Dr.Bart
#48
https://pubmed.ncbi.nlm.nih.gov/22085343/
[Here is a direct quote from this relevant paper - Niacin reduces lipoprotein (a) by 15% to 25%, but does not reduce death or ischemic cardiovascular events [[42]
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Neo
#49
This may be helpful to understand my understanding and perspective
(For context, many see Dr T as the world authority on Lp(a), which is why I had recommended that @isutiger check with him and why I assume that @isutiger when through the hassle to obtain a appointment with Dr T even if he had to wait 6 months for it):
Since @isutiger lowered his Lp(a) by almost 50% the benefit for him might be larger than in the average 30% lowering cases that Dr T discusses above.
lowered my Lpa from 130 to 68 nnmol/L
https://twitter.com/lpa_doc/status/1118957738661277696?s=46&t=zJMJ1xVdRJYEDYz-DHipTw
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Dr.Bart
#50
Harm can be done via action or inaction
In the medical field inaction is a very frequent and appropriate course of action. Inaction is rooted in ethical, medical and legal perspectives.
This why have DNR status for patients. This is why surgeons choose not to operate on patients that may not survive the surgery. This is why don’t prescribe antibiotics for viral infections. This is why we refused to prescribe Ivermectin for COVID… etc. etc. etc. You can write a whole book about this subject
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Elizabeth, is this the product you are referring with 1MNA? See Endoteliol 1MNA – OHP Health by Longevity Labs Inc.
Are you saying this 1MNA can reduce LPa levels more safely than Niacin?
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Dr.Bart
#52
Dr. T clearly states that these are his opinions. These tweets are from 2019, I wonder if his opinions would change given the recent studies as discussed above on Niacin.
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Neo
#53
Totally, if you looked at one of the very first posts I made above I said:
Suggest you give your context, mention the new paper and ask Sam T via twitter - he is a world authority on Lp(a) and seems to respond to people’s questions quite often.
It’s both. You asked for evidence / studies that can help inform our understanding and I was trying to point you to:
Would consider looking at that study.
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Neo
#54
Can you reply to this from above please? Would help me understand your holistic view here.
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Interestingly enough, I have an appointment with Dr. T in about 9 days and will get his opinion.
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Dr.Bart
#56
Imagine walking in to a doctor’s office and your doctor says; “Hey, we should try this new treatment. I read some tweets about it” 
Joking here, but yeah just cut to the chase and post link to the actual outcome study.
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That is the product.
Only availablle recently in the US! I tried forever to get it from Europe but no luck.
No studies on whether it lowers Lp(a) but it lowers the CV risk!
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Is trigonneline just as bad as other NAD precursors?
Neo
#60
Not sure what is breaking down in our communication on this one. My question is
Do you agree that high Lp(a) is one of the most severe risks factors for cardiovascular disease? Do you agree that it is much more atherogenic than normal LDL-apoB?
I found out I had atherosclerosis accidentally, because I developed tinnitus and it showed up on a scan done for that complaint
It seems to me that this should be an embarrassment to the doctors at Kaiser. Seems to me there might be some standard early detection test at least, when there’s still time to take mitigating actions. But that’s probably just my ignorance talking, what do I know? The three lipid panels taken over the the prior thirteen years were ‘perfect’, what more do I want?
It is said that a large percentage of people first find out they have cardiovascular disease when they die from it.
One of my PCPs on atherosclerosis: ‘Lots of old people have that.’ Beginning and end of discussion.
I think inaction is also rooted in financial perspectives.
Regarding LP(a).
Mine is 157/nmol/L. On the high side. I tested it through LabCorp.
I emailed my Kaiser doc, just as FYI. The nurse/message screener repolied, ‘If you have some concern you’d like to express, set up an appointment.’ I’m not sure the doc ever saw the message.
I’m confident that when LP(a)-lowering medicines are approved in a couple years, Kaiser won’t cover them. They don’t cover PCSK9 inhibitors.
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Dr.Bart
#62
Frankly I don’t know enough about it to make such definite statements. This is not my field. Great question for a cardiologist or cardiovascular surgeon.
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You’re absolutely right - but like all current healthcare providers, their focus is once you have the disease, not on prevention and early identification.
I love Kaiser for what they do, but they are definitely still sick care.
The biggest sign of this is when the CEO dies of a heart attack at age 60:
Look on the bright side… You’re getting better care than the CEO of Kaiser 
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Dr.Bart
#64
I won’t and cannot even try to get in to the enormous amount of detail missing in your case to make any judgement whether your case was handled appropriately.
However I can tell you for certain that the great majority of CAD, metabolic disorders, etc. is due to the INACTION of the patient in terms of their lifestyle.
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I’m happy to stipulate that my having cardiovascular disease is 100% my fault, and if I was a better person I wouldn’t have it. Like the girl in the short skirt, I asked for it.
Still seems like they could have given me a heads up a bit sooner. There is the remote possibility I might have repented of my sins.
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Neo
#66
I’m learning that we have a very, very different world view
Above might be technically true. But I’m not sure why that was introduced in the context of @anon16510610 post
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Dr.Bart
#67
spend 25 years in the medical field and you would be very enlightened
Above might be technically true. But I’m not sure why that was introduced in the context of @anon16510610 post
Because it’s not technically the truth, it is the truth and the more people realize it the less doctors they will need to see. So instead griping about doctor’s relative inaction, an individual should focus on their own inaction as that will have a far greater impact on their health than anything than modern medicine can possibly provide.
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