I think the EAS suggested cut-off is pragmatic, although risk increases
above 250-300. I think Lp(a) should be measured in all patients
suspected to have FH as a first step, measuring it in all with >10% 10
year risk may be some way off.
According to current NICE Guidance (CG67 and CG71), the only indication
for nicotinic acid is "in adult patients with heterozygous familial
hypercholesterolaemia in whom the response to existing treatments,
namely statins, bile acid sequestrants and ezetimibe, has been
inadequate." (CG71) In such cases therefore, nicotinic acid or
nicotinic acid/laropiprant may already be used in combination with a
statin and/or other treatments which have achieved a partial response,
for primary or secondary prevention. When Lp(a) is >500/mg/L (as
measured with an isoform independent assay) I would suggest that
addition of nicotinic acid or nicotinic acid/laropiprant may be
preferred over bile acid sequestrants and ezetimibe for addition to
statin.
Dermot Neely
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Robert Lord
Sent: 02 July 2010 16:41
To: [log in to unmask]
Subject: Lp(a) - when (if) to treat
For the few times I check Lp(a) I'm interested in others view as to the
level above which they would treat with niaspan.
I note the recent EAS guide of treating Lp(a) to bring below 500mg/L
Many thanks
Rob
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