#106

For reference Niacin dosing for lowering LDL was between 1000 - 6000 mg per day. Stanfield’s MicroVitamin dose is 50 mg per day.

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#107
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#108

Thanks Joseph. My guesstimate is currently that Niacin might be better for Apo B/LDL lowering than not doing anything, but for anyone without high Lp(a) there are so many other better/less risky Apo B lowering meds.

For people with high Lp(a) - especially if they respond in big Lp(a) lowering way to Niacin - the risk/reward might be worth it (until the Lp(a) lowering meds in late stage trials hopefully come online in a few years). But would love to hear any more experts’ views on this (incl Dr Sam T).

For NAD+ it might be worth it, but I’d not super dose and would def measure NAD+ levels to see (a) if needed and (b) so that the B3 (what we form not must Niacin but also NR or NMN) can be minimizes for the NAD+ effect one wants to target.

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#109

Related to above in NAD+ cases

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#110

Don’t understand the mechanisms here (yet), but may be worth looking into.

Does anyone know if this is unique to red meat or would it also potentially apply to fish?

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#111

Here is my update from meeting with Dr. Sam T. In short, I was impressed with the meeting. He met with me for one hour and 15 minutes. That is amazing to me given his time and expertise. We talked mainly about the quandary I’m facing regarding Niacin given Niacin lowered my LPa significantly. He was not overly concerned with the potential negative issues related to Niacin supplementation given many of his patients are on Niacin to lower Lpa and early studies examining the benefits of mono niacin therapy (without a statin) showed benefits. In my case, however, he feels that given I had several DVT’s in life that a PCSK9i could be better for me given it could lower LPa as well as reduce potential future DVT’s given the research shows that PCSK9i’s can help do both—lower LPa as well as prevent DVTs. So I’m going to stop Niacin and try a PCSK9i for two months and see what labs look like at that time. If the PCSK9i can lower my LPa as well a Niacin then I’ll stay off the niacin and stay with the PCSK9i. Dr. Sam T is very knowledgeable and really seems to know his stuff. He feels LDL as low as 20 would be ok and I’m not sure of that but will take it one day at a time.

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Is anyone having significant side effects from Bempedoic Acid?
#112

Thanks for posting the details.

For others like myself not familiar with DVT:

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#113

Several? Located where, if I may ask. Do you take an anticoagulant?

I’ve had DVTs in both legs, after extended sitting sessions. None since starting Pradaxa six years ago.

#114

DVT’s in both legs…one was provoked and one was not. Was on xarelto for several years but now just on baby aspirin. Have not had a DVT in 4 years. Forgot to add…Dr. Sam T said that there is some research that shows those with higher LPa are more prone to DVTs.

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#115

Thanks a lot - really appreciate it.

I’m the case where PCSK9i lowered it a little bit, not now nearly as close as the niacin, so you that you/Dr T would consider adding the Niacin back?

And did he say anything more about the paper? Did he seems to have read and thought deeply about it?

#116

Neo. The answer to your question is YES. He said if the PCSK9i did not lower the LPa as much as Niacin, he would consider for sure adding Niacin back. Regarding that paper, he said the study focused on niacin from one’s diet as opposed to supplementation and he needs to see more research before saying Niacin supplementation to lower Lpa was not a good thing.

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#117

Thank you @lsutiger

@Dr.Bart does above sound reasonable to you?

#118

of course! I tried to take very detailed notes from the visit so let me know if you have further questions.

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#119

Very impressive, he is maximizing the benefit by finding another indication. Comprehensive and pragmatic approach, I think you found a winner.

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#120

Yes, taking a baby-asprin / day (81 mg) is indicated for people with high Lp(a).

#121

Just read this thread as I’ve been absent for a while. As someone with high lp(a) and someone who took 4g niacin / day for 30+ years it interests me greatly. Something to clarify re the effect (or lack of–) of niacin on CV mortality…

Niacin suffers from the fact that statins were on the market prior to the discovery that Niacin improves the lab values of most lipid markers (raises HDL, lowers LDL, lowers TG. The only way to ethically test Niacin’s efficacy in preventing cardiovascular events was to add Niacin to statins in patients at risk and see if their were less events. The hypothesis was that raising HDL would improve risk and reduce the number of CV events. So there were two large studies (AIM-HIGH in 2011and HPS2-THRIVE in 2014). The patients had LDL levels driven below 80 with statins and then added Niacin to the protocol and there was no significant reduction in cardiac risk and an increase in stroke risk and T2DM in a small percentage of individuals. Because Niacin is off patent (ie no financial benefit) and because it would be unethical at this point to do so (statins have been shown to lower LDL and reduce events), a study of cardiovascular risk reduction with Niacin alone to my knowledge has not been done. Most cardiologists would use Niacin to further lower LDL cholesterol in the context of patients unresponsive or intolerant to statins until pcsk9 inhibitors came out.

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#122

You can have your lp(a) gene sequenced or probably better just have your genome sequenced since you may want to go back and look for other “stuff” as new information becomes available. I’ll have to check if rs10496731 is in an exon but also possible you could just do exome sequencing.

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#123

Hi, do you know of any reason clopidogrel instead of aspirin wouldn’t work just as well for those of us with high Lp(a) who can’t tolerate aspirin?

#124

Review the following article{link and attached is a PDF file) by the Medical Doctor who did the original trials in the US on nician for lip control. William B. Parsons, Jr., M.D., FACP.

Article

“Introduction of Niacin as the First Successful Treatment for Cholesterol Control, A Reminiscence”

http://www.orthomolecular.org/library/jom/2000/articles/2000-v15n03-p121.shtml

JOM_2000_15_3_03_Introduction_of_Niacin_as_the_First_Successful_Treatment-(1).pdf (111.6 KB)

#125

The problem with niacin is that many people cannot take it in therapeutic doses.
Minimal amounts cause them to have the unpleasant “flush” effect even when taking timed-release versions, which are dangerous for other reasons.
Even so, I don’t believe niacin is a first-line treatment for high cholesterol. If you just need a modest reduction and can tolerate therapeutic levels then niacin may be okay for you.

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