Please help me understand what this paper means.
I believe LDL-TG refers to “Low density lipoprotein triglycerides,” which is the amount of triglycerides found within low-density lipoprotein (LDL) particles in the blood.
My understanding of what you quoted from the paper is:
- ApoB and LDL are positively correlated with atherosclerosis if you’re not taking statins (higher ApoB → higher atherosclerosis). Though looking at the chart, there seems to be a sweet spot somewhere between 75-125 for LDL and 50-100 for ApoB
- If we add the cohort of people that’s on statins, there’s a high incidence of atherosclerosis at low ApoB and LDL. The authors believe that’s because some people are on aggressive statin therapy because they already have atherosclerosis, i.e. the high atherosclerosis came before the statins and resulting lower ApoB and LDL.
- LDL-TG is the most direct indicator of atherosclerosis. The relationship is quite impressive, almost a perfect predictor.
Does anyone know of any blood test that measure LDL-TG? And any remedies to keep it low?
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My mother had low LDL (38) but high Triglycerides (240). She had a heart attack and stroke. Low LDL is not enough. She is also diabetic 8.8 HBA1C. I believe the diabetes and triglycerides (from all the wrong foods) caused her heart attack and stroke. Luckily she had very quick treatment so the damage was minimized. She had the heart attack while her heart was being monitored in the hospital.
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mccoy
#1465
The article sure is not an easy one to understand. Graph 1 is clear enough though, the markers with higher positive correlation with ascertained ASCD (by imaging plaque measurements) are those in cluster 1= DA, AMDA, Log.IL6 mainly. but even the other markers, i cluster 1, exhibit some positive correlation.
Then there is the pretty clear explanation in the conclusions.
A key finding was that, out of tens of thousands of
blood-based molecules and biomarkers, LDL-TG emerged with
a potential central role in human coronary atherosclerosis,
potentially as a function of abnormal hepatic lipase activity.
This was seen in our hypothesis-free, causal, Bayesian network
analysis, which included 24,929 variables and 110,350 significant
edges in the models. LDL-TG was directly connected to human
coronary atherosclerosis in 95% of the models in the ensemble.
As a comment, OR is about the same as HR, the LDL-TG shows a more congruous trend, with small ORs at very small LDL-TG quantities
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AnUser
#1466
If LDL is low but triglycerides are high, with untreated diabetes, that probably means there were discordance between LDL and apoB and apoB was either normal or elevated. Having a normal or high apoB causes disease over time many decades, and diabetes is not good for anything and increases risk.
Just measure apoB…
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Just measure apoB…
ApoB does not look like a great replacement for LDL-TG, especially for statin users.
Paul
#1468
Anyone have these Hart tests by Provencio?
Claims are that 86% accurate at predicting one years heart/ stroke risk
Any independent 3rd party validation of their claims? False positives?
"The Future”: the only marketed prognostic blood test for 1-year risk of heart attack (MI), stroke or cardiac death (MACE or major adverse cardiovascular events). Yielding an accuracy of 86%, HART CVE™ assesses four clinically significant blood proteins in a machine learning (AI) algorithm to calculate a patient- specific risk score. Proteins include:
- NT-proBNP- associated with myocardial (heart) stress
- Kidney Injury Molecule-1 (KIM-1)- associated with cardiorenal dysfunction and injury
- Osteopontin (OPN)- associated with calcification and plaque formation
- Tissue Inhibitor of Metalloproteinases-1 (TIMP-1)- associated with plaque rupture potential and left ventricular enlargement and dysfunction
The Here and Now”: diagnostic blood test for obstructive coronary artery disease. Yielding an accuracy of 86%, HART CADhs™ assesses three clinically significant blood proteins and three clinical variables (age, sex, history of coronary intervention) in a machine learning (AI) algorithm to calculate a patient- specific risk score of obstructive coronary artery disease. Proteins include:
- hsTroponin- associated with myocardial ischemia and injury
- Kidney Injury Molecule-1 (KIM-1)- associated with cardiorenal dysfunction and injury
- Adiponectin- associated with glucose and fatty acid metabolism
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AnUser
#1470
Thomas Dayspring have said it’s a surrogate for apoB. If that paper is enough evidence for you, you can always measure both.
adssx
#1471
This preprint ( Obicetrapib (CETP inhibitor for dyslipidemia) - #130 by adssx ) quantifies the effect of cumulative LDL exposure on cardiovascular risk: HR 0.69 per 10–mmol/L×years; 95% confidence interval, 0.52–0.90; P=0.007
10 mmol/L = 387 mg/dL. So, if you reduce your LDL by 38.7 mg/dL over 10 years, you reduce your cardiovascular risk by 0.69?
