Health and Disease, Uncategorized

Lipoprotein(a): the Other ‘Bad’ Cholesterol

Health and WEllness Associates

EHS – Telehealth

 

Lipoprotein(a): the Other ‘Bad’ Cholesterol

There’s a simple blood test your doctor can order to detect Lp(a).

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YOU’VE PROBABLY HEARD about low-density lipoprotein, or “bad cholesterol,” but did you know there’s another cholesterol that may be equally bad? Called lipoprotein(a), or Lp(a) – L-p-little-a – for short, it’s a cause of heart attacks, strokes, aortic valve disease, peripheral vascular disease and blood clots. And it’s not picked up by standard cholesterol tests you may receive at a doctor’s office. So, what’s the good news? There is a simple blood test your doctor can order to detect Lp(a), and there are potential treatment options if your level is high. Here’s what you need to know about Lp(a).

 

What Is Lp(a) and Why Is it Important?

 

Lp(a) is structurally similar to LDL or “bad cholesterol.” Like LDL, it’s a small protein carried in the bloodstream that transports cholesterol, fats and proteins to organs in the body. At high levels, Lp(a) may deposit in blood vessels and cause atherosclerosis, or plaque buildup, in vessel walls. Plaque buildup causes blood vessel narrowing and reduces the blood supply to vital organs such as the heart, kidneys and brain. Lp(a) may also get in the way of other molecules in the body that help break up clots. As a result, people with high Lp(a) levels are more prone to developing blood clots that may manifest as heart attacks and strokes.

 

The standard cholesterol/lipid panel of tests taken at a doctor’s office doesn’t include an Lp(a) blood test. They measure total cholesterol, high-density lipoprotein (HDL) – or “good” cholesterol – and fats called triglycerides. LDL is typically calculated from these values. Historically, clinicians have focused on LDL because high levels were shown to cause heart attacks and strokes. Like Lp(a), LDL enters blood vessel walls and may cause significant atherosclerosis. However, recent studies have discovered that other cholesterol particles, such as Lp(a), may also independently cause heart disease irrespective of LDL values.

 

According to the Lipoprotein(a) Foundation, nearly 63 million Americans and approximately 1 billion people globally have high Lp(a) values. Nearly 1 in every 5 people have elevated Lp(a). With cardiovascular disease remaining the No. 1 killer of Americans, identifying all risk factors, including Lp(a), that lead to cardiovascular disease is critical.

 

 

What Are the Risk Factors, and Who Should Be Screened?

 

Lp(a) is inherited – the value is determined primarily by genes passed along from both parents. People with high Lp(a) levels have a 50 percent chance of passing on high Lp(a) to their children. Other factors such as age, sex and medical conditions such as diabetes and high blood pressure don’t appear to affect Lp(a) value. Without treatment, Lp(a) values tend to remain constant throughout life.

 

Lp(a) may be measured by a simple blood test, which is offered by most major laboratories across the U.S. Values are reported in two ways: either in milligrams per deciliter or nanomoles per liter, with milligrams per deciliter indicating the mass or amount of Lp(a) proteins in circulation and nanomoles per liter reflecting the concentration of all Lp(a) particles present in the blood. Typically, values above 50 milligrams per deciliter or above 125 nanomoles per liter are considered high, but these may vary slightly depending on the lab.

 

Experts advise that the following people may particularly benefit from Lp(a) testing:

 

 

Those with premature heart disease or a family history of early heart disease, defined as a heart attack or stroke in men under age 55 or women under age 65.

People with a condition called familial hypercholesterolemia, in which LDL levels are very high (often above 190 milligrams per deciliter) beginning at birth.

People with a family history of elevated Lp(a), since Lp(a) is genetically inherited.

People with progression of heart disease despite being treated with cholesterol drugs such as statins.

People with more than 10 percent 10-year heart attack and stroke risk according to U.S. guidelines – a recent study in the Journal of the American College of Cardiology found that in women, Lp(a) was more associated with heart disease in those with high cholesterol.

People with premature aortic valve calcification or peripheral vascular disease.

If a person is found to have high Lp(a), first-degree family members (parents, siblings and children) are encouraged to undergo screening as well because of the inheritance risk of Lp(a). As an important recognition that elevated Lp(a) is a specific disease-causing entity, there are now new International Classification of Diseases-10 diagnosis codes for elevated Lp(a) (E78.41) and a family history of elevated Lp(a) (Z83.430) that will go into effect in October of this year. ICD-10 codes are used in health care to classify all diagnoses, symptoms and procedures as a way of recording and identifying health conditions.

 

 

What Are the Treatment Options?

