We all know how important exercise is for the heart, the brain and for a myriad of other reasons.

Recently published in the British Journal of Sports Medicine, the World Health Organization (WHO) has updated its guidelines for exercise. Indeed, these are evidence-based public health recommendations.

Clearly a departure from the last set of guidelines in 2010, what is now recommended is 150-300 minutes of moderate exercise/week, 75-150 of vigorous exercise/week, or some combination of the two. The previously published guidelines recommended a total of 150 minutes/week. Thus, what we have now is a major upgrade.

Older adults, including those with chronic conditions and living with disability are not exempt from exercise. In fact, activities that emphasize functional balance and strength should be performed three or more days a week at moderate or greater intensity.

Exercise for children and adolescents was also upgraded. Now recommended is an average of 60 minutes per day of moderate to vigorous intensity aerobic physical activity throughout each week.

Also included were recommendations for pregnant and postpartum women who should aim for a minimum of 150 minutes of moderate- intensity aerobic activity per week.

Getting in the requisite amount and intensity of exercise in this era of COVID-19 and gym closures is clearly a challenge. Indeed, but some exercise is better than none, and more is definitely better! 88% of Americans are metabolically unhealthy. This alone underscores the need for lifestyle alteration.

Less than 5% of adults participate in 30 minutes of physical activity each day; only one in three adults receive the recommended amount of physical activity each week. Only 35-44% of adults 75 years or older are physically active, and only 28-34% of adults ages 65-74 are physically active.

Despite current challenges, we should all strive to maintain our physical well-being through diet and exercise. These new guidelines, which may seem unattainable to many, are a great reminder of what we need to achieve to obtain optimal health and wellness.

Further reading for those interested: an open source paper from The British Journal of Sports Medicine explaining the development of the guidelines: World Health Organization 2020 guidelines on physical activity and sedentary behaviour

As an integrative cardiologist practicing functional medicine, I’m always excited about learning everything I can about prevention. At this virtual conference, I learned a few good pearls, but I was hoping for more!

The topics were clearly of interest: assessing cardiovascular risk, dealing with LDL-Cholesterol over 210 mg/dl, using fish oil in clinical practice, strategizing prevention in women, and dealing with the aging population. However, from the onset it was obvious that the pharmaceutical approach was the holy grail.

Now in my 35 years of active practice, I have treated countless ill patients with life-saving drugs. I’m very aggressive about using meds when the science points to their efficacy. My background is deeply entrenched in traditional cardiology. In fact, I still take regular emergency call at my local hospital to intervene in those who present with acute heart attacks.

However, this was billed as a preventative program. What I found disappointing was that there was little voiced about lifestyle. It was mentioned, but in word only. In all fairness, the overall emphasis was on secondary prevention (or treating those with known disease who are automatically stratified as being high risk). Such treatment clearly mandates a more aggressive approach. But many of the speakers advocated LDL-C levels of 30 or lower, or what I call “lower is better”. I personally do not support this concept.

There was a particularly good presentation on the use of nutraceuticals in cardiac patients. Mentioned was the use of berberine, bergamot, fish oil and turmeric. I also learned a new role of niacin for the treatment of nonalcoholic fatty liver disease (NAFLD), a disease entity of increasing incidence.

There was a single lecture on nutrition. The presenter essentially espoused the dogma of the American Heart Association (AHA); an extremely low saturated fat diet, less than 8% of all calories. Such thinking has been since debunked by many. (see “what’s new” from July 2020 at www.heartwise.com).

Any benefit of a low carb diet, ketogenic diet, or any form of fasting was quickly dismissed, despite documented benefits in the medical literature.

The use of hormone replacement therapy in menopausal/post-menopausal women was discouraged because of potential cardiac risks. This was most probably based on the results of the Women’s Health Initiative, released in 2002. What was never mentioned was the use of bioidentical hormone replacement, which has a myriad of benefits for both heart health and bone health.

It’s interesting but disappointing how a university sponsored educational event can be so one sided and seemingly dated. However, I endeavor to take it all in and utilize both my traditional training and what I’ve learned in integrative cardiology. It’s about knowing which hat to wear when.

PS Contrary to the symposium’s flier photo, there wasn’t any mention about running, walking or any form of exercise!

