 20% of people with normal cholesterol will have abnormal ApoB, and be at risk of heart disease (ApoB is a structural protein in lipoproteins which cause arterial plaque).

* Lp(a) - the strongest hereditary risk factor for heart disease (Lp(a) acts as a multiplier on ApoB, since it camouflages cholesterol particles from your liver)

* HbA1c - insulin resistance /diabetes is a risk factor for just about everything.

* eGFR - estimates the volume of liquid your kidneys can filter, and is an input to the latest heart disease risk models (PREVENT).

All of these risk factors can be measured with a blood test + doctor review. Easy to order online: https://www.empirical.health/product/comprehensive-health-pa...

12 comments

You should probably disclose that the order link at the end of your post goes to your own company.

Basic LDL cholesterol and triglycerides blood panels are still an essential part of heart disease bloodwork, too.

I would suggest most people start by asking your doctor for some of these tests at your next annual checkup, as many of them and the doctor visit are likely covered by insurance. The ACA has special handling for routine annual checkups, so don’t assume it’s going to be expensive until you’ve checked the cost with your insurance. A routine bloodwork panel will also include a number of other important measures that are routine and very cheap. It’s helpful to have all of these on your medical record so trends can be identified over time.

Fwiw, since it seems like a number of people on here have Kaiser, my experience asking my Kaiser pcp for these as a mid-30s otherwise healthy person:

-lp(a) and apob were covered

-ldl is computed on the standard panel, not an actual measurement

-accidentally got lp(a) twice and it varied quite a bit, so they may use different labs that are calibrated differently

-hs-crp is not offered

-doctor didn’t seem particularly aware of the more “niche” tests but was open to putting them in during my yearly physical

Basic LDL cholesterol is often covered by insurance, but ApoB, Lp(a), and hs-CRP are unfortunately usually not. If insurance doesn't end up covering it, sometimes the fee is just ridiculous.

For example, one person got billed $1,338 for just an ApoB test when insurance denied coverage: https://www.reddit.com/r/PeterAttia/comments/14a4an1/apob_te...

Part of why we do cash pay (and pre-negotiated pricing with the labs) is that you avoid weird catastrophic scenarios like this. The price is upfront and transparent.

(It's too late to edit the original post, but my affiliation is on my HN profile.)

I'm curious how you managed to get access to testing centers in NYC. I thought there was a law that restricted this last I checked.

In our case, we're providing the testing as part of a comprehensive program (including a review of results with a doctor, customized nutrition plans, etc) -- so it's slightly different than companies that only offer the labs in isolation.

IANAD, but

1) Isn't ApoB measurement pretty much in tandem with LDL, VLDL, and triglycerides? I realize it's being recognized now as the necessary factor for arterial dysfunction, but it seems like a lot of hoopla is being made as if it were some "silent" overlooked factor when for the vast, vast majority of people their ApoB levels are entirely explained by the other 3 lipid panel line items carrying it, and they have been in use for decades and are strongly targeted by the medical establishment

2) Isn't Lp(a) a separate lipoprotein altogether which is an independent risk factor for MACE? I've never heard of it "disguising" other cholesterol in testing.

1) ApoB itself is more accurate than LDL and triglycerides. The latest evidence is that ApoB and Lp(a) together are more accurate than even LDL, VLDL, non-HDL, triglerycerides, etc combined: https://academic.oup.com/eurheartj/article-abstract/46/27/27...

2) The terminology is confusing, but each Lp(a) particle is "just" a cholesterol particle wrapped with an extra protein, apoprotein (a). So each Lp(a) particle includes one ApoB molecule (the structural protein in atherogenic cholesterol particles) and many cholesterol and triglyceride molecules, but the extra protein makes each Lp(a) particle about 6x more atherogenic than a typical cholesterol particle.

you're correct

there's a small subset of people with more atherogenic triglycerides that ApoB picks up over and above just tracking with the LDL, but...you probably knew that just looking at them

For lipids, besides the named tests, HDL, LDL, and triglyceride tests are older but shouldn't be overlooked.

For measuring inflammation, besides hs-CRP, additional tests are relevant and overlooked: regular CRP, ESR, and homocysteine.

Additionally, a heart attack can result from parasite induced inflammation too, e.g. in chagas disease, which is becoming increasingly common in the US while being very undetected without explicit testing. It is also very difficult to treat, but the gist 4196f31d12a43a95756e792500ff516f has some info on treating it. Lyme disease too can harm the heart permanently. In both cases a pacemaker could help as applicable.

Can you expand more on why you'd want regular CRP over hs-CRP (specifically for cardiovascular risk)?

For homocysteine, one proxy is B12 or folate (which are more cost-effective to test). To my knowledge, ESR is used in certain rheumatologic conditions, and was used more often in the past, but isn't currently used for heart disease.