 

While diet and exercise are recommended overall as part a healthy lifestyle to reduce cardiovascular disease, and they can improve other components of a person’s lipid panel, unfortunately lifestyle choices seem to have little effect on explicitly reducing Lp(a) levels. Even statins, which are used to reduce the amount of plaque caused by LDL, have no impact on Lp(a).

 

No specific medication is commercially available to specifically lower Lp(a). If Lp(a) levels are high, a prescription version of the dietary supplement niacin (vitamin B3) may be considered to lower Lp(a) values by as much as 40 percent, however evidence for this approach isn’t conclusive. In severe cases, an option is weekly plasmapheresis, a procedure similar to dialysis in which a machine can help filter out Lp(a) particles from the blood.

 

Research has been promising in the development of drugs specifically targeted for reducing Lp(a). In a 2015 landmark article published in The Lancet, volunteers with elevated Lp(a) levels were randomized into three groups to be administered the new drug ISIS-APO(a)Rx, which specifically targets the genetic material encoding for Lp(a). People in the group receiving the highest dose of this drug experienced an average decrease of nearly 78 percent in Lp(a) values after 30 days. According to a recent article in JAMA Cardiology, it was found that large reductions in Lp(a) are likely needed to produce meaningful benefit in reducing the heart disease risk. With these results, more clinical trials to test the safety and efficacy of these new agents are eagerly awaited.

 

For now, if a person is diagnosed with high Lp(a), experts recommend lifestyle changes and therapies to decrease the overall cardiovascular disease risk attributable to other modifiable risk factors. Strategies may include focusing on lowering blood pressure, eating a heart-healthy diet, losing weight, increasing physical activity, quitting smoking and reducing LDL levels. Aspirin, a platelet blocking drug, can be considered to prevent clots. An individualized plan should be made with a clinician trained in treating elevated Lp(a).

 

 

Take-Home Points

 

Lipoprotein(a), or Lp(a), is another “bad” cholesterol that increases your risk for heart disease and stroke, even when other cholesterol numbers are normal.

Lp(a) isn’t measured in a standard cholesterol/lipid blood test, but blood tests are available to measure a person’s Lp(a) level.

Patients at unusually high risk for cardiovascular disease should ask their doctors about measuring Lp(a). These patients include those with early heart disease or a family history of premature heart disease, familial hypercholesterolemia, a family history of elevated Lp(a) and progressive cardiovascular disease despite optimal medical management.

While we await clinical trials testing the safety and efficacy of new Lp(a) drugs, current treatment revolves around using established therapies to reduce modifiable cardiovascular risk factors.

 

 

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Health and Disease, Uncategorized

Black Lines in Your Finger Nails?

blackllines

 

Black Lines in Your Fingernails—Splinter Hemorrhages or Melanoma?

Have you ever looked down at your hand and discovered black lines in your fingernails? What about your toenails? It can be pretty weird and unsettling, and it can also be the result of some bigger health problems. When red or black lines in the fingernails are vertical in shape, it could be a sign of melanoma or heart disease, so getting it checked out by the doctor is highly recommended.

 

What Are These Black and Red Lines in My Fingernails?

 

Not every black or red line running vertically down your fingernail or toenail is a cause for worry. Sometimes it can be related to a nutritional deficiency or an injury, and other times it can be benign. But sometimes it means cancer.

 

What kind of cancer is represented by black lines in the fingernails? Melanoma; specifically, a type called longitudinal melanonychia. This occurs when there is an overproduction of melanocytes, which are mature melanin-forming cells, in the area of the nail. Sometimes called “nail moles,” these black marks are similar to moles that can appear on other parts of the body (such as your arms, shoulders, face or back), and many times they are not malignant, but all the same they should be checked out by a dermatologist.

Black lines may not always be directly related to mole growth or melanoma, but could also be caused by aging, nutritional issues, arthritis, fungus infections, or a heart infection. Red lines that may develop under your nails are also an indicator that something could be wrong. These red lines, called splinter hemorrhages, can be the result of a heart infection that have caused capillaries to burst. We’ll take a closer look at these later.

 

Are the Black Lines in Your Fingernails Cancer?

Upwards of 75% of the time, these black lines occur on your thumbnail or big toenail, and the severity and prevalence will differ on who you are and your age. Dark-skinned people, for example, are far more likely to see black lines forming under their nails, but they also have more instances where said lines are benign. On the other hand, such lines are far less common in Caucasians, but when they do appear there’s a better chance that it’s melanoma. It should be noted that this type of melanoma, subungual melanoma, is extremely rare, especially in the United States.