VERY IMPORTANT NOTE / DISCLAIMER: I am offering—always—only general information and my own opinion on this site. Always contact your physician or a health professional before starting any treatments, exercise programs or using supplements. ©Howard Elkin MD FACC, 2020

Many of us know that the ubiquitous chemical bisphenol A (BPA) found in plastics and epoxy resins is endocrine- disrupting, and is clearly antithetical to good health. In a recently-released cohort study of 3,883 adults in the United States, subjects with the highest urinary levels of this chemical had a higher risk of death over a 10 year period.

Those with the highest levels had a 49% increased risk of all-cause mortality, and a 46% increased risk of cardiovascular risk mortality.

This news is hardly unexpected given the populace of plastics in our lives. We are not just talking about the obvious plastics, but also many commonly used consumer products such as compact discs, medical devises, and dental sealants and composites. 

Endocrine-disrupters, such as BPA disrupt our hormonal balance and can lead to obesity, diabetes and metabolic syndrome. Exposure to BPA can accelerate coronary heart disease, and induce cardiac arrhythmias. 

The news is not good. We clearly need to limit the use of plastics and do a better job of recycling.  Moreover, we certainly need and deserve a government that works for the people, and who earnestly endeavors to protect us from environmental hazards.

You can read the original article from JAMA Network clicking HERE.

For years saturated fat has been vilified in the cardiology literature as well as by prestigious professional organizations such as the American Heart Association (AHA ). But many of us have questioned these motives, as we do not believe that universally restricting consumption of saturated fat is scientifically based. 

As a matter of fact, there is no true evidence that dietary fat, which generally contains significant amounts of saturated fat, has any harmful cardiovascular consequences. This is in contradistinction to what has been disseminated over the past fifty years.

Recently, a “State-of-the Art Review” published in the prestigious Journal of the American College of Cardiology provided evidence to the contrary which supports my view and the view of many others in the nutritional field. 

These are some of the highlights:

• Most recent meta-analyses of both randomized trials and observational studies found no beneficial effects of reducing saturated fat on cardiovascular disease and total mortality. Instead, protective effects were found against stroke.

• Although saturated fat increases low-density cholesterol (LDL), this is not due to increased levels of small dense LDL particles, but rather larger fluffy LDL particles, which are much less strongly related to cardiovascular risk. 

• Whole-fat dairy, unprocessed meat, eggs and dark chocolate are all saturated fat rich foods that are not associated with increased cardiac risk.

• The totality of available evidence does not support limiting these foods.

LET’S DEBUNK THE MYTH ABOUT SATURATED FAT!

Link to the Journal of the American College of Cardiology “Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review”

Click here for full PDF of the Study "Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review" from the Journal of the American College of Cardiology.

Seriously, I feel as if I’ve written enough about COVID-19. Most of you are probably sick and tired hearing about this topic. However, because this illness is so rampant and because it has claimed the lives of over 110,000 Americans in a very short time, there is a lot more that we simply need to know.

Firstly this virus is very fickle. How it affects individual patients varies greatly. Initially we thought the major cause of death and disability was Acute Respiratory Distress Syndrome (ARDS). Then we learned that the ARDS caused from this virus was heterogeneous, and varies from patient to patient. This can undoubtedly affect treatment.

Then we learned that the illness has many cardiac manifestations with presentations that actually simulate an acute heart attack. Next we became aware that this is a disease of hypercoagulability where the tendency for blood clotting is huge. Clots have been found in the lung, the kidneys, the brain, and the carotid arteries. Suddenly we learn that young folks are presenting with acute strokes.

This recent article from The Atlantic gives us a different and scary perspective from survivors of COVID-19 who never required admission to ICU and who never went on a ventilator. These are among cases typically classified as “mild”. However, such folks have wrestled with symptoms that have lasted at least a month, if not two or three.

Yes, such cases may be considered mild when compared to those dying alone in hospitals. However, they have been plagued by extreme fatigue, difficulty with concentration, exercise, and performance of simple tasks. Most are young and were previously considered fit and healthy.

Realizing that this group of patients, known as “long- haulers” may well represent a minority, it nonetheless gives credence that this illness can be manifested in several different ways.

Indeed we will continue to learn more and more as time goes by.

Link to The Atlantic Article “Covid-19 Can Last for Several Months”

We've all been inundated with the grim facts and statistics about COVID-19. I've talked and blogged about this repeatedly. My wish is for all of us to take this opportunity and give thanks to what we have versus lament over what we cannot control.

