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High Cholesterol Message Board


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mark,

The studies on Lipoprotein(A) are indeed fascinating reading and all over the net (apoA is a component of it.)
I like a summary in the Cleveland Clinic JM.
[quote]
LP(a) SCREENING: RECOMMENDATIONS

Does the weight of the current evidence justify routine screening for Lp(a)? In my opinion, no. Until more consistent prospective trial data or interventional evidence accrues, knowing a patient's Lp(a) level provides insufficient additional assistance in predicting cardiovascular disease risk in the general population to warrant its inclusion in a standard screening evaluation.

However, one should be aware of the Lp(a) level in special populations, ie, patients with premature coronary heart disease, those with a strong family history of cardiovascular disease, those who have undergone angioplasty or coronary artery bypass grafting, and those with documented cardiovascular disease in the absence of traditional risk factors. In addition to aggressive lowering of elevated levels of LDL-C, attempts to lower Lp(a) in these groups may be warranted on the basis of the epidemiological associations discussed above, especially in light of the efficacy and tolerability of the newer forms of niacin and of fenofibrate.

Finally, suspect Lp(a) excess in patients with hypercholesterolemia that is refractory to standard statin therapy. Since the calculated value of LDL-C includes the LDL contained in Lp(a), and since Lp(a) will not respond to statin therapy, significant hidden elevations of Lp(a) may account for the treatment failure. [/quote]

I plan on testing for it next physical (long overdue) since I'm obviously one of those "special populations."
What I'll DO with the info is anybody's guess.

An aside:
I actually DO know some people with HDL's higher than LDL's...two even with HDL's over 100!!!!!:eek:

Put me in the camp that thinks that 100 LDL is just fine for those with undamaged hearts...maybe BETTER than fine!
"Finally, suspect Lp(a) excess in patients with hypercholesterolemia that is refractory to standard statin therapy. Since the calculated value of LDL-C includes the LDL contained in Lp(a), and since Lp(a) will not respond to statin therapy, significant hidden elevations of Lp(a) may account for the treatment failure."

Wow! That may be why I'm not getting the statin response that Rahod assures me I should be getting...lol.

So....what do you do to reduce elevations of Lp(a)? Hmmmmmmm?

oh ... niacin.

mark
Incidentally, the Cleveland Clinic study you pointed me to Zip2 has some interesting insight into FH resistance to statin therapy.

It appears that FH'ers often have excessive levels of Lipoprotein A which is unafected by statins. That is bad news all around. Apparently I may not only have a concentration of the worst LDL, but the statins are only going to lower the "wus" type, and leave me holding the lp(a) bag.

They say,

[COLOR=Blue]"Finally, suspect Lp(a) excess in patients with hypercholesterolemia that is refractory to standard statin therapy. Since the calculated value of LDL-C includes the LDL contained in Lp(a), and since Lp(a) will not respond to statin therapy, significant hidden elevations of Lp(a) may account for the treatment failure."[/COLOR]

BUT, they also say,

"Another recent study of men with documented coronary heart disease and elevated levels of both LDL-C and Lp(a) found that Lp(a) seemed to lose its atherogenic potency once LDL-C was [B][U]aggressively[/U][/B] lowered."

my emphasis

I'm keeping a weather eye on my liver guys, but frankly, my liver is the organ that has fallen down on the job.


mark





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