HealthVault Wiki

A living synthesis mined nightly by VaultMiner. Domain: Annette's personal health, APOE4, hormones, metabolic labs

Last updated: 2026-08-11

Omega-3 and DHA

• APOE4 carriers may need about 2 g/day of preformed DHA, since APOE4 impairs DHA delivery to the brain (source: Omega-3 and DHA for APOE4.md)
• Annette's current omega-3 supplement provides about 770 mg DHA per day, which is suboptimal for APOE4 carriers (source: Omega-3 and DHA for APOE4.md)
• Plant omega-3 (ALA) is a weak source of DHA, with conversion rates under 1% in humans (source: Omega-3 and DHA for APOE4.md)
• LPC-DHA is the form preferentially transported across the blood-brain barrier, suggesting potential superiority over standard triglyceride DHA (source: Omega-3 and DHA for APOE4.md)
• APOE4 carriers show reduced DHA uptake in cerebrospinal fluid compared to non-carriers, suggesting higher dietary intake is needed for equivalent brain levels (source: Omega-3 and DHA for APOE4.md)
• Current prevention trials for APOE4 carriers are testing ~2 g/day preformed DHA doses (source: Omega-3 and DHA for APOE4.md)
• Annette's OmegaCheck score is 4.9%, below the optimal range for APOE4 carriers (source: Home.md)

Hormones and HRT

• HRT started near menopause is neuroprotective, per the Women's Health Initiative (source: Hormone Optimization for APOE4 Brain Health.md)
• Annette's hematocrit is 49.1%, elevated likely due to testosterone therapy and altitude (source: 2026-05-15 Lab Panel.md)
• Optimal hormone targets for APOE4 carriers: estradiol 40-70 pg/mL, progesterone for all HRT users, free testosterone 4-8 pg/mL (source: Hormone Optimization for APOE4 Brain Health.md)
• The neuroprotective window for HRT is near menopause; starting 15+ years post-menopause with existing vascular dysfunction may raise dementia risk (source: Hormone Optimization for APOE4 Brain Health.md)
• Changing to more frequent testosterone injections (same total dose) may lower hematocrit without reducing exposure, per UCSF Gender Affirming Health Program guidelines (source: Finding a testosterone prescriber in Colorado.md)
• Annette's TSH is suppressed at 0.27 (likely due to HRT effect), which is below the optimal target of 0.5-1.5 for APOE4 carriers (source: Home.md)

Cardiovascular and Metabolic Health

• Annette's ApoB is 126 mg/dL, with a goal of <60 mg/dL, justified by her APOE4 homozygous status (source: ApoB and Cardiovascular Risk.md)
• The FINGER Trial demonstrated that multidomain lifestyle interventions protect cognition in at-risk individuals, including APOE4 carriers (source: FINGER Trial and Multidomain Prevention.md)
• Midlife hypertension is a stronger dementia risk factor in women (source: Blood Pressure Lowering Protocol.md)
• For APOE4 carriers, midlife Diabetes and type 2 diabetes/insulin resistance is the highest-leverage modifiable risk factor (source: FINGER Trial and Multidomain Prevention.md)
• Annette's metabolic markers are excellent (A1c 4.8, insulin 5.8), making ApoB her primary open lever (source: FINGER Trial and Multidomain Prevention.md)
• Coronary artery calcium scan shows Agatston score 203.34 (90th percentile for women aged 55-60), with 81% of burden in the LAD (source: 2026-06-10 Cardiac and Carotid Imaging.md)
• Bilateral carotid ultrasound shows trace calcified plaque in left carotid bulb but no hemodynamically significant carotid stenosis (source: 2026-06-10 Cardiac and Carotid Imaging.md)
• Annette's homocysteine is 7.3 µmol/L, within normal range (source: Home.md)

Iron and Hemochromatosis

• Annette is homozygous for the C282Y mutation (HFE rs1800562 AA), but ferritin is normal (34 ng/mL) (source: Hemochromatosis - HFE Genotype and Iron Management.md)
• APOE4 carriers benefit from tighter iron monitoring (ferritin target 50-100 ng/mL) due to impaired brain iron homeostasis (source: Hemochromatosis - HFE Genotype and Iron Management.md)
• Female penetrance for clinical hemochromatosis with C282Y homozygosity is approximately 1% (source: Hemochromatosis - HFE Genotype and Iron Management.md)