THERE IS NO BETTER TIME THAN NOW!
To order, or arrange a nutritional evaluation, email our nutritionist Kristine Solomon at kristine@heartwise.com or call the office at (562) 945-3753.

In the next several weeks all 50 states will be "opening up" in one way or another. Exposure to COVID-19 and other pathogens won't  just wither away. We followed the requisite social distancing, etc. But we can't live that way forever. If you haven't already started practicing prevention, what are you waiting for ?

Working on optimizing your immune system should be number 1 on your list.  Most  patients who fare poorly are generally not healthy. They suffer from hypertension, heart disease, diabetes and obesity. It doesn't have to be that way.

I've talked about diet, exercise , hydration , sleep and stress reduction. Those are key.

I've gone one step further and created IMMUNOWISE. One capsule 3/day will help promote a healthy immune system. There are lots of supplements out there. My goal was to provide  an affordable product comprised of solid ingredients in appropriate doses that have been scientifically proven to be of benefit.

Please read the below fact sheet and feel free to contact  our clinical nutritionist Kristine Solomon at kristine@heartwise.com for any orders and/or inquiries. Office phone: (562) 945-3753.

Here's to your health; today and for always,

Howard Elkin MD

WHAT IT IS:

• A custom formulated high-quality blend of powerful immunity boosting and anti-viral ingredients.

WHY YOU NEED IT:

• Important for patients wanting to keep their immune systems on high alert to fight off infections and viruses and reduce duration of illness.

• All Natural, gluten-free, dairy-free, non-GMO

Vitamin C

Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C accumulates in phagocytic cells, such as neutrophils, and can enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing. Supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. Vitamin C has been used in hospital ICUs to treat COVID-19 infection.

Vitamin D

Activated vitamin D,1,25(OH) D, a steroid hormone, is an immune system modulator that reduces the expression of inflammatory cytokines and increases macrophage function. Vitamin D also stimulates the expression of potent antimicrobial peptides (AMPs), which exist in neutrophils, monocytes, natural killer cells, and epithelial cells of the respiratory tract. Vitamin D increases anti-pathogen peptides through defensins and has a dual effect due to suppressing superinfection. Evidence suggests vitamin D supplementation may prevent upper respiratory infections.

Zinc- Zinc contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. There is also evidence that it suppresses viral attachment and replication. Zinc deficiency is common, especially in those populations most at risk for severe COVID-19 infections, and it is challenging to accurately diagnosis with laboratory measures. Supplementation with zinc is supported by evidence that it both prevents viral infections and reduces their severity and duration. Moreover, it has been shown to reduce the risk of lower respiratory infection, which may be of particular significance in the context of COVID-19

Quercetin- Quercetin has been shown to have antiviral effects against both RNA (e.g., influenza and coronavirus) and DNA viruses (e.g., herpesvirus). Quercetin has a pleiotropic role as an antioxidant and anti-inflammatory, modulating signaling pathways that are associated with post-transcriptional modulators affecting post-viral healing.

N-Acetylcysteine (NAC)

N-acetylcysteine promotes glutathione production, which has been shown to be protective in rodents infected with influenza. In a little-noticed six-month controlled clinical study enrolling 262 primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement.

There is no question that COVID-19 has turned our world upside down, and has remained the number 1 health concern for essentially all of us. However, we never doubted that certain classes of blood pressure medications would be suspect for worsening morbidity and mortality.

ACE inhibitors (eg. lisinopril, accupril, captopril, enalapril, benazepril,etc.) and ARBs or angiotensin receptor blockers ( losartan, valsartan, olmesartan, etc), are amongst the most commonly used meds for hypertension. They certainly constitute the most widely used meds in my cardiology practice. However, with the pandemic of Coronavirus COVID-19, these meds have recently come under scrutiny. 

Concern for these drugs grew out of recent observational Chinese data showing greater morbidity  and mortality among patients with hypertension who went on to develop COVID-19. However experts have come forth reporting that there was no adjustment for certain variables. The validity of the Chinese observation is clearly being questioned. The current consensus is that the data is simply not there. 

Most cardiologists, including myself do not recommend changing to other medications to control blood pressure; even in the presence of COVID-19. There is definite potential harm in doing so. Firstly, there is no simple formula in switching from one class of medications that have successfully controlled a patient’s blood pressure to a new class. Why go from a well-tolerated class and dose of a specific mediation to an unknown? This could easily lead to worsening blood pressure, or drug toxicities due to changing to an entirely different class. From my perspective, this is not a time to attempt trial and error. 

