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LP(a) reduction using EvolocumabI

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  • LP(a) reduction using EvolocumabI

    I just read this interesting article in JAHA. Seems that one of the benefits of Evolocumab ( Repatha) is a significant reduction in LP(a) is this something those of us with elevated LP(a) should consider while we wait for Norvatis and others to get other drugs on the market? btw, my LP(a) is 240

    Thanks

    Alec

    https://www.ahajournals.org/doi/10.1161/JAHA.119.014129

  • #2
    If I had high Lp(a) levels I would consider using Repatha, but from what I have heard most health insurance plans will not pay for a PCSK9 inhibitor for anything beyond FH that cannot be adequately treated with a statin. I think that a study showing that decreasing Lp(a) results in lowering disease outcomes would be necessary, and we should get that out of the Phase 3 trial of a new specific Lp(a) lowering drug that is just starting. Given that drug trial is successful, then the drug will likely be expensive for the first few years. For people with higher levels of Lp(a), niacin is about the best option for now with keeping LDL-C lower using a statin the next best thing.
    Last edited by Tom; 03-03-2020, 11:58 PM.

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    • #3
      Hi
      I gave up. Just letting my LP(a) stay high. I have zero CVD and I'm 58. Don't care any more. I was happy and healthy until I found out at 55. I'm going to go back to that mental time.

      Comment


      • Tom
        Tom commented
        Editing a comment
        There is something to be said for not worrying excessively about something that you cannot fix entirely. However, there are prudent steps that you can take to minimize the risks to an extent.

    • #4
      Sometimes retreat is the better part of valor. I bet that was the right choice until another practical options comes up. I doubt the antisense drugs will be priced lower than the stratosphere any time soon. I bet about 15 years before thay are.

      Comment


      • Tom
        Tom commented
        Editing a comment
        Robin, It may be just your genetics tending towards FH, but your numbers are common (perhaps 25% or more) for people who are on a LCHF diet when the fat is primarily saturated fat. Peter Attia mentioned that several of his LCHF patients with such cholesterol numbers had those significantly reduced when they changed from eating a lot of saturated fat to monounsaturated fat (e.g. olive oil). Some people don't process saturated fat well. A lot of doctors worry about their patients having high cholesterol numbers, and I suppose it ultimately comes down to cardiovascular inflammation. If your cardiovascular inflammation markers are kept low, then the higher cholesterol numbers might not matter as much. Keeping your TG/HDL-C number less than one certainly helps.
        Last edited by Tom; 03-11-2020, 12:19 AM.

      • Tom
        Tom commented
        Editing a comment
        After thinking about this a bit more, there is another good option to consider. Some people make more cholesterol, and that is the case I mentioned about those who don't process saturated fat well. Other people re-absorb a good bit of cholesterol as part of the cholesterol re-cycling that takes place from the liver through the bile duct back to the small intestines. Zetia is a very effective drug for people who re-absorb a good bit of cholesterol, and 10 mg daily for most people will substantially lower their cholesterol numbers. I have pasted a link to a pictorial of this re-absorption path for those who might be interested.

        https://pbs.twimg.com/media/ESYbiFfW...pg&name=medium

      • laketahoebob
        laketahoebob commented
        Editing a comment
        Robin- Don't know if I'm missing something, but TC = LDL + HDL + 0.2TG. So your TC should be 119+60+6= 185, not 240? Wish I had your CVD, CAC and CIMT status.
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