Lipoprotein(a): Surprising Poll Results

No doubt, our little informal poll asking readers whether they have lipoprotein(a), is skewed towards people inclined to respond because they have this genetic trait.

Nonetheless, the response is telling. Of 82 respondents:

--40 (48%) said they did have Lp(a)

--16 (19%) said that they did not have Lp(a)

--26 (31%) said that they did not know whether or not they had Lp(a)


Though admittedly an informal analysis, I'd draw several conclusions from this simple "experiment".

One, while the proportion of people responding that they have Lp(a) may not be accurate, it is a prevalent genetic risk factor that, according to formal studies, is present in 17% of people with coronary or vascular disease, 11% of the broader population. This number may be even higher if the newer particle number assays (measurements) are used (with results expressed in nmol/L), since an occasional person with a "normal" Lp(a) in mg/dl (weight-based) will prove to have increased Lp(a) by nmol/L (particle number-based). (The reason for this phenomenon is not clear. It may be consequent to variation in apo(a) size, with larger apo(a) varieties of Lp(a) occasionally escaping detection .) As our little poll shows, plenty of people have Lp(a).

Two, readers of this blog tend to be highly motivated, sophisticated, and knowledgeable about health and heart disease. Yet a substantial portion--31%--did not know whether they have this crucial risk factor. That shouldn't be. The unnecessary difficulty of getting this simple blood test performed has been driven home to me repeatedly when I identify this factor in someone and then suggest that their grown children and parents, each of whom have a 50% chance of having Lp(a), be tested. It's not uncommon for a 35-year old son, for instance, to say that his doctor refused, claiming it is an unproven risk marker, or to simply say that he/she doesn't know what it is.

No doubt, just knowing whether you have Lp(a) or not is not the end of the story. Reducing Lp(a) and its associated co-factors is no easy matter. With several hundred patients in my practice with Lp(a), it occupies much of my time and energy. Sometimes it leads to enormous successes , but it can also pose a real challenge.

There should no longer be any doubt that Lp(a) is associated with significantly increased risk of cardiovascular disease. This has been demonstrated conclusively across dozens of studies. Risk from Lp(a) is over and above that posed by other risk factors; it also amplifies the risk posed by other factors, e.g., small LDL, inflammatory phenemena, homocysteine, total LDL, low HDL.

In the world of Lp(a), our two most desperate needs for the future are:

1) Better education of physicians and the public, and

2) More effective treatment options.

Thus, our reasons to form The Lipoprotein(a) Research Foundation. Steps to gain tax-exempt status are being pursued as we speak.

I can't help but wonder whether, like vitamin D, a solution is right beneath our noses. An investment in research to fund the trials to better explore both basic science as well as practical treatment options might yield an answer more readily than we think. Wouldn't that be great?

Comments (5) -

  • mike V

    5/6/2008 3:53:00 PM |

    Thanks for your work in achieving these goals.

    I am one of the naieve do not know my Lp(a)score.
    As I have mentioned in the past, I am fortunate to have no detectable plaque by recent CTA.
    What tests do you advocate for your patients in this circumstance?
    (I have long followed preventive nutrition similar to your advice.)
    Is age a factor? I am 72.
    Thanks again.
    mikeV

  • Ross

    5/6/2008 7:33:00 PM |

    Well, I didn't answer the poll because my Lp(a) was 16mg/dL in November and is now 12mg/dL.  So it was borderline and is heading down.

    So, do I "have" Lp(a)?  Yes.  There is Lp(a) in my blood.  But not so much that I'm worried about it.  And I do know what my Lp(a) is, so the "don't know" response isn't right.

    None of the responses seemed to fit me.  So I didn't respond.

  • Anonymous

    5/7/2008 3:17:00 AM |

    Similar for me too.  My lp(a) was 6 mg/dl in the first test, 7 mg/dl in the second and 11 mg/dl in the third.  Not quite sure what to make of this so I answered the poll "don't know."