 

When melanoma is responsible for the appearance of the lines, your doctor will consider a few things, such as:

 

Age: It’s much more common in those 50 to 70.

Width of the line: If the line is wider than three millimeters, it may be a cause for concern.

Pigment change: If the look of the pigment band at the top of the nail is discolored, it could be an indication that the lines are malignant melanoma.

Where it’s located: The thumb and big toe are the most common locations, followed by the index finger.

The coverage area: If the discoloration extends into the cuticle or nail fold, it could be cancerous. This means that your body is continuing to produce more of whatever’s causing the discoloration.

Family history: If someone else in your family has been diagnosed with melanoma, it could increase the chances you have it.

If you experience any of these symptoms, it’s recommended that you get to your doctor for an examination. There really isn’t much you can do on your own at this point, so it’s important to seek proper medical attention.

 

When Black Lines in the Fingernails and Toenails Aren’t Cancerous

Of course, the black lines in your nails may not be melanoma. As mentioned, they are common in dark-skinned individuals, often without health repercussions. Still, it’s a good idea to show them to your doctor regardless of complexion and age.

 

As mentioned earlier, a fungus could cause the appearance of these lines, or it could simply be a result of aging. It could also have something to do with nerve damage resulting from a chronic condition like arthritis. Sometimes it could even be linked to a nutritional imbalance or deficiency.

 

When it’s a result of nutritional imbalances, then low blood levels of zinc, iron, calcium, or biotin could be the culprits. High levels of selenium may also play a role in forming black lines under the fingernails, so paying attention to diet and supplementation could offer some help. As always, it’s recommended to eat a balanced diet packed with nutrients. When your diet is made up primarily of vegetables, fruit, healthy fats, animal protein, and whole grains, you’ll be getting adequate amounts of all the nutrients you need. Taking a daily multivitamin to fill in the gaps can be a good idea, but it shouldn’t be used as your primary source of nutrition.

 

Are the Black Lines in Your Fingernails Heart Disease?

Black lines can signify some further health troubles, but so can reddish or brown ones. These lines, mentioned earlier, are called splinter hemorrhages and indicate small areas of bleeding beneath the nails. These thin red lines run vertically down the nail, and basically look like splinters, from which they draw their name. These can occur for a number of reasons, and sometimes it can be an indicator of heart disease or cardiovascular problems.

 

Splinter hemorrhages may be caused by small blood clots that damage the small capillaries beneath the nail. They can also occur as a result of:

 

An infection to the heart valve (also called endocarditis);

Vessel damage from swollen blood vessels (vasculitis); and

A bacterial infection resulting from an injury to the area.

Damaged blood vessels can be caused from a variety of factors and they can appear in other areas of the body, as well. The eyes and nose are other places where this is seen, and can be a result of stress or heart troubles. To combat this from occurring, it might be worthwhile to explore some lifestyle changes including more exercise, an improved diet, limiting stress, quitting smoking, limiting drinking, and trying to find ways to get better sleep.

 

Black Lines in the Nails during Pregnancy

Pregnant women may also notice black lines or spots under their nails, or on other areas of the body. This is really nothing to worry about and should subside shortly after the pregnancy has concluded. Pregnancy prompts all kinds of hormonal changes, one of which can be accelerated melanin production.

 

Beyond Cosmetics: You Can’t Just Cover Up Black Lines in Your Fingernails

If you notice tiny black lines in your fingernails, there may be something severe causing it, with the worst-case scenarios being cancer in the form of melanoma or heart disease. If you notice these lines forming, please, don’t ignore them and go see your doctor as soon as you can.

 

Please share with family and friends.  Always call us with your concerns or questions, or picture of your fingernails.

 

Health and Wellness Associates

Archived: Marchione

312-972-Well

Foods

The Allium Family

oniongarlic

The Allium family of vegetables includes onions, garlic, leeks, chives, shallots, and scallions. Epidemiological studies have found that increased consumption of Allium vegetables is associated with decreased risk of several cancers. For example, one large European study found striking risk reductions in the participants who consumed the greatest quantities of onions or garlic for oral, esophageal, colorectal, laryngeal, breast, ovarian, and prostate cancers. A fifty-five to eighty percent reduction of almost all major cancers. Amazing!1

Anti-cancer effects of onions and garlic Allium vegetables are rich in cancer-fighting organosulfur compounds, which are produced when the cell walls of the vegetables are broken down by chopping, crushing, or chewing. These compounds are thought to be mostly responsible for the cancer-protective effects of Allium vegetables. In scientific studies, organosulfur compounds prevent the development of cancers by detoxifying carcinogens and halting cancer cell growth. These garlic and onion phytochemicals are also anti-angiogenic, which means that they can prevent tumors from obtaining a blood supply to fuel their growth.2 In studies of breast cancer cells, garlic and onion phytochemicals have caused cell death or halted cell division, preventing the cancer cells from multiplying.3-5

