Sep 13Liked by Dr Paddy Barrett

Super excellent post as usual! Thank you!!

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I saw an interesting change in Lp(a) after starting 10 mg of Crestor. My LDL-C was clocking in around 147 and has been that way for a long time (am 65). No real risk factors for CHD beyond elevated LDL-C (and it turns out elevated ApoB and Lp(a)). My Lp(a) was 84 prior to beginning the Crestor. After a month of the statin, my Lp(a) retested at 111 (though my LDL-C was 79).

I have no idea how to make sense of that and my cardiologist didn't seem concerned about the bump in Lp(a). Is lowering LDL-C/ApoB via statin while raising Lp(a) a reasonable tradeoff?

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Purely an N=1 observation, but 4+ years on a very low carb diet has seen my Lp(a) drop from 92 to 52 nmol/L. Maybe a result of losing 55 lbs.?

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Thanks for this review! I hope the meds in the pipeline do in fact show beneficial outcomes data. In the meantime I’m not sure testing everyone in a primary care setting once for Lp(a) makes sense. None of our practice guidelines recommend this, once again because interventions are not there yet, right?

I’m skeptical about PCSK9 meds and outcomes. A primary care oriented reference I subscribe to called Essential Evidence Plus had this to say recently:

“Cholesterol-reducer evolocumab associated with a nonsignificant increase in cardiovascular mortality (FOURIER)

A little sleight of hand here, perhaps unintended (perhaps not): Published data on the effectiveness of evolocumab to prevent mortality may not have represented the actual data in the clinical study report. When causes of death were re-adjudicated by a masked panel, cardiovascular deaths were numerically higher in the evolocumab group, though not to a level that reached statistical significance.”


Also not sure insurance companies will cover Lp(a) testing. Do you think this has a role in primary care? Once again thanks for the preview of the future treatments, and hoping they do better than the HDL increasing meds that did not help outcomes, but “should have!”

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