The other concern is losing the positive effects of ACEs and ARBs that are specific to this class of meds. These include preserving kidney function in those with diabetic kidney disease, and maintaining cardiac function in those with a history of congestive heart failure.

Fear of using these drugs stems from up-regulation of ACE2 receptors, possibly increasing viral entry into cells in the laboratory.  But we do not know the effect in the context of the human body.

In conclusion, we lack prospective data on the use of these commonly used Bp meds and their impact on COVID-19 patients. From the viewpoint of The Medical Advocate, I say stick with what works. 

Hypertension and cardiovascular disease remain the highest risk for mortality in those afflicted with COVID-19. Changing medications at such a vulnerable time is simply not recommended. It boils down to risks versus benefits. The potential risk of changing medications is outweighed by the benefits of remaining on these medications that clearly work .    

You can read the original article from TCTMD by clicking HERE.

Coronavirus  COVID-19 is  the hottest topic these days, and for good reason;  it's become a pandemic that has completely changes our lives.

In the span of less than a week, all of us are compelled  to practice social distancing. We can no longer hit the gym, or attend movies, concerts or sporting events. Eating out at restaurants and all social events are on hold. Children are no longer able to attend school. Many of us feel as if our lives have been turned upside down. All of that is understandable given the sudden nature of events. 

That said, we need to drop the panic mode and work together. During periods of social isolation we need to all do our part and remain positive. Uncertainty can be uncomfortable, but we can't allow that to stop us.

Below are a resources by two functional medicine practitioners. The first, a blog post written by Dr. Ben Weitz, DC of Weitz Chiropractic in Santa Monica, and a link to my latest Blog on COVID-19, Which you can READ HERE. Our aim is to give you our perspectives based on the knowledge we presently have with tools to move forward.

Coronavirus, what it is, and what to do about it. 

By Dr. Ben Weitz

If you’re watching the news reports all day while you are home from work, you can get completely panicked.  You may be thinking that the coronavirus will kill all of us, so you have to avoid contact with everyone and everything by staying in your house and dousing yourself and your pets and your house with bleach and alcohol.  In fact, you should bathe in bleach or alcohol.  You need to stockpile toilet paper and water and rice, beans, canned and frozen foods because there will be no food to eat or water to drink.  Or alternatively, you may think that the coronavirus is just a hoax from the fake news media to get President Trump out of office or it is just a mild flu that you should completely ignore. I have read up on some of the scientific reports about the coronavirus and would like to present a reasonable perspective on what the coronavirus is and how to keep yourself and your family safe without panic and fear.  Fear and anxiety will only weaken your immune system. 

First we will start with some of the basic facts.  

1. What is the Coronavirus and what is Covid-19?

• A virus is a tiny infectious organism that replicates inside of the cells of living organisms, including animals and plants and even bacteria.  

• The coronavirus that is the cause of the current pandemic is a type of virus similar to the SARS (Severe Acute Respiratory Syndrome) virus that also started in China in November 2002 and spread around the world.  These are both coronaviruses that originated from bats.  

• COVID-19 (Coronavirus disease 2019) is the disease caused by this current coronavirus.  Once the virus has infected you, it gets into your cells and starts reproducing unless your immune system can fight it off.  Because our immune system does not have antibodies to fight against this particular coronavirus it is referred to as a “Novel” virus, which is one of the reasons why it may be more dangerous than the seasonal flu.

• COVID-19 is rapidly spreading and the rate in the US is likely to accelerate over the next few weeks, partially because we have just ramped up testing.  The social isolation measures we are taking are designed to slow down the spread and it is likely that the measures we are taking will lead to a leveling off and a slowing of new cases, though this might take several weeks or months.  But no matter how long it takes, we will get over this and 6 months or a year from now, things will be much better.  

1. COVID-19 symptoms and incubation period.

• After being infected, there is an incubation period of up to 14 days, which means that you may not have symptoms and still be infectious for up to 14 days.  This long incubation period is one reason why it is more likely to spread throughout society.  

• One reason why you should not worry is that for 80% of those infected, they will have mild to moderate symptoms similar to the seasonal flu. 

