Abstract
Objective. To assess the effectiveness of niacin/fish oil combination therapy in reducing Lipoprotein (a) [Lp(a)] levels after twelve weeks of therapy. Background. Lipoprotein (a) accumulates in atherosclerotic lesions and promotes smooth muscle cell growth and is both atherogenic and thrombogenic. A clinical trials of combination therapy for the reduction of Lp(a) has not been previously reported. Methods. The study was an observational study following subjects with an elevated Lp(a) (>70 nmol/L) to assess impact of 12 weeks of combination Omega 3FA, niacin, and the Mediterranean diet on Lp(a). Results. Twenty three patients were enrolled with 7 patients lost to follow up and 2 patients stopped due to adverse events. The average Lp(a) reduction in the remaining 14 subjects after 12 weeks of combination therapy was 23% ± 17% [P = .003] with a significant association of the reduction of Lp(a) with increasing baseline levels of Lp(a) [R2 = 0.633, P = .001]. Conclusions. There was a significant reduction in Lp(a) levels with combination therapy. A more pronounced effect was noted in patients with higher baseline levels of Lp(a).
Highlights
ObjectiveTo assess the effectiveness of niacin/fish oil combination therapy in reducing Lipoprotein (a) [Lp(a)] levels after twelve weeks of therapy
Brooke Army Medical Center, MCHE MDC Cardiology Service, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200, USA
Patients were initially started on extended release niacin (Niaspan) at 500 mg daily and titrated up by increment of 500 mg per week until the target dose of 2 gm was reached
Summary
To assess the effectiveness of niacin/fish oil combination therapy in reducing Lipoprotein (a) [Lp(a)] levels after twelve weeks of therapy. The study was an observational study following subjects with an elevated Lp(a) (>70 nmol/L) to assess impact of 12 weeks of combination Omega 3FA, niacin, and the Mediterranean diet on Lp(a). The average Lp(a) reduction in the remaining 14 subjects after 12 weeks of combination therapy was 23% ± 17%[P = .003] with a significant association of the reduction of Lp(a) with increasing baseline levels of Lp(a) [R2 = 0.633, P = .001]. There are no prior case series or trials of combination therapy for lowering Lp(a) values; a case report from our institution did note a 70% reduction in Lp(a) levels with combination niacin-ER, omega 3FA supplements, and dietary modification [21]
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