#21

I have been reading up on natural PCSK9 inhibitors to reduce high Lp(a) levels- so far my list is: berberine (but I take your point on this) fisetin, resveratol, querectin, K2, curcumin, urolithin A, low dose aspirin and melatonin. Might be others but these are doable for me. Do you think these might help? I have not been reffered to a cardiologist I will ask my GP. He seems to think I am over reacting to the blood result and am just ageing. BTW my LDL is 3.7. nmol/L. I have a valid concern re contrast- firstly I have to have annual MRIs for an acoustic neuroma and secondly my renal eGFR is now 84. Optimal would be greater than 90. Contrast agents are inflammatory and accumulative. I need to think on. Right now am open to an echocardiogram again. My endo and GP both say at my age that low thyroid and elevated cholesterol is protective. However I now know that I was right in asking to test my Lp(a).

#22

Again, my question is: why? You’re talking about throwing 7+ “natural” products at something where there is a single medication we already know is effective.

I’m not saying that your concern are not legitimate. However, you have to consider that any supplements you buy have a reasonable chance of not being legit either. Time and time again, studies will test supplements and they find that the dose of active ingredient is way off from what’s on the label. Not just that, but you have no idea the purity. Some Chinese factory is mushing up whatever herbs and plants, boiling it, filtering stuff, drying it, putting it into bags which get shipped somewhere else to be put into capsules. You have no idea about the quality of the handling, whether the herbs are fresh, covered in pesticides, left to accumulate cockroach shits on the factory floor etc etc. At least with the medication there’s GMP grade production and regulatory oversight.

GPs are close to useless IMO. The phrase of “they think I am just ageing” sums it up, and they have very little interest in optimising your health. Lp(a) also has nothing to do with age - it’s inherited. My 6 year old had a Lp(a) of 2x the normal reference range.

The point is, there are a bunch of effective medications out there to lower risks of cardiovascular disease. The real problem here, IMO, is your healthcare systems total unwillingness to engage, which is leading you to seek alternatives. Trust me, when you have your first heart attack, and if you survive, then suddenly they’ll be super happy to prescribe you everything you want to prevent a heart attack.

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#23

Thank you for your response-and you have made some very valid points (diagnosed my own brain lesion after two years of trying to convince my doctor I had this and needed to have more investigation by the time I was referred to audiologist and MRI it was much bigger). I will look into medications - might be better to see a cardiologist am thinking. My endo and doctor said for past 4 years eat two brazil nuts a day for the low thyroid. In Australia they are reluctant to medicate statins and thyroid meds in older patients unless well over range eg TSH be 10. I am glad I pushed for the lp(a) testing or I would never have known. My cholesterol was in range until 4 years ago -I keep all my own records. Went up after Covid.

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#24

A Coronary Artery Calcium scan doesn’t use contrast, and takes about 3 minutes. Here in the US it costs about $140.

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#25

I just had a CAC scan here in the UK. £350 was the cheapest. Most GP/PCP’s have never heard if them.

I think it would cost me ÂŁ400 a month for PCSK9i treatment in the UK (as it is t allowed for primary prevention on the NHS) which is why many of us have to resort to the generics eg aspirin etc even though there is limited evidence of end-point CVD event reduction.

#26

I wouldn’t be happy with a doctor who figures “I gotta die of something so it might as well be the thing I got now”. Get a better doctor.

8 Likes
#27

Yeah, that sucks. But honestly, it’s your life that we’re talking. Personally I would not let the NHS, GPs or whatever stupid system prevent me from doing what is objectively best for myself.

PCSK9i are not some new or controversial medicine. Clinical trials were 15 years ago. They were approved in the USA a decade ago, and they’re standard practice in many places. Plus, most civilised countries will allow their prescription off-label for primary prevention because it’s really a no-brainer move.

The UK just seems to be stuck in an incredibly old-fashioned approach where they give you the oldest, cheapest statin, then just escalate the dose. That is not the modern approach, and again more than a decade of evidence says you get the best effects with ~5-10mg statin, plus Ezetimibe + PCSK9i. Again, if you’re a doctor then I’m probably preaching the converted. My advice: procure your own PCSK9i pens, whether by private prescription, or totally unofficially.

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#28

Thanks James I will look into that. Guessing it uses radiation? Had radiotherapy (Cyberknife), xrays (dental, shoulder) - GP said time for mammogram, DEXA. Just concerned re radiation is accumulative and damages DNA - am now 64 and every year it seems something else needs imaging. Over the years a lot especially dental (a theory my oncologist has that this caused my AN as linked to dental xrays as a child). I need to think about it. At the moment I choose ultrasound for everything or MRIs. Its quite ridiculous in Australia -when I fractured my shoulder 6 years ago - and the ortho said we could try conservative management I had over ten xrays - until I flatly refused and said why not MRI to monitor. Instead DEXA I get annual fasting metabolic bone tests.

