I have elevated lipoprotein a [lp(a)] and elevated cholesterol levels, am 70 years old and have a coronary artery calcium [CAC] score of 0 (or did before I started statins a short while ago). I just learned about the lp(a) level around 18 months ago. I started a 5 mg dose of simvastatin 15 months ago and it increased my modestly elevated lp( a) score significantly.
About one month before this year's blood draw, I stopped the simvastatin as an experiment. My lp(a) dropped from 43 mg/dl to 26 (this particular lab reports anything less than 30 to be normal). Of course my LDL climbed back into the 130s. HDL is 59. Triglycerides less than 100. I'm athletic, eat plant-based, and fast periodically (but still need to drop some weight).
Here's the thing, I lived for 30 years or more with my elevated total and LDL cholesterol levels and yet my CAC score remained zero. So, I feel like taking a statin that messes quite a bit with the lp(a) level may actually be more risky for me than living with an LDL in the 130s.
I've tried reading a few research articles, but my impression is that there is not real clarity around the lipoprotein a issue at the moment. I would sure love to hear other viewpoints, thoughts and insights.
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Desertflowerchild
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Hello! I find your post very interesting. Over a decade ago I went to my GP as I was concerned that I was approaching the age where my father, his brother and their father (I never met him as he scarcely got past 50) had all passed prematurely because of heart attacks. I was told not to worry as my BP and cholesterol (total 4.2 UK/162 US). Around the same time I was started on 10mg Atorvastain and a mini-Aspirin for PAD (peripheral arterial disease). I then read about Lp(a) and went and asked my GP for a blood test and was refused poinmt blank. To cut a long story short and to simplify things I had a quadruple bypass in 2018 and had my left leg amputated below the knee during the lockdowns after no one would see me despite a worsening ulcer. I am now with a different surgery and now you have reminded me I will ask again but a recent request for an HbAA1c was refused as I had one in November!
Thanks for your reply. I wrote a long reply to you yesterday and thought I had posted it, but don't see it here. First, it is quite awful what happened to you and I am so sorry you went through all this.
My doctor was trying to convince me to go on statins and so ordered one test after another to make his case. That is the only reason I ever heard of lp(a). Your comment made me realize my doctor did not order an HbA1C test this year and it should IMO be a basic annual screening test for anyone on statins.
I'm remembering more what I wrote yesterday that somehow disappeared. A recent study I read reported that those individuals whose Lp(a) increased the most in response to statin therapy tended to have bad outcomes. "Subgroup analyses revealed that a mild-to-moderate increase in Lp(a) was not associated with MACE, whereas there was a strong correlation between the highest quartile increase in Lp(a) (≥ 10.1 mg/dL) and MACE (HR = 2.29, 95%CI = 1.36–3.84, p = 0.002). This correlation was independent of baseline Lp(a) levels but not independent of on-statin Lp(a) levels."
I found out that simvastatin raised my blood sugar levels until I was prediabetec, my cardiologist offered me pravastatin , much lower risk, now on pravastatin and ezetimibe
Based on research, I'm the one that chose simvastatin and I was always on just 5mg whereas the normal dose is 20-40mg. The 5mg reduced the LDL to 90 and with my zero calcium score, doctors were fine with that.
How long did it take for your blood sugar levels to come back down? I have heard the increased risk of T2D remains after stopping statins . As I recall, that study I read had a 3 year follow-up.
What I noticed was, once I started simvastatin, I was hungry ALL THE TIME. My successful weight loss came to a grinding halt, and I began fighting, unsuccessfully, not to gain weight. My doctors (general and cardiologist) both looked at me like I was crazy, saying that was not a side effect of statin therapy. Ha! "The study shows that two statin drugs — atorvastatin and simvastatin — decreased leptin secretion, which may account for increased feelings of hunger. In turn, this could lead to weight gain when using statins long term."
But hopefully pravastatin increases your blood sugar less than simvastatin, at least? I found this reported in a 2018 research paper: "Considering individual types of statins, use of atorvastatin, rosuvastatin, pitavastatin, and simvastatin were significantly associated with increase of Δglu. Pravastatin, lovastatin, and fluvastatin were also positively associated with Δglu, but were not statistically significant."
