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  • Latest Bloodwork and My Meds Question...

    Hi All and hope all are well!
    I have appointment with my Cardiologist thursday am and would like to get your take on my situation if you'd be so kind.
    Have a high calcium score in one artery mainly (LAD) but a great CIMT but also LPa of 166 nmol/L.
    Anyway went to a bale doneed dr initally and I was borderline high with BP as well high 120/80's to 130's/high 80's mostly but sometimes a bit higher with anxiety, etc.
    Anyway, after my workup and with a heavy plant based with a little seafood diet my LDL was in the mid 90's so with that and calcium score and LPa he recommended the following:
    Ramapril 5 mg BID, Crestor 5 mg QD (But I take QOD) due to prior issues with lipitor, and Enduracin (start with 500 mg and move up).
    I left him after $$$ workup and due to the fact he is MDVIP and don't need to pay $$$ every month.
    I see a regular cardiologist and every day now takE Ramapril 5mg BID, Crestor 5 mg QOD, Zetia 10 mg QOD, Enduracin 1000 mg QD, 500 mg Nordic Natural Fish oil, 4000 IU D3, 2500 mcg B12,
    150 mg Ubiquinol, and 400 mg. Magnesium Calm.
    My BP routinely between 110 and 120 and low to mid 70's; My recent relevant bloodwork came back as follows (I was good with 2 hour oral glucose fast, homa IR, and hba1c, and liver and kidney fx tests, etc):
    Lipoprotein (A) 108.0 nmol/L
    Apolipoprotein B 56 mg/dL
    Cholesterol, Total 96 mg/dL 100 - 199 mg/dL
    Triglycerides 61 mg/dL 0 - 149 mg/dL
    HDL 38 mg/dL >39 mg/dL
    VLDL Cholesterol Cal 12 mg/dL 5 - 40 mg/dL
    LDL 46 mg/dL 0 - 99 mg/dL
    I welcome your commentary here and have just a few questions:
    1.) I am scared to go higher than 1000 mg of niacin daily as I heard it can raise blood sugar and mess with liver; should I?
    2.) I am considering asking Dr. to change me from ramapirl BID to Perindorpil QD; I heard FatMax and someone else say Perindopril has a better NO affect or something as such
    and I hate having to take a pill Twice a day?

    As a quick point when my LDL was higher my HDL was within normal range so it's not a big deal that HDL is a little lower due to a low LDL and not needing to carry as many particles away.

    Thank you all for any commentary and insight you can provide for me here and god bless you all and be safe!



  • #2
    Some people have liver enzyme elevation with large doses of niacin (along with medications and other supplements), and you might try taking TMG to help replace methyl groups that you essentially need to eventually deal with the nicotinamide overload. I think that the increase in blood glucose some people note will likely go away after a while according to what Dr. Brewer has found for his patients. If you can take 2 gm/daily of niacin, then you will probably find benefit for further reducing your Lp(a) and to a lesser degree triglyceride levels. Start at the 9:30 mark on this Chris Masterjohn video which discusses methylation and TMG replacement of methyl groups. https://www.youtube.com/watch?v=P5UMfCW_23w
    Probably no harm in changing from one ACE inhibitor to another. Usually people take their hypertension medication at night as the body resets blood pressure during the sleep cycle. Sometimes the hypertension medication can start to wear off a little early in the next evening, and I suppose that is why your doctor recommended the split dosage. Have you tried taking the daily amount of hypertension medication at night? Are you exercising much? If you can exercise (even walking briskly), that will help with keeping your blood pressure stable and more vigorous exercise will increase your HDL-C levels.
    Last edited by Tom; 03-31-2020, 10:17 PM.

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    • #3
      Hi Tom and Thank you for your valuable response :-)
      I exercise 5x/week on average at least 30 mins. cardio each time. Some weights 2x/week.
      One thing about the Ramapril is the half life is less compared to Perindopril which is and that is why ramapril is 2x/day and perindopril taken once a day.

      Is a LPa in the low 100's at 108 still considered real hazardous?

      Thank You Again. :-)

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      • #4
        With Lp(a) the lower the better in general. The one thing that a person cannot know is the kringle IV structure of their Lp(a) particles as there isn't a commercially available test to my understanding. Two people can have the same overall Lp(a) score, but one could have a higher risk factor due to their kringle IV repeats vs. the other person's. So, the best thing to do is to make Lp(a) particle number (not Lp(a) mass) overall as low as possible. If you are interested in Lp(a) developments, take a look at Sam Tsimikas's Twitter feed. https://twitter.com/Lpa_Doc

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        • #5
          Thank you again Tom! :-)

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          • #6
            Hi All,
            Dr. was happy with my results.
            After what I told him about ramapril and perindopril
            he liked perindopril better and notably as its a once a day formulation with better compliance. He put me on perindopril 4 QD
            and asked me to monitor my BP. I take a good amount
            of Mg a day and just start dr young’s Mg water so hopefully
            will not have to go beyond perindopril 4 mg.
            Last 3 readings were 1 in 120’’s over mid 70’s and 110 and 115 over mid 70’s. This dr is one of the clinical trial sites for antisense
            and he knows I want in if I qualify though (might not).

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