People’s Pharmacy: Statins raise a little-known risk factor for heart disease

Q. I inherited very high levels of Lp(a), and I have known for years there is little I can do to reduce it. I tried niacin, but I can’t tolerate it.

I grew up in Germany, where doctors test for this routinely. In the U.S., I have had difficulty getting it tested.

My cholesterol is around 220, with HDL over 60. Since my LDL is high (around 140), I am now on Crestor.

My doctor said lowering my LDL is vital because it also will lower the Lp(a). Is that true? I have read a lot about this problem over the years to educate myself. Everything I read says there are no medications to date that lower Lp(a).

I am 69 years old and worked hard for years following a healthy diet so as not to take a statin (I ate tons of oat bran.) The more I read about high Lp(a), the more scared I got. My mother had a stroke. Can a statin drug like the Crestor I now take really lower Lp(a)?

A. Lp(a) is short for lipoprotein(a), a particle in the blood that contains fat, protein and cholesterol. In the U.S., cardiologists have focused primarily on LDL cholesterol as a bad actor in the development of heart disease. Statins are very effective at lowering LDL.

On the other hand, Lp(a) also is an important risk factor for heart disease. High Lp(a) levels can contribute to calcification of aortic valves (Biomolecules, December).

Surprisingly, statins might actually raise levels of Lp(a) (European Heart Journal, May 20, 2019). A meta-analysis of statin trials found that even when LDL cholesterol levels are lowered, people run a substantially higher risk of heart disease if statins raise their Lp(a) above 50 mg/dl (Lancet, Oct. 13, 2018).

Don’t give up on exercise and diet just because you are taking rosuvastatin (Crestor). You might also want to ask your doctor about an alternate treatment for lowering LDL cholesterol. Evolocumab (Repatha) reduces LDL and Lp(a) and in your case might be helpful against heart disease (Circulation, March 19, 2019).

Q. After years of treatment by a dermatologist for persistent acne, my daughter went to a naturopath who advised her to stop consuming dairy products. Within a few weeks, her skin was perfect.

A. For decades, dermatologists maintained that diet didn’t matter with regards to acne. They preferred to treat pimples with antibiotics because they produced predictably positive results.

Now, however, many doctors are trying to limit the use of antibiotic pills for this condition (Journal of the American Academy of Dermatology, February 2019). There is growing recognition that long-term use of antibiotics can alter the bacterial balance (microbiome) of the body.

Scientists have found that your daughter’s experience is not unusual. A diet rich in dairy products appears to make young people more susceptible to acne (Nutrients, Aug. 9, 2018). Avoiding milk as well as food with a high glycemic index can be helpful.

To learn more about the anti-acne diet as well as home remedies and pharmaceuticals for clear skin, you may wish to consult our eGuide to Acne Solutions. This online resource is found in the Health eGuides section at peoplespharmacy.com.