AnUser
#38
A high Lp(a) is very bad so work on getting that down. IIRC Lp(a)-apoB is 6 times more atherogenic than LDL-apoB.
Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis, 2024
It just doesn’t seem reasonable to me that niacin would somehow be worse than the Lp(a) it reduces if you get no side effects. But I have not done that analysis or looked at this in detail.
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Dr.Bart
#39
For someone with not optimal Lp(a) those risks may strongly outweigh the unclear risks from this paper of associations to higher niacin
I would be careful making this statement, because you making it seem like the Niacin is CLEARLY mitigating the the risks of Lp(a), which is not the case.
In fact I believe that even though Niacin can lower Lp(a), it has no effect on ischemic events and death.
So you are dealing with dubious benefit vs potential risk of using high dose Niacin.
Do no harm.
1 Like
Neo
#40
As you quoted me:
For someone with not optimal Lp(a) those risks may strongly outweigh the unclear risks from this paper of associations to higher niacin
I’m sorry if it came across as it clearly does, I was truly trying to convey that it may.
Can you explain how may in my sentence does not mean may but comes across as clearly so I can be more careful in my posts in the future?
I think the statement " may strongly outweigh" does make it seem like you’re saying or at least suggesting it at least outweighs, and perhaps strongly outweighs… when compared to “unclear” risks from this paper…
Anyway, I get the points that both of you are making.
Given the many ways to reduce risks in the lipid/cardio area, I tend to go with the ones most tested and validated. This tends to be the pharmaceuticals simply because they have more money to do the RCTs that the FDA requires.
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Neo
#42
Harm can be done via action or inaction
In this case we know that inaction could have a very large potential harm given how bad high Lp(a) can be.
I personally don’t know how to weigh the risks.
So I can understand where you are coming from, do you believe the following [in bold] is correct or not correct:
I am on facuty for SSRP which is a cellular MEdicine educational organization and we have been preaching the risks of oversupplementation of niacin, and especially NAD and its precursors with disease states!! This finding is not news since excess contributes to higher levels of aldehyde oxidase which has end products of 2 and 4 pyridones which have been shown for years to increase CV risk. The other problem is the upregulation of the enzyme NNMT, which contributes to helping cancer cells, fat cells, and senescent cells. NNT blockers are being researched extensively to help cancer and metabolic disease as well as long covid and yet many people are taking lots of NAD and its precursors and upregulating this enzyme!!!. Bad news! It is hard to know how much is too much! ANd it likely depends on disease states and levels of AOX and NNMT. Likely low intermittent dosing is OK. But, We finally have access to a much better option recently available from Europe called 1MNA. 1 MNA blocks NNMT and increases SIRT. It has the benefits of niacin and other NAD precursors and NAD and not the risks since it controls the formation of these bad metabolites by blocking NNMT and being excreted directly into the urine to control oxidative stress. It has been shown to have marked antiinflammatory, CV and metabolic health benefits!
Song Z, Zhong X, Li M, Gao P, Ning Z, Sun Z, Song X. 1-MNA Ameliorates High Fat Diet-Induced Heart Injury by Upregulating Nrf2 Expression and Inhibiting NF-κB in vivo and in vitro . Front Cardiovasc Med. 2021 Oct 12;8:721814. doi: 10.3389/fcvm.2021.721814. PMID: 34712707; PMCID: PMC8545986.
10 Likes
Neo
#44
Thanks. I’ll reflect on it and try to be more clear in future communications.
To help clarify what I mean/believe:
- I think there is a lot of uncertainty here
- I think bad Lp(a) is really, really risky, really, really bad
- I know that there are no good medicines for Lp(a) (yet)
- I think the odds are meaningfully better than 50/50 that the risk/downside of Niacin in someone with high Lp(a) that responded well to Niacin and where it crushed Lp(a) levels are smaller than the risks of the Lp(a) as among the largest risk factors for the largest killer, cardiovascular disease
2 Likes
Neo
#45
Thank you. Will look into this.
Do you have a perspective in the context of high Lp(a) and the associated materially increased cardiovascular risks where there are no good alternatives (and not just in the context NAD+ “optimization”)?
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Dr.Bart
#46
There are two problems with your statement: First of all the problem is not “may”, it’s the use of “strongly”… Strongly implies that there is good evidence that Niacin mitigates the risk of Lp(a). I am not aware of any such evidence. Maybe you are then you can share it.
Second you label the risk of Niacin “unclear” and yet you put NO such a label on the purported benefit of the Niacin - which is even farther from clear.
So by doing using “strongly” for potential benefit and using “unclear” risk of Niacin you give the appearance that there may be a net benefit over the risk ratio of using Niacin with Lp(a) risk- which is absolutely unsupported by any evidence.
I think you are conflating "lowering Lp(a) with positive clinical outcomes, which is a common mistake. In medicine it’s the outcomes that really matter, affecting data point without positively affecting the outcomes is of little clinical significance.
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AnUser
#47
Niacin is an FDA approved drug?
Dr.Bart
#48
https://pubmed.ncbi.nlm.nih.gov/22085343/
[Here is a direct quote from this relevant paper - Niacin reduces lipoprotein (a) by 15% to 25%, but does not reduce death or ischemic cardiovascular events [[42]
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Neo
#49
This may be helpful to understand my understanding and perspective
(For context, many see Dr T as the world authority on Lp(a), which is why I had recommended that @isutiger check with him and why I assume that @isutiger when through the hassle to obtain a appointment with Dr T even if he had to wait 6 months for it):
Since @isutiger lowered his Lp(a) by almost 50% the benefit for him might be larger than in the average 30% lowering cases that Dr T discusses above.
lowered my Lpa from 130 to 68 nnmol/L
https://twitter.com/lpa_doc/status/1118957738661277696?s=46&t=zJMJ1xVdRJYEDYz-DHipTw
3 Likes
Dr.Bart
#50
Harm can be done via action or inaction
In the medical field inaction is a very frequent and appropriate course of action. Inaction is rooted in ethical, medical and legal perspectives.
This why have DNR status for patients. This is why surgeons choose not to operate on patients that may not survive the surgery. This is why don’t prescribe antibiotics for viral infections. This is why we refused to prescribe Ivermectin for COVID… etc. etc. etc. You can write a whole book about this subject
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Elizabeth, is this the product you are referring with 1MNA? See Endoteliol 1MNA – OHP Health by Longevity Labs Inc.
Are you saying this 1MNA can reduce LPa levels more safely than Niacin?
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Dr.Bart
#52
Dr. T clearly states that these are his opinions. These tweets are from 2019, I wonder if his opinions would change given the recent studies as discussed above on Niacin.
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Neo
#53
Totally, if you looked at one of the very first posts I made above I said:
Suggest you give your context, mention the new paper and ask Sam T via twitter - he is a world authority on Lp(a) and seems to respond to people’s questions quite often.
It’s both. You asked for evidence / studies that can help inform our understanding and I was trying to point you to:
Would consider looking at that study.
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Neo
#54
Can you reply to this from above please? Would help me understand your holistic view here.
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Interestingly enough, I have an appointment with Dr. T in about 9 days and will get his opinion.
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Dr.Bart
#56
Imagine walking in to a doctor’s office and your doctor says; “Hey, we should try this new treatment. I read some tweets about it” 
Joking here, but yeah just cut to the chase and post link to the actual outcome study.
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That is the product.
Only availablle recently in the US! I tried forever to get it from Europe but no luck.
No studies on whether it lowers Lp(a) but it lowers the CV risk!
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