Cortisol and Stress

• Single-point morning cortisol (18.7 mcg/dL) is insufficient to assess diurnal rhythm. APOE4 carriers require monitoring of evening cortisol and Cortisol Awakening Response (source: Cortisol - Measurement, APOE4 Risk, and Optimization.md)
• APOE4 upregulates HSD11B1 in neurons, increasing intraneuronal cortisol despite normal serum levels (source: Cortisol - Measurement, APOE4 Risk, and Optimization.md)
• Transdermal estradiol does not distort cortisol measurements (unlike oral estrogen) (source: Cortisol - Measurement, APOE4 Risk, and Optimization.md)
• APOE4 carriers show greater hippocampal dendritic retraction at equivalent cortisol concentrations (source: Cortisol - Measurement, APOE4 Risk, and Optimization.md)

Autoimmune and Inflammatory Markers

• Annette's ANA is positive at 1:40 speckled pattern, requiring follow-up (source: Home.md)

HRT Protocol

• Annette is on oral micronized progesterone (200 mg/day) for endometrial protection post-ablation (source: HRT Protocol.md)
• Endometrial ablation does not eliminate all endometrial tissue; islands remain hormonally responsive (source: hrt-post-ablation-endometrial-safety.md)
• Oral micronized progesterone 200 mg/day provides robust endometrial protection (source: hrt-post-ablation-endometrial-safety.md)

Blood Pressure Management

• SPRINT MIND cognitive-protection target is <120 systolic (source: Blood Pressure Lowering Protocol.md)
• Key interventions: sodium reduction (<1,500 mg/day), aerobic exercise (150 min/week), DASH diet (source: Blood Pressure Lowering Protocol.md)
• Midlife hypertension raises Alzheimer's disease risk more sharply in women than men (source: Blood Pressure Lowering Protocol.md)
• Annette's baseline blood pressure is 129/90 as of 2026-06-17 (source: Home.md)

Statins and CoQ10

• Statins deplete CoQ10 via the mevalonate pathway (source: Rosuvastatin-CoQ10-APOE4-Clinical-Reference-2026.md)
• APOE4 is not a proven statin myopathy risk factor; SLCO1B1 gene variant is the key predictor (source: Rosuvastatin-CoQ10-APOE4-Clinical-Reference-2026.md)
• Rosuvastatin shows a 28% dementia risk reduction signal in observational studies, with possible enhanced benefit in APOE4 carriers (source: Rosuvastatin-CoQ10-APOE4-Clinical-Reference-2026.md)

Lab Ordering and Testing

• Annette's next Quest Diagnostics draw will use Ulta Lab Tests (~$347.50) for 9 tests: ApoB (91726), testosterone free+total+SHBG (37073), hepatic panel (10256), OmegaCheck (92701), TSH (899), CBC (6399), hs-CRP (91737), iron/TIBC/ferritin (5616), and estradiol (4021) (source: Quest Test Codes - Lab Ordering Reference.md)
• The testosterone test code was switched from 14966 to 37073, which measures free testosterone by equilibrium dialysis instead of calculated, providing a better measurement at lower cost (source: Quest Test Codes - Lab Ordering Reference.md)
• NT-proBNP and Vitamin B6 were dropped from the order due to cost (source: Quest Test Codes - Lab Ordering Reference.md)
• The OmegaCheck requires avoiding fish, seafood, and fish oil the day before the draw (source: Quest Test Codes - Lab Ordering Reference.md)
• Colorado is not a restricted state for these direct-access tests (source: Quest Test Codes - Lab Ordering Reference.md)

Vision

• Annette experiences double vision, specifically binocular diplopia, which disappears when either eye is covered (source: Double Vision and Strabismus - Adult Onset Diplopia.md)
• The pattern points towards sagging eye syndrome, the single most common cause of adult diplopia at 31.4% in a 945-patient series (source: Double Vision and Strabismus - Adult Onset Diplopia.md)
• Annette has booked an appointment with the Colorado Center for Eye Alignment, Erie office, for further evaluation and treatment (source: Double Vision and Strabismus - Adult Onset Diplopia.md)