Treatment
Currently, the recommended treatment for an elevated lipoprotein(a) is niacin, 1-3 grams daily, generally in an extended release form. Niacin therapy can reduce lipoprotein(a) levels by 20-30%. Aspirin may be beneficial as well. A recent meta-analysis suggests that atorvastatin may also lower Lp(a) levels. In severe cases, such as familial hypercholesterolemia, or treatment resistant hypercholesterolemia, lipid apheresis may result in dramatic reductions of lipoprotein(a). The goal of treatment is to reduce levels to below 50 mg/dL.
Other medications that are in various stages of development include thyromimetics, cholesterol-ester-transfer protein (CETP inhibitors), anti-sense oligonucleopeptides, and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors. L-carnitine may also reduce lipoprotein a levels.
Gingko biloba may be beneficial, but has not been clinically verified. Coenzyme Q-10 and pine bark extract have been suggested as beneficial, but neither has been proven in clinical trials.
The effect of estrogen on lipoprotein(a) levels is controversial. Estrogen replacement therapy in post-menopausal women appears to be associated with lower lipoprotein(a) levels. However one large study suggested that there was a decreased association between lipoprotein(a) levels and risk. In other words, it is unclear what a high lipoprotein(a) level means in a women on estrogen therapy. Estrogen as a prevention strategy for heart disease is current topic of much research and debate. Risks and benefits may need to be considered for each individual. At present, estrogen is not indicated for treatment of elevated lipoprotein(a). Tamoxifen and raloxifen have not been shown to reduce levels.
The American Association of Pediatrics now recommends that all children be screened for cholesterol between the ages of 9 and 11. lipoprotein(a) levels should be considered particularly in children with a family history of early heart disease or hypercholesterolemia. Unfortunately, there have not been enough studies to determine which therapies might be beneficial.
Read more about this topic: Lipoprotein(a)
Famous quotes containing the word treatment:
“[17th-century] Puritans were the first modern parents. Like many of us, they looked on their treatment of children as a test of their own self-control. Their goal was not to simply to ensure the child’s duty to the family, but to help him or her make personal, individual commitments. They were the first authors to state that children must obey God rather than parents, in case of a clear conflict.”
—C. John Sommerville (20th century)
“I feel that any form of so called psychotherapy is strongly contraindicated for addicts.... The question “Why did you start using narcotics in the first place?” should never be asked. It is quite as irrelevant to treatment as it would be to ask a malarial patient why he went to a malarial area.”
—William Burroughs (b. 1914)
“I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a pessary to cause abortion. I will keep pure and holy both my life and my art.”
—Hippocrates (c. 460–c. 370 B.C.)