Cholesterol Experts Say Everyone Needs a LP(a) Test

Moving my LP(a) journey over here, from another thread -

Well, I just tested again, and LP(a) is down to 114.9 nmol/L. So 25% below what I assumed to be the baseline level of 156.

I was literally about to start Repatha and wanted to verify a return to ‘baseline’ so I could later test and see the actual net benefit. No idea what ‘baseline’ is now.

None of this makes any sense.

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Are you also taking rapamycin? If so, did you track when the Lp(a) test was relative to the dose?

I’ve found that mine has ranged from 175 to 195 nmol/L depending on the day after the dose. In general, it was higher 7 days after the dose, while on day 4, it tended to be lower. At the same time, LDL-C was higher on day 4 and lower on day 7. It seems like the LDL-C and Lp(a) move in opposite directions as a function of time after a rapa dose, but I’ve never seen any studies on it.

Anyway, your Lp(a) is definitely high. If I could get in repatha, I would. Ezetimibe doesn’t affect it according to what I’ve read.

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Seems like a better test just got approved in the U.S.:

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“nanomoles per liter (nmol/L) as opposed to milligrams per deciliter.”

I’m confused. Both of the testing centers I’ve been using switched to molar units years ago, like maybe 10 years ago(?)

Some labs still use US style units which are unreliable when the molecular weight varies.

I think the test in mol up until this point have not been FDA approved but “investigational” or something like that?

If so, hopefully this approved one will be more precise and have less of the big random variation we have been seeing

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Perhaps an approach until new anti-LP(a) drugs become available:

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Yeah, unfortunately, it doesn’t mean that lowering the Lp(a) number translates into less MACE. It might just affect the biomarker, without affecting the outcomes. There are several agents that lower Lp(a), all with the same problem: aspirin, niacin, HRT, several others:

Do We Know When and How to Lower Lipoprotein(a)?

Therapeutic Lowering of Lipoprotein(a): A Role for Pharmacogenetics?

https://www.ahajournals.org/doi/10.1161/CIRCGEN.118.002052

And the story is complicated - genes enter the picture:

Lowering of lipoprotein(a) level under niacin treatment is dependent on apolipoprotein(a) phenotype

https://www.sciencedirect.com/science/article/abs/pii/S1567568815000094