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...
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.)
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
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?
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...)
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.)
https://www.privatemdlabs.com/
https://www.discountedlabs.com/
I’ve used both of these in USA with no physician or insurance involved at all. Zero red tape. I believe Canada has some additional rules/barriers against private testing without a physician.
The CEO of PrivateMD labs is on HN: https://news.ycombinator.com/user?id=JeanPierreK
To be fair, I don't think anyone actually does it, because who will do their own bloods, but you definitely can. Labs expect to see an order from the doctor, because that's what 99.9% of people have, but they're happy if you just pay out of pocket too.
In the US you can buy 100+ tests from Quest Labs directly, the price even includes a discussion with MD about the results.
The reason I would do it, or do it when in the US is just the convenience. Seeing a doctor is complicated and obviously involves at least one extra step. If you just go and get the tests and have the info, it simplifies things, which is presumably the reason why these direct to consumer options exist in the US.
It's interesting to hear that notionally they have the same model as us of a doctor needing to prescribe the test. The difference in Canada is that private healthcare is not available so you are forced to deal with the public system and the pace and inconvenience that entails.
No, the doctor doesn't need to prescribe the test, you can test whatever you want. It's just that the vast majority of people don't test anything unless a doctor tells them to.
There are places like 'Any Lab Test Now' in the US that are cash/card and do a large number of tests like this without a prescription.
> Direct-to-consumer lab testing technically exists, but is always ordered by a doctor.)
More like rubber-stamped by a doctor. There are numerous websites where you can buy the labs you want and the requisition will appear in your inbox shortly afterward after being “reviewed” by a doctor.
It’s really not an impediment at all.
Anyone can order labs via websites like https://directlabs.com/
If there is a doctor involved, it’s invisible to the consumer.
I believe there are 2-3 states where the rules are different (one being New York) where you can’t self-order tests, but every other state is unrestricted.
Even in New York where you can’t order via the typical websites, you can still go directly to Quest or Labcorp and buy your labs directly from them (without talking to a doctor).
Source: I regularly get blood panels without seeing doctors. I highly recommend direct labs, or Quest Direct if you live in NY.
Fun fact… my primary care provider ordered a Vitamin D and lipid panel for me last year. The cost of the labs after insurance was 3x more expensive than buying the labs myself without insurance. Insanity.
Edit: states with self-testing restrictions: AZ, NJ, NY, RI
If you check the lab report, did you see a doctor listed somewhere near the top? (Even if you didn't explicitly talk to that doctor, I think it's legally necessary in all US states).
(Agree that ordering and paying the cash price is often cheaper than insurance.)
Every reference lab in the US is required to have a medical director who is legally accountable for quality. That doctor's name will often appear somewhere on the report but that doesn't mean they ordered it. The ordering provider (if any) will be listed on a separate field.
Yes, there is an ordering physician.
The parent commenter we're both responding to said "I can go to a lab, order this, and pay for it." -- the point I'm trying to make is that the system in the US is basically the same, since the ordering physician is employed by the lab testing company and you never interact with them, so it's as if they don't exist for the purposes of comparing to Greece.
Edit: I see you own a blood testing startup! Now I understand why you were surprised about the ordering physician detail. I thought you were implying that the process is difficult in some way because a doctor is involved.
This is very much not true. I just paid $12 to have a lipid test done. No doctor order or involvement at all.
At least for the tests I've gotten in the past, there's always a doctor's name on the lab order. They might not do an appointment with you, but it's still a legal requirement to get the test done.
I believe it depends on the state.
I'm in the US and our local hospital lab has "test fair" week every year when anyone can roll up and get any test for a nominal payment (basic common tests). No doctor involved.
> In the US, a doctor has the order the labs
Concierge doctors will do this with a text. It’s dumb. So dumb. But doable.
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)
Hm, over here you need a prescription for medication, but you can do whatever test you want to pay for. I don't know about Canada, though.
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).
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.
So is poor oral hygiene a risk factor?
Is the fat rapture because the body wants fat to release vitamins and other stuff to help power itself to fight off the bacteria?
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.
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.
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!
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.
Really any of the three would be qualified.
thanks for your input on this
There are already pretty serious blood disorders linked directly to oral health (https://en.wikipedia.org/wiki/Actinomycosis almost took down slackware linux)
I think I'll go floss.
Titles like this are very confusing. The paper better explains it, but a disease can't be contagious or infectious. The paper describes a link between a potential bacterial infection and myocardial infarctions that may take years or decades to develop.
The disease is only the named group of symptoms. The potential cause of the disease is the bacterial infection. Those are very different concepts.
I assume this is a "here's another way this can happen" rather than "actually this is caused only by this and not by what we used to think"?
