Strategies for dealing with lipid profile

Posted by Bob on June 20, 1999 at 11:30:00
I am a male 55, 3/99 heart attack with arrest (scary!) and two blockages stented.  Remaining multiple 50-60% blockages in all arteries.  I am thin, in shape, smoker until attack, cholesterol historically about 200 with HDL  30-34.  My cholesterol after 90 days on Ornish diet and 10mg Lipitor:  LDL 69, HDL 27, Triglycerides 115. Not satisfied with HMO, I had additional tests done at NMR lab and local university.  They showed:  Lipoprotein(a) sky high at 121 mg/dl, LDL predominantly L1 ("small"), HDL predominantly "small".  In addition, homocysteine is 12 despite taking 1g folic acid daily.  My HMO has not offered niacin prescription, instead suggests exercise.  I am really anxious for a second opinion from you, not a "discuss this with your doctor" answer.  Given the high Lp(a), what sort of target should I be setting for LDL, HDL, homocysteine, and other factors?  Should I continue to be aggressive in diet and exercise, or is adding some mono fat back to my diet a good tactic?  How helpful is niacin likely to be?  Any other suggestions?

Posted by CCF CARDIO MD - CRC on June 21, 1999 at 10:53:07
I think Niacin is your best option.  It will help lower the Lp(a) and raise your HDL.  I don't know why your HMO is reluctuant to start Niacin.  It is one of the cheapest drugs on the market.  It does need to be properly started and some liver tests monitored but is otherwise a well tolerated drug.  We place many people here on the combination of a statin such as Lipitor and NIacin. In addition make sure your are exercising 40 minutes a day at least 3-4 times a week.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
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