I wish I knew more about exactly what Lp(a) will do that will cause me problems.  I have high Lp(a)(22 on my VAP test).

I am 5'2" and weight 110.  I am a fitness professional -  healthy blood pressure level.

My TC at it's worse was 226 with low Trig, high HDL, and high LDL (144).  My Dr wanted me to get the LDL down with drugs.  I chose the supplement path, and increased my fiber intake.

My TC is now around 224, but my HDL is 86, and LDL 118.  My real LDL size pattern is A/B.  My HDL 2 & 3, and VLDL 3 are all in the desireable range.

Oh - I do have a family history of heart disease (mother had strokes in her 60s).

I had a heart scan - no measurable plaque found.  I'm 55 years old.

That darn Lp.  Should I be worried it's going to do something I'm not aware of?

Bonnie

Yes. You might have a Lp(a) variant that accounts more for carotid disease than coronary disease, judging from your mom's history. Also, you are still young. Some women will not fully express Lp(a) characteristics until their late 50s.

All the principles we talk about for Lp(a) on the Track Your Plaque website still apply. Also, please see our upcoming report that summarizes unique strategies for Lp(a) treatment to be released in the next two weeks.

If Bonnie thinks her LP(a) at 22 is high, I guess mine is high also at 24, but at least its a whole lot better than it was 18 months ago when it was 52.   I attribute the reduction to DMAE and NAC,thanks to your recomendations, Dr. Davis.

Your list of possible examples of high LP(a) just doesn't include me.

My BMI is 21.  I have relatively low blood pressure,95-110 over 70.  My age is 65.   Total Chol=190; LDL=110  HDL>65 and sometimes as high as 100.  Low Trigs < 70.

No family history (mother still kicking at 95). Father died in hi 70's from pancreatic cancer with a very strong heart and lung system.  And yet I have had a really high LP(a)!!!

I can't afford a CT scan, as much as I would like to get one, but I did have a lipoprotein breakdown which showed
VLDL=25; LDL particle number 789 dense LDL IV=101 HDL Total=9066 and Buoyant HDL 2b=2528.  All  measured in (nmol/L).  My density was neither A nor B, but in an intermediate zone near the A border.

My homocysteine is raised (12.26) probably because of the 750mg of Slo-Niacin I take, but I'm trading niacin's lipid enhancements for it.

When my LP(a) was at 52, all blood work was similar to now, weight was the same, exercise, diet, everything was the same.   I don't understand why it was so high.   I was hoping your list would give me a clue, but I'm just not on it!!!

Noreen

Thanks.  My mom unfortunately led an extremely sedentary lifestyle, and didn't eat well or take care of herself.  I always assumed her strokes were a result of that.  I guess it was probably part of it, but not all of it.

I did not know about Carotid disease - seems all I ever hear about is Heart Disease these days.

I look forward to finding out more about the new approaches to dealing with Lp(a)!

Bonnie

Hi, Noreen-
I'm curious about the DMAE. I've used it (unsuccessfully) for memory enhancement, but not to reduce Lp(a). What is the basis for this?

Big Goof, Dr. D!!!  I was tired and didn't get up to check my supplements.  I'm taking 50mg of DHEA for lowering the LP(a)!!!

Sorry, thats what I get for getting into this stuff so late at night!!!

I'm still at a loss as why mine went so high (52)!!!   Especially with no family history of heart disease.

Noreen

Noreen - your post reminded me of something that I find curious.

When I first had my Lp(a) tested it wsa a separate test from my Cholesterol test.  Results came back 59 wih a reference range of  0-29.  

Next time it was measured it was part of a VAP test, and when I saw it at 22 I thought it had dropped (by some miracle .  Then I noticed the reference range was different, and that the high end of the range was 10.  

Different tests maybe?

Bonnie

Thanks Bonnie -- Yes, it was different labs, but the reference range was less than 30 on each one.   I did read somewhere that some labs use less than 20 as the normal range, but these two labs used < 30.

This lab also did a nutrient profile and found that I was deficient in pantothenate, glutamine and glutathione.   I was already taking 500mg NAC, but they recommended 1000mg, so I'm now taking 1200mg of Jarrow Sustain NAC in hopes it will satisfy the glutathione deficiency and lower that LP(a) further.  