It is true that hs-CRP is relevant for cardiovascular risk. CRP and ESR are more for broader inflammatory risk, for acute and chronic values respectively.

Understanding this is a shameless plug, it's very cool this exists.

You don't need to use this specific blood test, by the way. Any lab near you will test these biomarkers for you.

I live in Canada, despite being free this would be way more complicated to get. I don't want to be political, but just paying for this would be very appealing.

I live in Greece, I can go to a lab, order this, and pay for it. I actually did, the other day, though it was free because the government happens to be running a Lp(a) testing program right now.

Can you not get private labs in Canada?

I've always thought you need a requisition from a doctor, you can't just go pay for something, that's the only way I've seen it done. At least I've never seen services like the OP advertised, that's why I was stricken by it.

(Happy to be corrected)

Interesting that you can do this in Greece. In the US, a doctor has the order the labs. (Direct-to-consumer lab testing technically exists, but is always ordered by a doctor.)

What is the purpose of running lp(a) testing, if i may ask? Just for knowing the risk factor and dealing with it? As far as i know there is no easy way for dealing with it once and for all times (gene editing...)

There are easily accessible direct-to-consumer startups in Canada that do this sort of testing.

I did mine a while back with Nia Health. Every marker on the OP’s list was included. You will have to pay out of pocket, but the cost was not unreasonable when i did it.

Thank this looks interesting though I do see it's a very early stage startup (and inexplicably subscription based which appears to just be a naked cash grab).

I’ve used getmaple.ca for this kinda thing. You end up using web chat to ask a NP for what you want and it gets done. All said, lack of private medical care in general has played a big part in stopping me moving to Canada.

I live in Romania. You can have whatever test you want if they can do it. Mostly they can at least in our central area. No doctor's note needed.

Lots of Canadians come to the USA as medical tourists and pay out of pocket for treatments they can't get (or have to wait for) at home.

Seriously. It's infuriating how hard it is to get "non-essential" diagnostics.

It being an ad casts suspicion on the entire post.

There’s plenty of incorrect information on the internet. We should all be skeptical of claims like this regardless of who makes them.

It still casts suspicion? That doesn't change anything.

The standard risk model based on SCORE-2 and PREVENT like parameters are very poor as reported in the recently published paper on the their accuracy performance by the Swedish team [1].

>All of these risk factors can be measured with a blood test + doctor review

As all CVD risk stratification with cardiologist review, the most important accuracy is sensivity (avoiding false negative that will escape review) of SCORE-2 and PREVENT, 48% and 26%, respectively [1].

The paper alternative proposal increased the sensitivity to 58% by performing clustering instead of conventional regression models as practiced in the standard SCORE-2 (Europe) and PREVENT (US).

These type of models including the latest proposal performed very poorly as indicated by their otherwise excellent and intuitive display of graphical abstract results [1].

[1] Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models:

https://academic.oup.com/eurjpc/advance-article/doi/10.1093/...

For what it's worth, I did one of these sorts of heart health blood panels, which showed everything as fine except for hs-CRP which was something like 8x what it should be.

I took it to the doctor, doctor just shrugged it off and said it's probably fine and I might have just been fighting off a cold.

Do you happen to know how much that test costs? (Clicking a link to try to find out brought me to a page that asks for my zip code.)

> Do you happen to know how much that test costs?

FYI the person who posted the link is cofounder of the company he linked to.

You can ask your doctor to order these tests at your annual checkup, too.

That panel is $190.

in the US? There was a question from Canada

Yes -- in the US. I'm not super familiar with the options in Canada, unfortunately!

Is the fat rapture because the body wants fat to release vitamins and other stuff to help power itself to fight off the bacteria?

What's the recommendation for someone with a hilariously high Lp(a)? Just pin LDL as low as possible?

Currently yes. There are some really promising drugs in the pipeline that are doing well in trials, though.

So is poor oral hygiene a risk factor?

It's been known for years that bad oral health leads to heart disease.

What do you do next if one is high? See your Doctor?

Yeah. If you don't have obvious symptoms, they'd likely prescribe you a statin, metformin, or some sort of dietary intervention. But you'd want to discuss it with your doctor in any case...

This particular panel includes a consult with a doctor (who can advise on next steps, prescribe medication, and so on). Or you can take the results to your doctor.

are you a cardiologist? Excellent points, thanks

Not a cardiologist, but adjacent to this type of research. I'm an MLE but have published research in cardiology.

TIL MLE = Machine Language Engineer. It wasn't listed in Google's AI overview, although I did get

Major League Eating (MLE): a professional organization focused on competitive eating contests.

Mister Leather Europe (MLE): an event within the European leather subculture.

I've never heard of machine language engineers. Machine learning engineer, on the other hand, is a fairly common title nowadays.

Really any of the three would be qualified.

thanks for your input on this