Lp(A) Levels - genetic blocking; can it be avoided?

[forest gump]

My father at age 50 had triple bypass (1998)His cardiologist never checked his aorta artery or carotid artery after bypass, and then 1 year later, had a AAA (and lived). After the AAA, they then checked his carotid, which then had to be immediately operated on. Beofre bypass, my father smoked 1 pack of cig's per day & had a Cholesterol level of 220. Since bypass, father immediately stopped smoking, eats no fat, and is on a VARY low cholesterol diet. Father has never been over weight. Obiously, genetics has a lot to do with this. it has been 3 years since bypass, and 2 since his AAA. Below are his Cholesterol, triglycerides, HDL and LDL levels over the past 3 years.
       09/98  12/98  06/99  12/99  06/00  01/01
Chols. 222    150    136     165    145    154
Tryg.  103    107    75       93    50     112
HDL    53      39    46       42    50     38
LDL    148     90    75       104   85     93
I question the kind of health care her is receiving . My fathers cardiologist never recommended that he take a multi vitamin w/and additional folic acid supplement. My father is not taking Niaspan (I dont' know if he needs it or not, but it seems like a good preventive measure). He is on an ACE inhibitor, and takes Lipitor.  His doctors have NEVER preformed a NMR LipoProfile, Homocysteine or a Lp(a) test (the Homocysteine test is recommenced by the American Heart Association as a routine test for high risk heart patients). Last week, my father demand a stress test and echo cardiogram by his Cardiologist. They found blockage. What if my father didn't demand this test???? It has only been 3 years since his bypass and his arteries have re-clogged (we don't know which arteries yet until they do the catherization). My father takes Lipitor. Obviously, Lipitor failed for endothelial dysfunction. Clearly, his blockage is genetics (as he is as anal retentive about his diet, exercise since his bypass 3 years ago). My question is, if his doctor preformed a NMR LipoProfile, Homocysteine and Lp(a) test, wouldn't they noticed that the Lipitor was not working correctly? My father has never tried  Zocor or Prevachel. My question to you, is this new blockage seems as if it could have been avoided if the cardiologist took more tests and was more aggressive with his treatment. How do we make sure he receives the appropriate medical care? What should I do on my end to help with his follow up care? Do you think he should find a new cardiologist?


Thanks!

[CCF-M.D.-CRC]

Dear forest,

Your father's genes (and yours as well!) have played a role in the development of the atherosclerotic disease as have the elevated cholesterol levels.  However by far and away the single biggest contributor to his disease was the smoking.  Tobacco is the leading cause of artery disease throughout the body (heart, aorta, carotid, etc).  Stopping smoking was the best thing he could have done for himself.  Unfortunately, the effects of the abuse still linger even after the offending agent is removed.

I agree that a homocysteine test would be helpful and he should be taking folate if his levels are high.  Niacin would be helpful if his Lp(a) levels are elevated.  However, it is a difficult drug to take and must be taken in large doses to be effective. Fractionation of the lipids as is done in a NMR LipoProfile is less well established as mainstream therapy and probably would not be as helpful in guiding treatment.  

Dosage of the statin drugs (Lipitor) is important and I would not give up on it until maximum doses have been tried.  Your father may benefit from a consultation with a preventitive cardiologist.  We have a prevention clinic here and if he would like to be seen in Cleveland he can call the number below to make an appointment with Dr. Sprecher in the prevention clinic.

[davoud]

hello
i very tanks that you.
i live in iran and 38 yers old.i have ASD defect and size is 2.7cm.
i have a guestion :
can i  opraitin closd.and how much the risk in this opraiton or open opraitin.
very tanks for yor help.
godbye