  • Bad_CRC

    5/7/2008 3:08:00 PM |

    Ross,

    Dr. D has said that Lp(a) is not one of the markers where a normal value is 0.  In the TYP book and online library, he says that a desirable score is <30 mg/dL (again, with the caveat about mass vs. particle size).  Superko's book puts the threshold at 20, and the VAP score sheet puts it at 10.  Mine was 7 by VAP, and I took this to mean that I don't "have" Lp(a).  Sounds like you're in the same boat.  See Dr. D's response to me under "Red flags for lipoprotein(a)."

    I didn't respond to the poll simply because I didn't notice it until it was closed.

    Dr. D, out of curiosity (if you have time to respond), what percent of the population scores zero for Lp(a)?

  • Dr. William Davis

    5/8/2008 2:37:00 AM |

    bad_crc--

    Curiously, a Lp(a) of zero is rare.

    Perhaps this provides some insight, though I'm not sure precisely what.

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Fish oil for $780 per bottle

Fish oil for $780 per bottle

At prevailing pharmacy prices, one capsule of prescription Lovaza fish oil costs $4.33 each.

Yes, you heard right: $4.33 per capsule.

What do you get for $4.33 per capsule? By omega-3 fatty acid content, you get 842 mg EPA + DHA per capsule.

I can also go to Sam's Club and buy a bottle of their Triple-Strength fish oil with 900 mg omega-3 fatty acids per capsule at $18.99 per bottle of 180 capsules. That comes to 10.5 cents per capsule. That puts the price of fish oil from Sam's Club at 97.6% less cost compared to Lovaza for an equivalent quantity of omega-3 fatty acids.

What if we repriced Sam's Club's Triple-Strength and brought it "in line" with what we pay for Lovaza? That would put the value of one bottle of Sam's Club Triple-Strength fish oil at $780 per bottle.

I take patients off Lovaza every chance I get.

Comments (16) -

  • Cathy

    8/19/2009 10:31:05 PM |

    Thanks for that.  I still take Lovaza; have been lazy about switching.  I just checked the price my mail-order pharmacy pays and it's $546 per bottle of 120, or just over $1.50 per capsule.  While considerably less than what you quoted, it's still $6 per day and $2185 per year!  I'd no idea.  Plus I take Niaspan for another $900 per year.  I'm switching to OTC for both.  No wonder insurance rates are going up!

  • John Smith

    8/19/2009 11:16:18 PM |

    It's amazing how much some of these companies will try to scam people with 'pharmacy grade' vitamins. It's easy for me to tell how much fish oil is oxidized by taste and how well it works and the best brand I've found is from trader joe's for 8 bucks a bottle. For stuff like vitamin C the process is so simple it's pretty much literally impossible to have any real difference brand to brand aside from how absorbable it is and again it's easy to tell when pills are not absorbing due to how they feel.

  • Clamence

    8/20/2009 12:26:19 AM |

    And we wonder why healthcare costs are spiraling out of control in america...

    What's sad, is the problem isn't limited to just pharmaceuticals, so many other areas like diagnostic imaging and durable medical goods are so much more expensive than they should be.

  • Dr. William Davis

    8/20/2009 1:40:55 AM |

    Do your part to reduce healthcare costs: Reject the idea that fish oil, niacin, and vitamin D should be costly prescription agents.

    Pay for them yourself for SUPERIOR preparations that you can obtain without a prescription. This small effort alone will save us all hundreds of millions of dollars.

  • Nameless

    8/20/2009 3:04:42 AM |

    Anyone know when Lovaza is going generic? I thought I read that perhaps by end of the year their exclusivity may be up, which should open up cheap prescription alternatives -- and sort of kill Lovaza's profits too.

  • Anonymous

    8/20/2009 3:09:24 AM |

    I use otc niacin at about $3 a bottle, and one of the doctors I work with asked me why I hadn't asked my doc for a prescription for Niaspan.
    I just didnt know where to begin.

    Jeanne

  • Anne

    8/20/2009 7:54:19 AM |

    Wow - I'm so surprised that there are worries about a national health care service in the US such as we have in the UK. Here, Lovaza (Omacor) costs the National Health Service £50 for 100 capsules, ie 50p per capsule !