And it does seem grapefruit is allowed with pravastatin, which, for me, would be a big plus.
Pravastatin does increase your blood sugar levels less, but no evidence that it will drop if you stop statins, in Britain they ask you to go on a diabetes prevention course
Wow @Desertflowerchild, I find your post and this thread to be highly interesting.
It sounds to me like your LDL is fine without the statin, especially in light of your CAC score, healthy HDL-C and LP(a) concerns. Obviously, I am not qualified to give advice, but I think you would do well to seek a second opinion.
Worried about my LP(a) after much reading and family history, I decided to pay for my own LP(a) test as my local surgery bods weren't getting back to me on my request. Two days ago I got my results and discovered that my LP(a) is 370 nmol/L, which I understand to be in the top 1% of everyone!
Elevated LP(a) is a now understood to be a significant risk factor and also know to be difficult to manage - being genetically determined. If recent studies are to be believed, it is more significant in terms of risk than LDL-C levels. In my opinion - not a doctor blah blah blah - medication that raises this LP(a) number should be avoided, if at all possible.
Also, as it seems relevant, I have become pre-diabetic after being on statins for the last 6+ years.
I am currently busy coming to terms with my recent LP(a) bad news while also looking to plan my way forward.
Madly, I believe the NHS(NICE) guidelines are to offer up statins for this condition (if not already prescribed - I am on Atorvastatin 40mg, FYI). Statins are known to both raise LP(a) and blood sugar/HbA1c levels (as already mention by others here).
There are other medicines such as PCSK9 inhibitors which I believe can reduce the LP(a) by 30% while also reducing LDL-C. I don't think that these are easy to get on the NHS due to price.
There are also conflicting opinions regarding niacin supplements which some reports state can reduce LP(a) by 20-30%. Others believe the effect to be minimal and cause flushing. I will be looking more into these as I go.
Also new RNA/antisense medication is currently being trialed that apparently can reduce LP(a) levels by as much as 95%. Obviously, this breakthrough is in the early stages and there may be genetic issues/concerns that may prevent it quickly gaining approval, especially in the UK. I believe there is also a type of dialysis that can be done every 2-4 weeks but I don't believe this is offered in the UK (mostly in Germany) and it is also intrusive.
There is current talk of the NHS offering more tailored/personal advice regarding health to individuals and my hope for the future is that solutions can be patient specific based on common sense and current science. We can but hope!
I wish you good health and good luck with your choices.
I'm sorry about your bad news. That is certainly an unacceptable Lp(a) level that needs to be treated. And, yes, the question is how!
I have not gone back on simvastatin and won't. You may be interested in the following: In looking at different statins, I found that pitavastatin is different, is not linked to increased risk of new onset diabetes, does not raise blood glucose levels, and, either does not affect or may slightly reduce Lp(a). So, for me, although I will need to pay out of pocket for pitavastatin, I am going to give it a try to see how my numbers react.
The research article that made me concerned stated that irrespective of Lp(a) baseline, those individuals whose Lp(a) values increased the most when taking a statin had worse MACE outcomes. In this study, the upper subgoup were those whose Lp(a) increased more than 10 mg/dl when taking a statin. In general, statin research is less than stellar because it often lumps several unnamed statins together and also often fails to differentiate by subgroup (such a men, women, pre-menopausal and post-menopausal).
It does seem to me that the Lp(a) apheresis is performed in the UK but has even more stringent eligibility requirements than in the USA.
Thanks Desertflowerchild . I will take a look at pitavastatin. I, like you, keep myself in good shape. Also I eat healthily and currently have my bloods taken every month to check on my lipid panel/inflamation markers/HbA1c etc. as I test different medications.
Please can you point me to the research regarding the link between LP(a) sensitivity to statin therapy and the related MACE outcomes. I came off my Atorvastatin 5 weeks ago but unfortunately I didn’t have an LP(a) test at that time so I can’t see the movement in my LP(a) since then!
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