Am I getting into trouble asking for a lipoprotein a

M

Mark K

Guest
Here's a question for some of the AME's or anyone else with some insight that I'm curious about.

Considering third class medical--

I have a reasonable cholesterol, but a family history of early CAD. That consists of a father who was a three PPD smoker. I don't have established cardiovascular disease. Well, with the exception of well controlled HTN. My 10 year risk from the PREVENT calculator is ~6-7%. Lipoprotein a could sway me towards a statin. I mean, did I inherit something from my dad or was it his smoking? Lipoprotein a could help answer this. I'm doing all the other things right, Diet, exercise, weight close to bmi target (25.1 working on getting to 24.5)

But, is asking my pcp to order lipoprotein a the lab equivalent of a coronary CT scan? Would it just open a bag of worms with the FAA? Would a high risk value just make them want additional testing?

Thanks in advance. I tried searching but didn't find a great answer. I mean, I guess I could just wait 2-3 years, my PREVENT score drifts up and I take a statin based on the odds, since they will slowly drift up with age...
 
the benefits of taking a statin for someone with no previous CAD or strokes are so small that they approach zero. Not worth the risks...not even close.
Cholesterol is not the risk factor it's made out to be
I don't have time at the moment to dig up some links and references for you...I'll try to remember to come back later to chime back in
....but I've gone down a very deep rabbit hole for almost 2 years now researching this stuff and changing my diet to an animal-based one.
Carbohydrates are probably the most significant thing you need to get under control if CAD is a concern.... (insulin resistance)
 
I agree with lifestyle as the primary treatment of cardiac risk. And insulin resistance is a major problem, from the typical American diet, lifestyle, lack of exercise.

But, full disclosure. I'm a practicing general internist with 25 years' experience. The issue of who needs a statin is well established for some folks. There are grey areas in lower risk individuals. We take a patient's preference into account. Some folks hate the idea of a statin, and certainly, there are enough very well produced YouTube videos to convince everyone to toss their statin. but statins reduce risk markedly for high risk groups.

Still, a fair number of folks with cardiac events (20-30%) have no known cardiac risk factors. So what to do if I have a family history of early MI in my father? He was a 3ppd smoker, overweight, had his fatal MI in an era where bp wasn't controlled, no exercise, terrible diet of the 1960's. I don't smoke, exercise daily, try to practice what I preach about diet. Still try to hike the 9900 foot peaks in the Sierra every couple of weeks here in the summer as well as running and cycling. I've got my bp into the 115-130/70's range and have what would be considered an "average" ldl but a solid hdl in the 60's.

But, what if that's not good enough and I'm still genetically predisposed. Maybe it's not about my dad's lifestyle or my lifestyle. Maybe he had high lp(a)? And maybe I do too? Lipoprotein a is an interesting marker. If I had a very high level, say, over 100, I would strongly consider a statin. If it's under 30, then I stay off a statin for the time being and focus on lifestyle.

But I am also considering 3rd class and don't want to open a can of worms. If I have a high lp(a), does the FAA consider this an issue? Are they going to want further testing? Is it the same rationale as avoiding a coronary CT scan? (which I think can be useful in the right setting, but yeah, think very carefully about having this if you're a pilot...)

Just don't want to make this harder than it will have to be...In medicine sometimes not ordering a test is the correct move...
 
So, one (smoking 3 packs!) parent equals family history? 4 grandparents and mother ok?

Anyway, other threads have recommended consulting with an ame without filing medexpress forms etc so it’s not in the FAA system.

There are several ame posters here but I’m not sure how long it takes for them to appear

Good luck
 
interesting timing... Just this morning in my youtube suggestions, came this video posted by an MD who professes in the "ketogenic space"
discussing one particular graph presented in a published study... I haven't read the study but I have read several others and seen many lectures presenting very similar information...


