1. Family history of CVD? get tested for Lp(a) know your risk factor!. 2. Telmisartan and secondary prevention, anyone take this BP med?

[Raylpa]

Hi fellow hearties

I have elevated lipoprotein (a) or Lp(a) for short. This is a genetically inherited condition and recognised as a significant and independent risk factor for the development and progression of CVD.

At my level of 90> mg/dL my heart health risk factor is multiplied by 3. If early outset CVD, without lifestyle issues, runs in your family insist on a blood test at your specialist lipid clinic. If you haven't insisted on a blood test for this condition you will not have been tested! It's not included on a standard lipid panel. Your GP has likely never heard of it yet 20% of the population carry this risk factor.

The Lp(a) factor has now become very real to me as I have just been diagnosed with aortic valve calcification. I had an acute coronary syndrome in 2015 and I had a stent at that time. I fear the Lp (a) will progress my CVD and in particular the heart valve disease.

In respect to my stroke risk I note from the NHS / NICE web site that only one blood pressure medication, Telmisartan, is indicated as a benefit for CVD risk and stroke risk reduction. (anyone have experience on this medication)

My blood pressure drug Irbesartan is not indicated for anything other than high blood pressure and diabetes, the latter I don't have. Obviously given my history and progression of my CVD, with my recent heart valve issues diagnosis I am wanting to do all I can to mitigate my risks. I have spoken to my GP about this and she has said Telmisartan isn't on her list of available drugs, yet my Chemist says its available and no more expensive than my current Irbesartan.

Sorry for the life story, my question is, does the community have any experience of possible Co- Benefits associated with some blood pressure medication or any other medications which may offer mitigations on risk for an individual with elevated Lipoprotein (a) who has an obvious developing CVD issue.

Ps I am on a whole food diet and largely plant based diet and take daily exercise, I think I am doing all 'I can' hence the focus on medication.

[MichaelJH Heart Star]

Both Telmisartan and Irbesartan are ARBs. These are primarily prescribed to reduce BP, and in doing so help protect against heart attack, stroke and kidney disease (particularly diabetes related). ARBs are often prescribed where ACE Inhibitors have caused an irritating dry cough in some individuals.

Besides controlling BP it is important your cholesterol is kept in range. The primary drug for this are statins. In addition to reducing cholesterol they also reduce irritation, often a precursor to plaque formation, and stabilise any existing plaque. Are you on a statin? A mini Aspirin is probably also appropriate. If you are not on Aspirin (75mg) it would be sensible to talk to your doctor about this.

If following a basically vegetarian diet you should take care not to become Vitamin B12 deficient.

[Raylpa in reply to MichaelJH]

Hi Michael, thanks for taking time out to reply. Following the stent I take Aspirin 75 mg. I take Atorvastatin 40 mg and my lipids are all exceeding the right numbers at least 'now' they are following a diet and exercise revolution over the last two years. So lipids great apart from the Lp(a) lipid issue which is genetic and the 3x multiplier for my CVD and stroke risk factors.

My ask to the community is: please can anyone offer any experience of their GP or Cardiologist having prescribed a BP medication such as Telmisartan or Losartan with a consideration to these particular ARB's being indicated for persons with established CVD and who have a higher risk of developing further CVD or stroke risk? My Irbesartan has no such co-benefits indicated.