• Here are the most common symptoms in order of frequency:

  • Fever 

  • Cough 

  • Sore throat 

  • Runny or stuffy nose 

  • Body aches 

  • Headache 

  • Chills 

  • Fatigue

  • Sometimes vomiting and diarrhea

1. How deadly is COVID-19?

While most (~80%) who contract the coronavirus will have mild symptoms, it appears to be more deadly than the seasonal flu by an order of at least 10 to 1.  The numbers out of China look like the fatality rate is between 3 and 4, while the rate in the US right now is between 1 and 2, but that is with many people with minor symptoms who have not gotten tested.   The more people who have had it will make the percentage who have died go down due to the math.   And we are only just rolling out our testing now, so there are many Americans who have been sick with COVID-19 and were sent home and have recovered and those numbers we don’t know now.  When the antibody tests are available, we will be able to get a sense of how many people previously had COVID-19 and recovered.

Those at biggest risk of severe symptoms like pneumonia are those with a weak or compromised immune system or who have existing heart or lung diseases.

1. How is the coronavirus spread?  

While this virus is not airborne, it is spread through respiratory droplets, often produced while coughing or sneezing, which can then land on your face or hands or a nearby surface that you might touch, followed by touching your eyes, nose or mouth or some food or drink.  Once this virus lands on a surface, such as a countertop or a door handle it can live there for a few hours and possibly as long as 9 days, according to one study.   This is still being debated by the experts. 

1. What is the best way to protect ourselves from getting Covid-19?

   1. Wash your hands for at least 20 seconds with soap and water.  The soap makes the fatty layer that surrounds the coronavirus fall apart.  Singing Happy Birthday twice is about 20 seconds.  Make sure to wash both the palm side and the back side of your hands and fingers. Wash under your fingernails and wash both thumbs. 

   2. Wash your hands multiple times per day, including after you blow your nose, cough, or sneeze. Also make sure to wash your hands after you have had close contact with others, after the bathroom, and before and after you eat.  You should also wash your hands before, during, and after preparing food, after you touch or feed your pet, and after visiting public spaces, such as stores.

   3. After washing your hands, drying them with a hand towel or paper towels is important, since you can remove germs with the friction.  

   4. If there is no soap and water, hand sanitizer or gel that contains at least 60% alcohol is your best bet.

   5. Clean and disinfect frequently touched surfaces, including doorknobs, light switches, desks, phone, keyboards, toilet seats, sinks, etc.

   6. Avoid shaking hands and instead use the elbow or forearm bump. and close contact with others except when necessary, such as going shopping, getting your hair cut, or going to your dentist or doctor.

   7. Avoid touching your face, rubbing your eyes, biting your nails, etc.

   8. If you have to cough or sneeze, do it into the crook of your elbow.

   9. Get chiropractic adjustments, which increase the likelihood that your nerves that start in your spinal cord and exit your spine in between vertebrae can flow freely.  Several scientific studies have shown increases in various measures of immune function with chiropractic adjustments.

1. What not to do.

   1. There is no need to stock up on toilet paper or water. There is not going to be a lack of water. It is a viral infection, not a natural disaster.  There is no lack of toilet paper, except that too many people are hording it.  Calm down and stop worrying about stuff like this.  

   2. There is no need to horde food. There is plenty of food. Give the grocery stores a few days to stock their shelves and you will be able to get the food you need.  While some stores might be temporarily out of rice and beans and pasta and frozen foods, there is plenty of fresh fruits and vegetables, which is what much of your diet should consist of anyway.  Even if you must be isolated, you will still be allowed to go to the grocery store.

   3. Don’t watch the news before you go to bed or you may have trouble sleeping.  Read a book instead.

   4. Don’t stop exercising, even if gyms are closed, as they are in Los Angeles. Do pushups and bodyweight exercises, use bands and dumbbells, and go out for a walk.  Walk up a hill at a rapid pace.

   5. Did I mention not to spend too much time watching or reading the news?

1. Ways to strengthen your immune system to help you fight off the coronavirus if you come into contact with it.  Since there is currently no effective treatment for COVID-19 and a vaccine is not available and it could be a year away or longer, the best way to protect yourself is by keeping your immune system strong.

