Adding Lipofen to Simvastatin

[Ruthiejb]

I'm a 60-year old woman, non smoker, 5'2", 109 lbs; occasionally drink a glass of white wine; lifelong exerciser 3-4 days per week.  My medications are Lotrel 5/20, Spironolactone 25 mg. (I was on HCTZ, however, it caused me to have a skin reaction from the sun so my doctor switched me to Spironolactone), Simvastatin 10 mg. and Synthroid 50 mcg.  Grandmother had angina; sister has CAD partly due to poor lifestyle (very high triglycerides, poor diet, lack of exercise).  My doctor gave me a new sophisticated blood test and based on those results he wants to add 150 mg Lipofen to my regimen.  Here are those results:
TC 209, LDL-C 101, HDL-C 72, Triglycerides 115, Non-HDL-C 137, Apo B 100, LDL-P 1206, sdLDL 37, %sdLDL 37, Apo A-I 200, HDL-P 50.6, HDL2 17, ApoB:ApoA-I Ratio .50, Lp(a) Mass 15, Lp-PLA 133, NT-proBNP 27, Apolipoprotein E Genotype 3/4, Insulin 3, Free Fatty Acid .37, Glucose 92, Uric Acid 4.6, Homocysteine 8, 25-H Vit D 40, CRP 0.9 .
I'm hesitant to add another drug at this point especially since my triglycerides and HDL are in the optimal range.  Do you feel adding Lipofen is the best course of treatment?  I would like to trying increasing my Simvastatin dose to 20 mg instead to see if that helps.  What would you recommend? Thank you.

[Lee Kirksey, MD]

An  extensive discussion of all of the genetic tests performed is beyong the scope of this post. Briefly you have several lab results which are associated with a higher risk of heart disease including elevated Apo B greater than 90, elevated LDL >. and apo e genotype 3/4. The decision to treat you aggressively for CVD risk factors should be a mutual discussion between you and your physician based upon a mutual understanding of your goals for therapy. This will require your physcian or delegated personnel to provide resources so that you understand the results of the sophisticated test and how these may influence the judgment to alter your medication regimen.


Best of health and I apologize if you felt the detail and length of my question was insufficient

[Ruthiejb]

Dr,
Can you please give me more information about my Apolipoprotein E Genotype being 3/4?  My doctor didn't really tell me much about it; the nurse called to tell me about adding the Lipofen.  What does it mean exactly?  I know I'm high risk; does that mean even if my numbers are in control, it will not necessarily help?  Neither one of my parents had heart disease (that we know of).  Thank you.

[Lee Kirksey, MD]

hello
Its good that you have had state of the art testing for your cholesterol disease. I think that what you are suggesting is reasonable as long as you have had no intolerance to simvastatin. As you know his reason for adding an agent is based upon your high risk genetic profile. Either way, I agree that your parameters should be driven lower.

Good luck and best of health