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Do statins and healthy habits reduce lipoprotein levels?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

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Published At May 15, 2024
Reviewed AtMay 15, 2024

Patient's Query

Hello doctor,

I am a 44-year-old female, 5.2 feet tall, and weighs 147 pounds. There is a family history of heart disease; my grandfather died of a heart attack at 41, and my father had heart disease in his 40s, ultimately passing away from a heart attack at 72. One week ago, I discovered that my lipoprotein (a) level is 278.4. Despite maintaining a reasonably healthy vegetarian diet for the past five years, I have consistently had high cholesterol throughout my adult life. I am now considering reintroducing occasional meat in my diet due to a perceived lack of certain nutrients. Although my doctor previously advised against statins, citing a low risk (calculated at 0.5 percent based on factors such as good a1c, low blood pressure, non-smoking status, and age), last week's revelation of an elevated lipoprotein (a) level (278.3 mol/L) has prompted reconsideration.

I have a new doctor, and he says I am overthinking this and did not seem to think I even need to worry about lipoprotein (a) being so high because of my low risk. I feel he is dismissive of the risk as it was low before we knew about the lipoprotein (a), but what about now? According to everything I have been reading this week, this is a serious matter, but I do know the internet can be a scary place to look for medical information. He prescribed statins anyway because I was upset and needed something to make me feel like I was lowering my risk, so I started tablet Atorvastatin 20 mg yesterday. I initially asked for PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors as I read they can lower lipoprotein (a), but he said he could not do it.

My test results show, lp(a): 278.4, Apo B: 122, total cholesterol: 235, HDL: 54, triglycerides: 124; and LDL: 159 (measured approximately four months ago). So many questions came up, and I could not get answers, so I wanted a second opinion. Is my risk as low as my doctor says, even with this high lipoprotein (a)? Can people with high lipoprotein (a) still live long, healthy lives, or are we guaranteed heart disease? Will a statin that increases lipoprotein (a) increase my risk rather than reduce it? Do you agree with the course of treatment? Should I take Aspirin as a preventative measure (I read high lipoprotein (a) can cause clots)?

Please feel free to tell me if I am overthinking. It would help me sleep tonight, but I also want to know my real risks.

Thank you.

Hello,

Welcome to icliniq.com.

I can understand your concern.

Your LDL (low-density lipoprotein) is 159, and your lipoprotein (a) levels are high. According to the latest guidelines of the American College of Cardiology and the American Heart Association, you should take a statin. Take one tablet of Rosuvastatin 10 mg per day. Another option is Ezetimibe, which lowers lipoprotein (a) levels. In addition, adopt a Mediterranean diet, engage in regular exercise, and ensure adequate sleep. Maintain normal blood pressure and sugar levels. Consult a specialist doctor, talk to them, and then take the medication.

I hope this information is helpful. Please do not hesitate to reach out if you need further assistance.

Thank you.

Patient's Query

Thank you for the reply, doctor.

Is my risk still low even if lipoprotein (a) is high? Can people with high lipoprotein (a) still live long, healthy lives, or is heart disease guaranteed? Should I take Aspirin to prevent clots because of my high lipoprotein (a)?

Hello,

Welcome back to icliniq.com.

There are risk estimation scores calculated based on risk factors and lipid profile, but none of these scores include levels of lipoprotein (a). Elevated levels of lipoprotein (a) increase the risk of cardiovascular diseases, but the extent of this increase is unknown. American guidelines consider lipoprotein (a) levels a risk enhancer, meaning they enhance the risk associated with other underlying risk factors. Ideally, LDL levels should be less than 100, but yours are at 159. Currently, no medication is specifically designed to lower lipoprotein (a) levels, but lowering LDL levels and adopting a healthy lifestyle can help reduce the overall risk of cardiovascular events. There is no benefit to taking Aspirin, but you should take Rosuvastatin 10 mg once a day. Note that its contraindications include pregnancy and breastfeeding. It should be discontinued six weeks before pregnancy. Consult a specialist doctor, talk to them, and then take the medication.

Instead of focusing solely on lipoprotein (a) levels, consider all your overall risk factors and work on lowering them. Avoid a sedentary lifestyle, smoking, alcohol, and stress, and ensure adequate sleep. Engage in regular exercise and reduce consumption of fatty foods.

I hope you find this information helpful. Please let me know if you need further assistance.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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