To: LindyBill who wrote (1827 ) 10/31/2008 12:09:40 PM From: rich evans Read Replies (1) | Respond to of 39288 Comments from my Brother in Law to your article, Lindy. A practical approach to Lp(a) It is nearly always worth beginning with the treatments most well-studied for reduction of Lp(a): ________________________________________________________________________ * Niacin—Doses may be higher than that for other conditions, up to 2000–4000 mg or more per day (only under physician supervision). . (Inositol hexanictinate; it is non flush producing and doesn’t cause liver problems. It’s available as “Non flushing Niacin” at Sam’s Club and it’s cheap). <!--[if !supportEmptyParas]--> <!--[endif]--> Testosterone for men; estrogens for women. (Nope, got to watch my prostate). * DHEA (Anne is on this, I’m not). * LDL reduction—with statin drugs or otherwise (We’re both on this, with the addition of substantial Co-enzyme Q10 to counter- act the 40% reduction in Q10 caused by the statin). We’re on the newer form, ubiquinol rather than the common ubiquinone, which is 3-5x more available at the cell level and is in the form in which it is stored in the cell.) * A diet rich in fish and omega-3 fatty acids, (Yes, we’re on this big time both with fish and fish oil supplements). But not the following: perhaps unrestricted in saturated fats (from good sources like organic or farm-raised red meats, eggs, cheese; not cured meats like bacon and sausage, or fried foods whose structure has been altered by high-temperature oxidation). * Raw almonds, ground flaxseed. (nuts & flax). * Alcoholic beverages, preferably deeply-pigmented red wines (NO). * Aspirin (yes, both of us). After this basic starting list, that's when we begin to turn to the less well-tried strategies. The treatments most likely to yield useful effects include: * High-dose fish oil (Yes) * Fibrate drugs—especially fenofibrate (Tricor®) (No) * If diabetic, treatment with metformin (Glucophage® and/or pioglitazone (Actos®) Although more investigation is needed, we are advocates of reducing homocysteine levels when Lp(a) levels are high, since these two molecules have the potential for adverse interaction that heightens plaque-growing risk. Since the treatment is relatively benign and inexpensive (B vitamin supplementation), it is a small price to pay for added peace of mind. (Yes, formulation of high dose Vit. B6, B12, folate plus Trymethylglyceine, though I don’t believe that a lot more investigation is needed. It is well-established, except in traditional medicine). This is an amazing article, as it prescribes what we’ve been basically doing for the last 15 years or longer. It kind of strengthens/endorses our understanding of coronary protection. Thank you for sending it! I’ll have to send you the newest article on the recent Plaque Test for heart attack risk………Love, Ken