b'Addressing Lp(a) in Clinical Practice:antioxidant capacity in the blood, and23%, and effects at dosages under Considerations significantly lowered triglycerides,2000 mg/day were comparable to Beyond biologics and plasmatotal cholesterol, LDL, and VLDLanhigher dosages in the trials studied;apheresis, addressing Lp(a) level isimpressive combination of effects,again, niacin-related risks should be challenging. We all have our variousespecially since these women oftenconsidered for each individual. protocols, likely most of us leaning onshow just the kind of oxidative andOne meta-analysis of studies inniacin as a foundational intervention.glycation stress that may increasehealthy women found hormone Here is a run-down of additionalLp(a) modification.replacement therapy (HRT) use takeaways we gleaned from theA meta-analysis found that oralassociated with around 19% lowerresearch:L-carnitine may significantly lowerLp(a) levels and reduced CVD risk, Lp(a) by an average of about 9 mg/ while another in diabetic and predia-Given Lp(a) resistance to lowering, follow a full, foundational FxMeddl; studies used mainly 1 or 2 gramsbetic women found that it (oral forms) approach so general inflammation isdaily, and results did not differ bylowered fibrinogen and platelet dialed back, resilience is up, nutrientsdosage.activator inhibitor-1 levels as well as are optimized.Another meta-analysis found thatreducing Lp(a) levels by 25% in theseReference ranges. In general, 10mg/ CoQ10 supplementation producedwomen; again, though, HRT may be mild yet still significant Lp(a) reduc- better for women with higher base-dL is associated with a reduced riskline Lp(a) levels, and postmenopausal of CVD and anything higher isuse primarily to manage CVD risk associated with increased risk.may not be recommendable. Concern ranges are 30mg/dL or higher. (Some Lp(a)Lingering Questions and the assays use nmol/L. ConversionLp(a) Rabbit Holecalculators are readily availableIt seems very likely that online.)lifestyle interventions that dont Optimize all lipid andnecessarily impact Lp(a) levelsinflammation markers using anstill influence vascular health and advanced panel, even as Lp(a)function in beneficial ways that is treatment resistant.limit the production and patho-Include fibrinogen in yourgenicity of Lp(a). Here are a few questions we have about Lp(a):work-up as a surrogate marker Could Lp(a) be a milieu of clotting risk (recall Lp(a)s clotting kringles). Since fibrin- marker, a canary for the cardio ogen is fairly easy to addresscoalmine? Might it communi-with omega 3s and proteolyticcate an increasingly pro-oxidant enzymes, I try and keep it onexposome, or reflect body the lower side of normal. burden of lipid damage? tions of about 3.5 mg/dl, especially atIs Lp(a) a chaperone protein to limit Risk from elevated Lp(a) levelswould seem to be additive (maybehigher dosages (200-300 mg/day) andthe activity of modified lipids that even synergistic) with high LDL orin those with baseline Lp(a) levels ofmight otherwise induce further oxPL levels, very high HDL levels, or30 mg/dl.damage? high mean HDL size. In the future,In hypercholesterolemic men andCould lifestyle therapies targeting well take a closer look at particularpostmenopausal women, consumingredox biology and metabolic flexibility polymorphisms that may help clarify40 g/day ground flaxseed in bakedaddress production and modification for whom they affect risk and if thereproducts lowered Lp(a) levels by 14%of Lp(a)? Might fat-soluble vitamins, are any known lifestyle considerationsand HOMA-IR by 23.7%, and thisomega-3s, or antioxidants affect Lp(a) that modulate risk.intake level was well-tolerated. synthesis or enzymatic detoxification Consider obtaining a coronary arteryIn clinical trials, aspirin dosages of 81of damaged lipids?calcium score as a part of a generalor 150 mg daily significantly lowered work-up for Lp(a) folks Lp(a) levels, especially in persons atKara Fitzgerald, ND ( Naturopathic In polycystic ovary syndrome (PCOS)higher baseline concentrations; allDoctor), is a certified practitioner withpatients with elevated Lp(a), supple- the same, risks inherent to aspirin andThe Institute for Functional Medicine menting with 1 g omega-3s fromaspirin dosage should be consideredin Newtown, CT. She wrote this article flax (including 400 mg ALA) alongfor each individual.with the help of Ann Sims, RD, LD, CDE, with 400 IU vitamin E daily downreg- A meta-analysis found that the use ofCLS. The full article may be accessed here:https://www.drkarafitzgerald.ulated mononuclear cell Lp(a) andextended-release niacin could signifi-oxLDL expression, improved totalcantly lower Lp(a) levels by almostcom/2019/11/14/the-lpa-conundrum/.www.njchiropractors.com I 19'