I also started taking pantothenate to satisfy that and read that it can reduce LDL, so I'm hopefull there.   I upped the glutamine that I was already taking and switched to a powder form.

Thanks,
Noreen

Hi, Noreen-
Somebody, Mom or Dad, had to give you Lp(a), though the expression and consequences of Lp(a) can vary.

Is it a dominant characteristic from just one parent or can it be a recessive one from both with neither having it?   I don't think my mom has ever been tested, but her doctor said her heart is still very strong at 95.    My paternal grandfather died of a massive heart attack at 78.  Before that he was hospitalized several times with fluid in his chest (cardio-myapthy) maybe?

I was under the impression that if it were genetic that nothing will reduce it.  Is this wrong?   Mine did come down to 24 after taking the NAC and DHEA.   I'm really looking forward to reading that paper on lowering it too.  Thanks so much,
Noreen

Dr. Davis, just to clarify:

1. Lp(a) is not like IDL, where having any measurable amount is abnormal, right?  Mine was 7 mg/dL, and I took this to mean that I don't "have Lp(a)."

2. Also unlike IDL, small LDL, etc., it's purely hereditary and not a symptom of metabolic syndrome or similar, correct?  So if I don't have it at 30, I don't need to worry about developing it by 50?

Thanks

Lp(a) is genetic but blood levels are manipulable. But Mom or Dad HAD to give it to you, they just may not have fully expressed its consequences (which does happen occassionally, for not entirely clear reasons).

Hi, Bad--
Yes, correct on both counts.

But Mom or Dad HAD to give it to you, they just may not have fully expressed its consequences (which does happen occassionally, for not entirely clear reasons).

So Dr. Davis, are you saying that if you have this genetic marker, that it is inevitable that at some point down the line it will do bad things - no matter how good all of the rest of your risk factors are? (assuming there continues to be no reliable way to reduce it).

Bonnie

No, not inevitable, but darn close. It could be expressed as hearet disease, carotid disease, aneurysms, or just hypertension.

Are there any major differences between  Lp(a) testing via a VAP test as compared to NMR?

VAP seems to use a lower test range (over 10 being considered high). Does this mean their test is different than others, or simply they use a lower marker to differentiate between high and low? And would a Lp(a) test via VAP be as accurate as one from NMR, etc,?

My VAP numbers for Lp(a) was pretty low, around 4-5, if I remember right. I just want to make sure this was an accurate test.

There are several methodological differences among the various Lp(a) measures. For this reason, I advise everyone to always stick with the same laboratory. There may also be differences in the validity or accuracy. This is detailed in a full Special Report on the Track Your Plaque website.

My Lp(a) score came back at 160--that's right--160!  I have a stent in one artery, obviously I have CAD.  I presently take Zocor 20 mg. and an Ace Inhibitor drug.  I can not take Niacin---what can I do?


   Joan

Dr Davis,
My Cardiologist has me on 1500mg Niacin which reduces LP(a)to around 30 and that seems to be about the lowest I can get it, as more Niacin gives me a rash. So He says we need to reduce LDL as low as possible by diet,exercise and possibly a low Statin dose. Reducing the amount of carriers, He says, will negate to a large degree, the risk of my high LP(a). Does this sound like sound treatment?   Thanks.....

That sounds like a very solid approach to Lp(a). Congratulations to your doctor for being up to date in his thinking about Lp(a).

Also, watch for an upcoming report on our Track Your Plaque website for a review of unique therapies for Lp(a).

I'm afraid that's a bit too much to handle in a blog post.

You are invited to read our Track Your Plaque Special Reports on Lp(a), including an upcoming review of unique therapies to be posted within the next two weeks.

Also, watch for an upcoming report on our Track Your Plaque website for a review of unique therapies for Lp(a)

Can you see me tapping my foot..... impatiently.....  

  
(Just kidding)


I hesitate to take Niacin because I have a tendency toward slightly high liver enzymes for some reason (possibly mild NAFLD since all other tests came back negative), and I've read Niacin can raise liver enzymes.  I look forward to hearing about other possibilities.