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Thomas Dayspring have said it’s a surrogate for apoB.
Thomas Dayspring might have said that, but the paper definitely does not. “Adjusting the model for age, sex, LDL-C and ApoB levels demonstrated that the association of LDL-TG with atherosclerosis was independent of these well-known factors [, including ApoB].”
Just look at the chart for the population in the study for ApoB and LDL-TG. You could be patting yourself on the back for having lowered your ApoB < 50 with statins, but your LDL-TG could still be elevated, increasing your CAD risk.
you can always measure both.
I would love to, know how I can get a measure of LDL-TG? I looked at sites like RequestATest.com and couldn’t find one.
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Yoo
#1474
Isn’t LDL-TG just a composite marker of LDL-C and triglycerides (which we know are both independently related to CVD)?
If this is the case, since apoB is better than LDL-C wouldn’t apoB and triglycerides together be more predictive for disease than LDL-TG alone?
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AnUser
#1475
Looks like that study method is B.S. with a B.S graph.
50 apoB doesn’t have the same risk as 120 apoB. Just another fake U-shape curve with residual confounding.
It would be nice if there was a way to get LDL-TG from TG and LDL-C. I couldn’t find any resource online to do that. FWIW, I asked ChatGPT and got the following.
It is not possible to calculate LDL-TG (low-density lipoprotein triglycerides) directly from a standard lipid panel because such panels typically report:
- Total cholesterol
- High-density lipoprotein (HDL) cholesterol
- Triglycerides
- LDL cholesterol (calculated or measured)
The triglycerides reported in the standard lipid panel reflect all triglyceride-rich lipoproteins, not specifically those in LDL particles. LDL particles typically contain very little triglyceride, and LDL-TG levels are not routinely measured in standard clinical settings.
Methods to Estimate LDL-TG
To measure or estimate LDL-TG, specialized techniques like ultracentrifugation or nuclear magnetic resonance (NMR) spectroscopy are required. These methods separate LDL from other lipoproteins and allow for direct triglyceride content analysis.
If you’re interested in exploring this, it’s best to consult with a healthcare provider or a lipid specialist to discuss the need for advanced lipid testing.
EDIT: @adssx shares a way to estimate LDL-TG here.
adssx
#1477
Formulas are here: Cardiovascular Health - #1451 by adssx
But that’s only the estimated LDL-TG (eLDL-TG). If you want to find your real LDL-TG you need to test it but as you said it’s not commercially available in most labs.
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The bottom line is that small LDL particles tend to stick to arterial walls, causing arteriosclerosis.
Large particles do not tend to stick; is this not true? Am I missing the point?
If this is the case, then the best measurement that is commonly available for a reasonable price is:
HDL P
HDL SIZE
LARGE HDL P
LARGE VLDL P
LDL P
LDL SIZE
SMALL LDL P
VLDL SIZE
Here is a real example of my lipid tests taken at approximately the same time.
The conventional lipid tests all fall within acceptable margins.
However, the Lipoprotein Fractionation NMR test shows that not all is well.
LIPOPROTEIN FRACTIONATION NMR:
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They tend to stick less than small particles but contain more cholesterol so overall the net effect is the same for both types.
Imagine a cal 50 BMG round hitting you once or 9mm bullets hitting you 10 times. In both cases you’d end up dead.
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AnUser
#1480
It’s not the impact that matters most of the time, it’s the amount of bullets, so the 10 9mm bullets would be more harmful to the arterial wall in this context… that’s what apoB measures.
Not sure about LDL particle sizes. LDL-TG is a component of LDL, so maybe LDL size doesn’t matter as much?
Using your lipid values to estimate LDL-TG, I get 31 mg/dL. Per the paper, ideally you would want this below 20. In your case, the main target would be lowering triglycerides. But who knows, the estimate only has a R2 of 60%, so there’s a lot of room for error.
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