Mark K said:
......The issue of who needs a statin is well established for some folks. There are grey areas in lower risk individuals. We take a patient's preference into account. Some folks hate the idea of a statin, and certainly, there are enough very well produced YouTube videos to convince everyone to toss their statin. but statins reduce risk markedly for high risk groups.
........
Click to expand...
I wonder if the marked risk reduction you're referring to is the regarding "relative risk" number the drug companies like to present... The absolute risk reduction numbers I've seen are quite small...as in significantly less than 1%. One study I remember reading a long while ago looking at a group of folks that have had a history of coronary events.... and as I recall even in that group taking a statin bought them only a negligible if any benefit. Not the huge numbers I remember hearing from my doctor a long time ago.

here's one study that discusses this relative vs absolute risk issue.
pubmed.ncbi.nlm.nih.gov

How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease - PubMed

We have provided a critical assessment of research on the reduction of cholesterol levels by statin treatment to reduce cardiovascular disease. Our opinion is that although statins are effective at reducing cholesterol levels, they have failed to substantially improve cardiovascular outcomes. We...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I should qualify I'm not a medical professional in any way. I'm a mechanical engineer who became interested in metabolic health pushing two years ago now. Got myself on a deep dive nerding out on this stuff, listening to lectures and interviews by doctors and medical school professors, and even trying to read and understand some published studies in medical journals, which are often not easy reads!

I've become convinced that pretty much nobody should be on statins.
I was pondering this topic a few weeks ago regarding my 87-year-old dad who has been showing strong signs of dementia. He's type 2 diabetic and his diet isn't exactly stellar. He's been on atorvastatin for quite a long time now. That's the same statin I started taking maybe a decade ago. It's a lipophilic statin, and I understand there is evidence to show that this one can cross the blood-brain barrier, and there might be some possibility of dementia-like side effects. The brain produces its own cholesterol to build and repair, so why would we want a cholesterol-lowering drug in there???
Anyway, I was pondering...should he even be on a statin?
or should he be on a hydrophilic statin instead?
He has no history of CAD or stroke. 87 years old. There is evidence of a few different side effects that could be from a statin, including his brain not working right.
My "not a doctor" gut feeling is that he should not be on one at all...
BUT, given the fact that he still eats quite a bit of carbs and processed foods.... maybe he does fit into a category that should take them.​
Maybe folks who have but refuse to do anything about any of the risk factors that are much more significant than LDL (diabetes, metabolic syndrome, hypertension, obesity, smoking, high triglycerides) and are still eating a high-carb diet with lots of processed foods...yeah maybe they should address 7th or so* most important risk factor....if that's all they are willing to do. *
jamanetwork.com

Risk Factors by Age at Onset for Incident Coronary Heart Disease in Women

This cohort study evaluates risk factors associated with incident coronary heart disease in women by age at onset.
jamanetwork.com jamanetwork.com
​
 
Mark K said:
Considering third class medical...
Click to expand...
Why? What is your mission and does it require a medical? A third class is less valuable with each passing day.

You're in a better position than most to advocate for your own health; don't fall into the recto-cranial inversion trap of playing mother-may-I with the FAA.
 
GeorgeC said:
Why? What is your mission and does it require a medical? A third class is less valuable with each passing day.

You're in a better position than most to advocate for your own health; don't fall into the recto-cranial inversion trap of playing mother-may-I with the FAA.
Click to expand...
Well, my plan would be one class three physical, then basic med all the way.

I do actually plan on emailing and seeing If I could retain Bruce (Dr Chien) for his opinion and recommendations in the near future. Being a doc, I have a pretty good understanding of what's involved and its' a bit easier for me to navigate the system. But as to how 'it really works, getting the expert opinion from him would be worth the cost. And, at the end of the day, depending on what he says, I might just go down the lightsport route. The future of that looks super promising. But it's in flux since the final FAA rules aren't out though-hard to know exactly how that will all pan out.

My ultimate plan is just to put together a kit, Van's or similar. I'd like the flexibility of a class 3/private, but could accept the light sport route.

I asked about the blood test since I was due and did some other routine tests today. I decided against asking my pcp to add a lipoprotein a for now...

Thanks all
 
Even if you do get an LPa result that is above some arbitrary “normal” AND you decide to take a statin to lower it, so what? statins are not grounding.

A high LP(a) isn’t a diagnosis of anything.
 
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Let’s say you test it. And it’s high. Now you get to have that part of your medical record when you apply for life Insurance.
Statins don’t lower apo-lipoproteins anyway.
The choice of to statin or not can be made without this info.
 
Mark K said:
My ultimate plan is just to put together a kit, Van's or similar. I'd like the flexibility of a class 3/private, but could accept the light sport route.
Click to expand...
The landscape may be different in 2024 2025 after Godot MOSAIC.
 
I think concern about Apo A is misfounded. Apo A is a marker but the evidnece that moving the "marker" does anything desireable- that'll be about five years in ahead in the "knowing".

It's the difference between observation and causality.
 
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