Surely this? The number of ‘oh, it turned out to be more more complicated’ scenarios in medicine is high.
Of course it depends on fractions. You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. So knowing that all the plans towards eliminating this disease focus on HPV.
On the other hand most people with "flu" in summer months are not infected with Influenza, so an improved influenza treatment isn't going to make a big difference for them unlike in winter. We know other reasons you might get those symptoms which are more likely in summer.
Peptic ulcers are another well-known case, in which most (though not all) instances can be traced to a Helicobacter pylori infection. Other causal factors include NSAID usage, stress, and diet.
<https://en.wikipedia.org/wiki/Peptic_ulcer_disease>
<https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disea...>
One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis.
Successful treatment and elimination of syphilis in patients and populations through antibiotics. As one of the few cases of near-total elimination of a class of mental conditions, this a useful reminder to the psychiatric profession that not all mental conditions have causes limited to the brain and its function, whether through its biochemistry or neural/behavioural processes.
<https://en.wikipedia.org/wiki/General_paresis_of_the_insane>
> One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis.
I think a better example is the very recent (i.e., in the 2000s) discovery of anti-NMDAR encephalitis which can very closely resemble schizophrenia [1].
In syphilis, there were at least other manifestations of disease that can (and were) known, unlike this totally unappreciated mechanism (which better resembles Barry Marshall and H. pylori).
> You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection.
What are these other ways? There's an intuition that bodies are like computer programs that can fail in unpredictable ways, but this is usually false and belies a failure to see links between 'novel' and previously described mechanisms.
“Dormant bacteria within the biofilm remain[ing] shielded from both the patient’s immune system and antibiotics because they cannot penetrate the biofilm matrix…”
Phages can penetrate biofilms [1]. (They have practice.)
But you can't patent phages, so we'll just continue ignoring them
This is basically a myth.
There are countless ways to make medicines and treatments around old technologies and other things that are off-patent, in a way that is novel and able to be patented.
Even boring old generic medicines often find themselves reformulated into new treatments as combinations, variations, or in some cases simply a different dose and indication.
"simple, obvious and wrong".
Phages are intensely species specific to bacterial species, so they don't work unless you identify exactly what you're targeting. Also, even if they can penetrate biofilms, that doesn't mean you can successfully deliver them to the biofilm in the human body, since they have to survive the whole blood stream and the normal human immune response to "not self" things.
Adding to this: a chief advantage of antibiotics (particularly the early ones) is that they were both broad-spectrum (controlling a vast array of bacteria) and sparing of non-bacterial cells (e.g., those of our own bodies).
Evolved resistance is changing at least the first part of that relationship.
Phages as you note are far more tailored, and may (if I understand correctly) need to be targeted to a patient's specific infection's genetic line. It's as if you had to select ammunition based on the specific type of target you were hunting, if not specific individuals. In the early days of antibiotics it was far more a case of "fire and forget" with a single magic bullet. (Not literally always, but for the overwhelming majority of bacterial infections.)
> you can't patent phages, so we'll just continue ignoring them
Nope. Plenty of governments fund this sort of research. And chances are there isn’t an off-the-shelf phage that ticks the boxes, which means you need some amount of genetic engineering, in which case Monsanto has your back.
Anecdotally, I had a myocardial infarction at 23, and I was honestly surprised to learn that it wasn’t already well known that infectious diseases could trigger such events.
Up until that point, I’d never had any heart-related issues, nor does anyone in my family. Just two days before being admitted to the hospital with a suspected heart attack, I came down with food poisoning. It wasn’t pleasant, of course, but I thought it was nothing unusual—something a couple of days of rest and hydration would normally resolve.
Since my bloodwork at the hospital matched the expected results for a heart attack, and I underwent surgery, the doctors understandably focused on treating the immediate problem rather than identifying the underlying cause (I’m eternally grateful to the team and staff at St. Vincentius-Kliniken. I truly don’t think I’d be here without them).
That said, I’m glad to see this area receiving more attention. Hopefully, it will lead to further studies and the development of better strategies for prevention and treatment.
Can you clarify -- if you're comfortable sharing additional details -- did you have an "occlusion MI" heart attack, involving balloons / stents in the cath lab?
Most people assume that "heart attack" is a distinct clinical entity, but the majority (~80%) of elevated troponin levels are not exactly what comes to mind when people say "heart attack," but will often be described to patients as a heart attack (sometimes out of ignorance and others out of convenience, as the actual explanation for what is going on takes a lot more time and effort).
The original title is "Myocardial infarction may be an infectious disease" which appears to be clickbait, with the title posted here being much more accurate.
Immune response to bacteria in arterial plaques can cause them to break up and cause the attack (my lay-interpretation) so the bacteria is a trigger, but "infectious disease" is a bit of hyperbole.