Onions, garlic, and their family members also contain flavonoids and phenols. White onions are not as rich in these antioxidant compounds as yellow and red, and shallots are especially high in polyphenol levels. Red onions are particularly rich in anthocyanins (also abundant in berries) and quercetin.6 Flavonoids such as quercetin can contribute to preventing damaged cells from advancing to cancer, and also have anti-inflammatory effects that may contribute to cancer prevention.7-1

Fighting Heart Disease

Consuming onions and garlic also might help you prevent heart disease. Onions are rich in natural chemicals called flavonoids, which can protect you from heart disease, says Vegetarian Nutrition.info., and onions also might reduce your risk of blood clots, which can lead to heart attacks and other forms of heart disease. Garlic might also decrease your risk of blood clots, help keep your arteries flexible and help reduce your blood pressure, the Linus Pauling Institute reports.

Onions and the other vegetables of the Allium family can be added to any and every vegetable dish for great flavor and anti-cancer benefits. Remember that they must be eaten raw and chewed well or chopped finely before cooking to initiate the chemical reaction that forms the protective sulfur compounds. When you cut onions and your eyes begin to tear, they are creating the anti-cancer sulfur compounds.

Adding Onions and Garlic to Your Diet

Allium vegetables such as onions and garlic are the richest food sources of healthy sulfur compounds, which recommends eating them regularly to obtain their full health benefits, rather than taking supplements that might contain widely varying amounts of the healthy compounds. Onions and garlic have complementary tastes, so you might eat them together in the same meals. You can also add onions to stir fry dishes and use them to flavor soups, salads and dips. The Linus Pauling Institute recommends eating garlic cloves raw, or crushing or chopping garlic cloves before cooking them to help them retain their beneficial compounds during the cooking process.

How to cut an onion to maximize anti-cancer compounds and minimize eye irritation:

  • Make sure that the onion is cold before you cut it. Even putting the onion in the freezer for 5 minutes is sufficient.
  • You can use a fan to blow the gaseous compounds away from you if you like.
  • Cut the end of the root off with the root facing away from you, preserving as much of the onion adjacent to the root as possible. The root is the part of the onion with the highest concentration of these anti-cancer compounds.
  • Make sure to then cut or chop the onion finely, slice thinly, or put it in a food processor before adding to your soup, salad, or vegetable dish to maximize the production of sulfur compounds.

References 1. Galeone C, Pelucchi C, Levi F, et al. Onion and garlic use and human cancer. Am J Clin Nutr 2006;84:1027-1032. 2. Powolny A, Singh S. Multitargeted prevention and therapy of cancer by diallyl trisulfide and related Allium vegetable-derived organosulfur compounds. Cancer Lett 2008;269:305-314. 3. Modem S, Dicarlo SE, Reddy TR. Fresh Garlic Extract Induces Growth Arrest and Morphological Differentiation of MCF7 Breast Cancer Cells. Genes Cancer 2012;3:177-186. 4. Na HK, Kim EH, Choi MA, et al. Diallyl trisulfide induces apoptosis in human breast cancer cells through ROS-mediated activation of JNK and AP-1. Biochem Pharmacol 2012. 5. Malki A, El-Saadani M, Sultan AS. Garlic constituent diallyl trisulfide induced apoptosis in MCF7 human breast cancer cells. Cancer Biol Ther 2009;8:2175-2185. 6. Slimestad R, Fossen T, Vagen IM. Onions: a source of unique dietary flavonoids. J Agric Food Chem 2007;55:10067-10080. 7. Ravasco P, Aranha MM, Borralho PM, et al. Colorectal cancer: can nutrients modulate NF-kappaB and apoptosis? Clin Nutr 2010;29:42-46. 8. Miyamoto S, Yasui Y, Ohigashi H, et al. Dietary flavonoids suppress azoxymethane-induced colonic preneoplastic lesions in male C57BL/KsJ-db/db mice. Chem Biol Interact 2010;183:276-283. 9. Shan BE, Wang MX, Li RQ. Quercetin inhibit human SW480 colon cancer growth in association with inhibition of cyclin D1 and survivin expression through Wnt/beta-catenin signaling pathway. Cancer Invest 2009;27:604-612. 10. Pierini R, Gee JM, Belshaw NJ, et al. Flavonoids and intestinal cancers. Br J Nutr 2008;99 E Suppl 1:ES53-59.