   1. Make sure you get good sleep, since getting sufficient, quality sleep strengthens the immune system. 

   2. Continue to exercise regularly, since moderate levels of vigorous exercise improve immune function, including enhanced activity of macrophages, immunoglobulins, and anti-inflammatory cytokines.  If you are somebody who exercises by going to the gym like myself and your gym gets cancelled, you should find a way to exercise, such as by  

   3. Avoid sugar, processed foods, and junk food

   4. Eat foods that have immune boosting properties, like garlic, ginger, turmeric, onions, broccoli, mushrooms, citrus fruits, red peppers, and green tea.

   5. Drink plenty of clean, fresh water and don’t trust your tap water.  Your best bet is to get a water purification system, since plastic water bottles are problematic since chemicals from the plastic can leach into the water.

   6. Meditate 

   7. Listen to my Rational Wellness podcast (just kidding).

   8. There are a number of nutritional supplements and nutraceuticals that can benefit your immune system to help you fight off viruses, including the following favorites of mine:

      1. Vitamin C—take 500-1000 mg at least twice per day.  If you are sick take 100 mg every couple of hours. Reduce it if you get diarrhea.  Intravenous vitamin C may be beneficial in getting very high dosages into your system and there are several clinical studies using 12,000 to 24,000 mg/day IV vitamin C for patients with COVID-19

      2. Vitamin D is super important for your immune system and while it is best to get it from the sun, I have found that even in Southern California many patients have serum levels that are either low or less than the optimal level of 50-70 ng/mL. I have found 5000 IU per day to be a beneficial dosage for many patients, and ideally it should also contain vitamin K.

      3. N Acetyl-Cysteine is an antioxidant has been shown to help with acute respiratory diseases like COVID-19. I recommend 500-1000 mg twice per day. 

      4. Resveratrol and quercetin have both been shown to inhibit other types of coronavirus infections, so consider taking both of these. There is currently a clinical trial using quercetin in Wuhan for treatment of COVID-19.

      5. Selenium is a mineral that boosts the immune system. You can either eat 2-3 Brazil nuts or take a supplement of 200 mcg of selenium per day.

      6. Zinc has been shown to have antiviral effects, including against coronavirus. I recommend taking 15-20 mg twice per day for a month or two. If you do this for more than a few months, you should add 1-2 mg of copper.

      7. Reishi, shitaki, and other mushroom supplements contain beta glucans and are extremely potent immune strengtheners.  Check out episode 103 of my Rational Wellness podcast with mushroom expert Jeff Chilton.

      8. Probiotics are very important for immune function and there are even specific ones that are more potent for immune strengthening. 

      9. Andrographis, echinacea, elderberry, garlic, oregano, and astragalus are some of my favorite immune strengthening herbs that have activity against viruses.

Join Dr. Elkin and Mended Hearts of Whittier as they discuss what a heart healthy diet consists of in 2020.

Lipoprotein (a) or simply Lp(a) levels , are genetically determined.  When elevated they are a risk factor for both coronary disease and aortic stenosis. This is no small problem, because as many as 20% of the population is affected. As an integrative cardiologist, I measure Lp(a) levels in essentially all my patients with abnormal lipids, which include both cholesterol and triglyceride levels. In my patients who have experienced a cardiac event such as a heart attack or stroke, or have received balloon angioplasty/ stent or bypass surgery, this measurement is even more crucial.

Up until now, there have been no effective treatments. Statins may work well in lowering LDL cholesterol, but they do nothing to lower Lp(a). Exercise and diet also play no role. It’s simply genetic and lifestyle measures do nothing.

That is until now! An investigational drug targeting LPA gene expression successfully reduced levels of Lp(a) . This was a modest study comprising 286 patients, but it was double-blinded, and placebo controlled. Lp(a) lowering was dose dependent and observed as early as the first month of therapy. The study was led by investigators at UCSD and Ionis Pharmaceuticals.

The 80% reduction in Lp(a) levels would be expected to have a major impact over currently available therapies . For years I have used niacin in relatively high doses to lower Lp(a) levels. However, I have often noted varying success.

Drugs are no panacea. This drug will be expensive and not without potential side effects. However, the ability to lower Lp(a) levels in a large cohort of patients where lifestyle management is ineffective  will hopefully affect outcomes in a positive way.

You can read the original article from MedPageToday by clicking HERE.

Source Reference: Zheng B, et al "Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults: A 10-year cohort" Neurology 2019; DOI:10.1212/WNL.0000000000008581.