Bonnie

SO after all is said and done should a LP(a) redaing of 12 be of any concern? It is noted as "high" on my VAP test but it certainly is close to normal. All of my other readings on the VAP are normal.

John

These red flags are not perfect. If you lack any of them, it doesn't necessarily rule out the possbility of having Lp(a). They simply serve as signs to suggest that Lp(a) may be lurking.

What is your opinion of "Nia-Span"?  My former doctor insisted that this "by prescription only" drug was the only way to take niacin.  The cost per month was virtually the same as for a statin.  (BTW, I declined this product and continued with regular niacin.)

FYI: the Slo-Niacin link isn't working.

RDA for niacin is 18 mg/day - what is your opinion on that, sir?
BTW, do you guys in the States just go to a pharmacy and buy niacin and D3 without a prescription?

"Slo-Niacin" uses a "polygel" to delay release of the nicotinic acid.  I've been taking Carlson's "Niacin-Time" (also nicotinic acid) which uses brazil wax to delay release.

The Carlson's product is about a third the price of the Slo-Niacin.

I've been taking regular (not no-flush) niacin for a few months.  Dr Davis recommends "Slo-Niacin" but I got sick from taking timed-release niacin back in the 80s and "Slo-Niacin" sounds suspiciously like "Timed-Release".  I should know in January when I have bloodwork, if the regular niacin helps.

JPB: Niaspan releases over 6-8 hours and yes..it is prescription only. I substituted it for Endur-acin which is MUCH cheaper and non-prescription and also releases over 6-8 hours. No difference in my lipid profiles...just big savings in my pocket book.

Zbig: 18mg is probably sufficient as a RDA, but in order to achieve the lipid lowering affects from Niacin, one has to take larger doses of 500mg or more from what I understand. And yes, we can buy many supplements like (high dose) niacin, vitamin D3 & even DHEA without a prescription here in the USA.

Anonymous: I believe Carlson buys their "Niacin-Time" from Endur. I looked at the picture on the Carlson website and the tablets are the exact same shape as Endur-acin. Endur has been around since the late 1980's from what I understand. You can buy direct from Endur.

IggyDalrmple: Here is a link to an excellent article about (time-release) Niacin written by Doctor Davis himself:

http://www.lef.org/magazine/mag2007/mar2007_atd_01.htm

Hi, Id like to know what research supports flush free Niacin has no effect on the human body ?
I had/have horrible heart palpitations after a heart attack, and after taking Flush Free Niacin 2 to 3 times daily, control them, while time released I tried did not .. and Im afraid to take regular Niacin being so unstable.  I take several other things as well now, but not at the beginning.  I have Late Stage Lyme which has its own set of causal factors as well as the typical ones, but if it has no effect on the human body .. it wouldnt work period.  So, I would guess ..  like all else one thing might work for some, another substance for another depending on what I wish they would narrow down to "Cause".  I still have high Blood pressure, some medications work for a week or two, then stop being effective.  Areas of the brain control heart beat .. I have no clue if this is the whats causing high blood pressure or not .. Lyme can go any where and do anything .. Ive had it since I was a child with mild symptoms until my immune system got a faulty in mid thirties when it became aggressive.  No Doctors know how to treat other than antibiotics, dont treat symptoms like really bad hypercoagulation (thick blood) caused by being exposed to bacteria etc for a long period of time and the immune system becoming over active .. 2002 I had an attack which took me out almost completely .. No heart or other doctor even tried to diagnose and gave me a "hearts fine" .. 3 yrs later I had an almost deadly heart attack.  All these yrs, almost 10 .. spent trying to find help, treating symptoms on my own, having no family and absolutely No life, except for trying to survive. (people with Lyme ramble) Though its good to know info.... Question still remains about Flush Free Niacin...

"IHN is more effective than niacin in its hypocholesterolemic,
antihypertensive and lipotropic effects"
Welsh AL, Eade M. Inositol hexanicotinate for improved nicotinic acid therapy.
Int Record Med 1961;174:9-15.

"significant lipid-lowering effects of IHN at doses of 400 mg 3-4 times daily"
Dorner V, Fischer FW. The influence of m-inositol hexanicotinate ester on the serum lipids and lipoproteins. Arzneim-Forsch 1961;11:110-113.