#29

The amount of radiation in a Dexa scan is trivial, less than the amount of background radiation you receive per day.

3 Likes
#30

If that’s 150 mg or 75 mg praluent every 2 weeks, you can just take one 150 mg pen, one time a month and get a large benefit, for half the cost. It’s around 50% lowering of LDL-c:

In the alirocumab 150 mg Q4W and 75 mg Q2W groups (49.1% and 36.0% of patients received dose adjustment, respectively), least‐squares mean LDL‐C changes from baseline to W24 were −51.7% and −53.5%, respectively (placebo [+4.7%]; both groups P<0.0001 versus placebo).

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image699×546 78.6 KB

https://www.ahajournals.org/doi/10.1161/jaha.116.003421

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#31

CAC scan is about 1 millisieverts. Annual radiation dose from the sun is about 6 mSv. But maybe evidence of blockage would qualify you for pcsk9 inhibitors?

Suggest statins plus ezetimibe plus pcsk9 inhibitors.

4 Likes
#32

I’m in the same boat as you except I’m 34.
You can’t compare apoB alone you need to compare the apoB to apo1 ratio (or the opposite I don’t remember) and this ratio will tell you if you need to fix anything else

#33

Can you please share more about this?

From my knowledge, the total ApoB concentration is pretty deterministic by itself. If it’s higher than 20mg/dl, you can reduce risk by lowering it.

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#34

Yes I would also like to know. My Apo b was 0.98 they didnt put anything else re ratio. I find tests frustrating here in Australia- they never give the whole picture it seems or investigate thoroughly (and you dont know what you dont know to ask). I have to find out what’s missing then ask for further tests. Thyroid is a good example. After I had test I said what about antibodies then had another test done for that. Irritates me.

#35

Maybe time for some medical tourism:-

#36

My Experience Lowering Lp(a) – What Worked for Me

I’ve been experimenting with different protocols to lower my Lipoprotein(a) [Lp(a)] levels and tracking my progress with monthly full lipid panel tests, including Lp(a) and ApoB.

Getting ApoB below 0.5 g/L has been fairly straightforward for me using:

  • Rosuvastatin 5mg
  • Ezetimibe 10mg
  • Bempedoic Acid 180mg

However, reducing Lp(a) has been much more challenging—with one major exception.

The most effective intervention I’ve found so far is immediate-release Niacin. Taking 2g daily (1g with breakfast, 1g with dinner) has lowered my Lp(a) by just over 50%.

I suspect I could get even greater reductions by increasing the dose, but I personally don’t tolerate higher amounts well (flush and nausea become limiting factors).

For anyone looking to reduce Lp(a), I highly recommend trying immediate-release Niacin—but be aware that extended-release and no-flush versions do not have the same effect.

Has anyone else had success with Niacin or other strategies for lowering Lp(a)? Would love to hear your experiences.

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#37

This is great to know – thank you. Wondering if it would apply to Repatha, the other PCSK9i.

#38

Didnt work for me.

All flush and little Lp(a) redn.

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#39

Please be aware of the controversy surrounding nicotinic acid (immediate release niacin), when it comes to lipid control in the context of CVD. Yes, NA at an appropriate dose does lower LDL and also raises HDL, in addition to lowering Lp(a). However, in multiple trials, this lowering of LDL and raising of HDL has not translated into MACE/CVD benefits - it’s been a BUST. This is in contrast to statins, where the lowering of LDL (and raising of HDL - at least in the case of pitavastatin) has most certainly translated into MACE/CVD benefits. In other words, it’s one of those situations, where the biomarkers numbers are affected (all lipid numbers going in the “right” direction), but not the underlying disease mechanism. Additionally, NA at those doses can have some rather bad side effects, particularly on the liver. As a result, cardiologists have almost completely moved away from NA for lipid control once statins became available - the failed NA trials were crucial here.

In summary, I would not hang my hat on NA lowering Lp(a) - it might lower the number, but unless there’s a study showing that this translates into actual CVD benefits, I’d shy away from NA for this purpose. I rather suspect that NA is affecting the Lp(a) number, but not the underlying biochemistry - which is why we saw no good signal in the NA trials wrt. MACE/CVD. YMMV.

5 Likes
#40

Today I read that the SNPs (rs3798220 and rs10455872) indicate that low dose aspirin might be effective. I watched a video on how high lp(a) is associated with blood clotting. Here is link to video and article. This changed my view on just targetting inflammation or LDL. Its blood clotting I am now looking at working on.

https://www.atherosclerosis-journal.com/article/S0021-9150(22)00687-6/fulltext

1 Like