    Of course that's not what patients pay. Patients who are charged prescription charges will pay  Â£7.20 per prescription of 100 capsules, and patients who don't pay prescriptions charges at all (approx 70% of patients), well they don't pay anything for their Lovaza....they have paid in their taxes for it already.

    But to me the biggest surprise is that the pharmacutical company that makes Lovaza charges so much less in the UK than it does in the US !

    Anne

  • Richard A.

    8/20/2009 6:32:00 PM |

    Another way to save on prescription drugs--pill splitting. Too often the smaller dose costs almost as much as the bigger dose. Getting the bigger pill and cutting it down to smaller doses can save a lot of money.

  • pyker

    8/20/2009 9:09:30 PM |

    I'm surprised we don't see scrips for "pharmaceutical-grade water", to wash these down.

  • Anonymous

    8/21/2009 2:21:12 AM |

    pyker, its called "bottled water"

  • JLL

    8/25/2009 1:38:15 PM |

    It's not really a problem that pharmacy grade fish oil is ridiculously expensive, as long as it's not illegal to sell cheaper fish oils too.

    In Europe, the trend seems to be that supplements are becoming available only in pharmacies, which can then charge extraordinary prices for everything.

  • Boris

    9/7/2009 1:22:32 PM |

    I have moderately high triglycerides at 255. My physician gave me a sample bottle of Lovazza to try which has 28 softgels. I have been taking one softgel a day.

    I have been looking into OTC fish oil supplements. Some are very diluted and some are very concentrated. Most break down the EPA and DHA content while others don't. I created a spreadsheet that collects the EPA and DHA content of several OTC fish oil supplement. In order to make a fair comparison, I adjusted my serving size for each brand name to give me about the same quantity of the essential fatty acids. The prices range from $0.11 per dosage to $1.76 per dosage.

    So once I figured out what's the most cost effective brand to buy now I have to worry and wonder about purity. Am I getting a less refined formula that will have heavy metals, PCBs, and other nasty chemicals? The words "triple distilled" mean nothing to me. I'd like to see "Contains no more than 0.010 PPM of arsenic" or something like that.

    The Lovazza might have the advantage here since the FDA probably won't let poisoned fish oil out. I have no idea what my effective price per dosage is with Lovazza since my sample bottle was free. My company takes a decent chunk of my pay for health care and I rarely use it. Maybe it's time I get my money's worth and get some subsidized Lovazza?

  • trinkwasser

    9/10/2009 2:51:21 PM |

    "I'm surprised we don't see scrips for "pharmaceutical-grade water", to wash these down."

    What, like this?

    http://www.marksdailyapple.com/bling-water/

  • Boris

    9/30/2009 4:29:47 PM |

    My one month experiment with Lovaza is over. I received a free sample bottle with 28 capsules last month from my physician. The recommended dosage was four a day but he told me to take one. I did that for one month. My triglycerides went down from 255 to 135 with no significant change in diet. My total cholesterol went down from 221 to 177, and it was all LDL. Unfortunately, my HDL levels stayed almost the same.

    So do I continue with Lovaza and get a prescription or do I get a high quality OTC like Omapure?

    I will see my physician tomorrow.

    Decisions, decisions, decisions!

  • moblogs

    3/24/2010 12:59:07 AM |

    Just want to add that Omacor (European Lovaza) costs £2 per day, while Triple Strength Omega 3 from a reputable company costs 12p per day in comparison, for roughly the same amount of EPA and DHA. You just have to take 6 capsules instead of 4.
    My jaw would've dropped if I hadn't been getting my vitamin D! Smile

  • buy jeans

    11/3/2010 9:50:53 PM |

    I can also go to Sam's Club and buy a bottle of their Triple-Strength fish oil with 900 mg omega-3 fatty acids per capsule at $18.99 per bottle of 180 capsules. That comes to 10.5 cents per capsule. That puts the price of fish oil from Sam's Club at 97.6% less cost compared to Lovaza for an equivalent quantity of omega-3 fatty acids.

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