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
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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
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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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Is trigonneline just as bad as other NAD precursors?
Neo
#60
Not sure what is breaking down in our communication on this one. My question is
Do you agree that high Lp(a) is one of the most severe risks factors for cardiovascular disease? Do you agree that it is much more atherogenic than normal LDL-apoB?
I found out I had atherosclerosis accidentally, because I developed tinnitus and it showed up on a scan done for that complaint
It seems to me that this should be an embarrassment to the doctors at Kaiser. Seems to me there might be some standard early detection test at least, when there’s still time to take mitigating actions. But that’s probably just my ignorance talking, what do I know? The three lipid panels taken over the the prior thirteen years were ‘perfect’, what more do I want?
It is said that a large percentage of people first find out they have cardiovascular disease when they die from it.
One of my PCPs on atherosclerosis: ‘Lots of old people have that.’ Beginning and end of discussion.
I think inaction is also rooted in financial perspectives.
Regarding LP(a).
Mine is 157/nmol/L. On the high side. I tested it through LabCorp.
I emailed my Kaiser doc, just as FYI. The nurse/message screener repolied, ‘If you have some concern you’d like to express, set up an appointment.’ I’m not sure the doc ever saw the message.
I’m confident that when LP(a)-lowering medicines are approved in a couple years, Kaiser won’t cover them. They don’t cover PCSK9 inhibitors.
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Dr.Bart
#62
Frankly I don’t know enough about it to make such definite statements. This is not my field. Great question for a cardiologist or cardiovascular surgeon.
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You’re absolutely right - but like all current healthcare providers, their focus is once you have the disease, not on prevention and early identification.
I love Kaiser for what they do, but they are definitely still sick care.
The biggest sign of this is when the CEO dies of a heart attack at age 60:
Look on the bright side… You’re getting better care than the CEO of Kaiser 
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