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Editor's Correspondence
March 12, 2001

Reduction of Lipoprotein(a) in Postmenopausal Women

Arch Intern Med. 2001;161(5):771-778. doi:

As a general surgeon who is interested in the prevention of postmenopausal heart disease and in particular in the reduction of lipoprotein(a) [Lp(a)], I read with great interest the recent review by Dr Mosca1 regarding the role of HRT. Rapid progression of arteriographically determined coronary artery disease has been significantly more common in subjects with Lp(a) levels higher than 25 mg/dL.2 Approximately 33% of the population have elevated levels of Lp(a) (>25 mg/dL), a condition that is an independent risk factor for coronary artery disease.3,4 The treatment currently recommended for postmenopausal women with Lp(a) levels higher than 25 mg/dL consists of a combination of HRT and niacin.4 The adverse effects of niacin use are flushing, headache, and liver dysfunction. I am a 53-year-old woman with a significantly elevated level of Lp(a) (27 mg/dL), but I found that I had to stop taking niacin primarily because of headaches. Thus, after a thorough review of the literature, I began to follow the advice of Linus Pauling. For individuals who have an Lp(a) level higher than 25 mg/dL and a family history of heart disease, the recommendation is to take 3 g/d of both ascorbic acid and L-lysine monohydrochloride.5 After 6 months of this regimen, with no adverse effects, my Lp(a) level decreased to 14 mg/dL, a reduction of 48%. The Lp(a) testing was done by the highly reliable Lawrence Berkeley National Laboratory/Berkeley HeartLab Department Technology Transfer program. The theory is that lysine is an Lp(a)-binding inhibitor and thus blocks the Lp(a) attachment to the arterial blood vessel wall and that ascorbic acid helps to repair the collagen injury to the blood vessel and acts as an antioxidant.5-7 Currently, pilot studies are being conducted on the Pauling therapy of elevated levels of Lp(a).