Sommer H. Nicotinic acid levels in the blood and fibrinolysis under the influence of the hexanicotinic ester of m-inositol. Arzneim Forsch. 1975;15:1337

"IHN was found to be more effective than niacin in reducing hypercholesterolemia"
El-Enein AMA, Hafez YS, Salem H, Abdel M. The role of nicotinic acid and inositol hexaniacinate as anticholesterolemic and antilipemic agents.
Nutr Reports Int 1983;28:899-911.

"Derivatives of niacin have been examined for their ability to alter lipid levels as well as niacin. It would be advantageous if the niacin vasodilation (flush) were eliminated or removed. The main disadvantage of the niacin derivatives will be cost. Inositol hexanicotinate is an ester of inositol and niacin. In the body it is slowly hydrolyzed releasing both of these important nutrients. The ester is more effective than niacin in lowering cholesterol and triglyceride levels, Abou El-Enein, Hafez, Salem and Abdel (1983). I have used this compound, Linodil, available in Canada but not the U.S.A. (at the time this paper was written) for thirty years for patients who can not or will not tolerate the flush. It is very gentle, effective, and can be tolerated by almost every person who uses it."
From: Niacin, Coronary Disease and Longevity by Abram Hoffer, M.D., Ph.D.

Question:  at dinner took 500 mgm Slo-Niacin and within a few hrs had some stomach unpleasant...sensations might be the best description, then my glucose rose.  Fasting rose 25 pts (shock) and yesterday was marked with ravenous hunger and 15-20 pts higher glucose all day; today's fasting was still higher than usual.  Is this expected?  It's almost as if it is undoing the work of my 1500 mg metformin ER in reducing the production of sugar in the liver. This isn't going to wk with higher glucose.  Suggestions? Comments?
6/25/09 labs: TRI-119, calc LDL-150, HDL-57, D-35, TSH-4.5, AIC-6.4. Taking 12.5 mg Maxzide, 4K IU D3.
9/22/09 labs: TRI-145, calc LDL-147, HDL-60, D-41, TSH-5.5, AIC-6.5, ApoB-111. Taking 12.5 mg Maxzide, 8K IU D3.
Doc put me on 25 mcg levothyroxine (don't think this is enough or I need Armour).

I think my TRI is up from too much carb (eat super low, ate a bit more more berries over summer).  I think my LDL is up from my rising TSH (free T4 & T3 midrange), been rising since Sept08 when it was 2.8 (when I started taking vit D). Wt loss (obese) has been stalled until I started subbing eggs for hi-protein shake with 2-3 ozs coconut milk a month ago.  TSH was high in 2001 (4.7) with high amts of reverse T3 (doc won't test for it)& given 2 mcg Cytomel but my TC was 205 with TRI=100. Now what to do?  Try the 250 mgm SloNiacin & see what happens?  Or just concentrate on improving D levels and improving thyroid function and hoping they help normalize lipids? Just looking for suggestions, not treatment, all ideas will be run by doc. He said statins or niacin...I'm female no familiy hist of heart probs, why statins with no good studies for women? 'Cause he takes a statin *sigh*.

After my heart attack from Late Stage Lyme Disease causing hypercoagulation/thick blood .. after released from the hospital, I had/have severe heart palpatations .. and IM SORRY BUT, FLUSH FREE NIACIN DOES WORK!!  I have to take 2-500mg twice daily and it stops the heart palpatations .. its no gimmick or hype.  IT Works !!  Ive heard about the severe very uncomfortable flush rush with regular Niacin which I think would scare me and make me panick, if not make me ill with the fragile state my system is in.  Purchased at any store online or otherwise .. a lot less than and w/no side effects, I also take Argnine to help open my vessels, but is not needed to stop my heart palpatations. Obviously, something is wrong though if I or anyone is having heart palpatation, so you should keep looking or asking RN/head nurse until you find a heart doctor who will actually address the issue and find out whats going on!!  Once in a while with stressful event I do need to take a beta blocker to stop palpations, but only 3-5 times a yr.  NO SIDE EFFECTS like beta blockers...

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