> bacteria in arterial plaques can cause them to break up and cause the attack
“Dormant bacteria within the biofilm remain[ing] shielded from both the patient’s immune system and antibiotics because they cannot penetrate the biofilm matrix” whose rupture “result[s] in thrombus formation and ultimately myocardial infarction” sounds like infection more than careless bacteria kicking up muck.
Not all infarctions are due to infectious disease. The title (even on HN) is incorrect.
"Some myocardial infarctions attributed to an infectious disease."
My maternal grandfather died of an aortic separation. This caused a myocradial infarction, which was not due to infectious disease. I had my aortic valve replaced with a mechanical when I was 2, and 9, and 31, so I'll have a more nuanced kind of heart failure.
The bacterial contribution to MACE has been an ongoing subject of investigation for decades
https://www.nejm.org/doi/full/10.1056/NEJMoa043526
still hasn't really panned out
This has been suspected for decades.
https://www.thelancet.com/journals/laninf/article/PIIS147330...
Hopefully it leads somewhere that brings us new preventative care.
This raises two questions.
- Does this suggest that courses of antibiotics might reduce heart attack risk?
- Does this suggest that regular use of, e.g., Listerine might reduce heart attack risk? (While, perhaps, slightly increasing esophageal cancer risk.)
It would be interesting to run an epidemiological study to see if current interventions move the needle in a meaningful way.
Listerine would make it worse for sure.
Don't use "antiseptic" mouthwash; it kills beneficial bacteria in the mouth, causing bad bacteria to multiply.
I have personal experience of this.
agreed, after much research the only mouth wash i use is therasol
For the Listerine part: they are referencing this study: https://pubmed.ncbi.nlm.nih.gov/16373688/ that seems to show a correlation between poor oral health and sudden cardiac death, so it might help indeed, with other good oral health practices.
I only use very dilute Listerine - for the fluoride. A dentist told me that undiluted, alcohol based products can cause tissue damage (which conceivably would result in a vector for oral bacteria infiltrating to the bloodstream?)
Most Listerine products do not contain fluoride. Additionally, there are a variety of readily available alcohol-free mouthwashes that have fluoride.
Alcohol-free mouthwash is even more likely to cause tissue damage because they almost all contain SLS. Some people are more sensitive to it than others (causing the mucosa to peel) but it causes mild damage to everybody.
I probably should find sources first but I was always under the impression that the mouth biome is strongly correlated to gut biome which strongly correlated to immune system.
TFA says the biofilms protect the bacteria from antibiotics. Better approach is probably engineered antibodies or even a phage (engineered virus that attacks the bacteria).
Yes, there are studies where they compared heart attack rates for people who'd taken a course of antibiotics with those who hadn't and there was quite a large effect in some of them.
eg. https://www.science.org/content/article/antibiotics-cut-hear...
This seems like a good explanation of how my father died. He had the flu, and died overnight from a massive heart attack.
https://www.health.harvard.edu/heart-health/what-does-the-fl...
How does flu affect the heart? The virus only rarely infects the heart directly. Instead, the adverse effects of the virus on the heart are due to atherosclerosis of the arteries of the heart. Many people over age 50 have atherosclerosis — and in some people it has not yet been diagnosed. Because atherosclerosis narrows the arteries and reduces the flow of blood, less oxygen reaches the heart muscle. When the effect of the flu on the lungs lowers the amount of oxygen in the blood, this further reduces the supply of oxygen to the heart. This can lead to a heart attack or cardiac arrest (sudden death).
Is this risk more than theoretical? Many careful studies have shown there is an increased risk of heart disease following a bout of flu. In one study of 80,000 adults with influenza, nearly 12% had a serious cardiac event, such as a heart attack, during or in the weeks after getting the flu.
> In one study of 80,000 adults with influenza, nearly 12% had a serious cardiac event, such as a heart attack, during or in the weeks after getting the flu.
That sounds really high
Okay I just looked it up and this was only among hospitalized individuals which makes a lot more sense because most people just stay home unless it's very bad but that is still surprising to me
For sure it exacerbated an existing cardiovascular system. Once the system is weakened things cause big problems quickly.
In the context of the article, it's inflammation rupturing the 'fibrous cap' on plaque deposits leading to a heart attack, so I presume OP is talking about the inflammatory response to having the flu.
> How does flu affect the heart?
Even temporary stress on the respiratory system can cause long-term damage to the brain, lungs, and heart. Because of Covid, we started to learn that an acute, severe infection can affect people much later.
That research led to the beginning of an understanding that repeated flu infections can contribute to premature death even many decades later.
sure does. chain of events. The epidemiologists should be able to validate these claims.
Wasn't that a plot in DBZ where a virus weakens Goku's heart?