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Does a LP-PLA2 result of 283 warrant taking a statin medication? 

Hi! I am male, 50 now, and had a lipid panel five months ago. I had total cholesterol of 218, HDL 36, LDL 159. Statins were prescribed and I made a decision to instead work out, take niacin, and quit smoking. So five months later I made good progress according to another panel -- total cholesterol down to 201, HDL up to 54, LDL down to 131. Not yet awesome but a nice improvement. However the panel also includes the levels of LP-PLA2 enzyme -- mine is 283, called very high risk for stroke and cardio disease. I was told (not by a doctor) the only way to lower the LP-PLA2 appreciably is to take a statin. I am disappointed when I seemed to be doing quite well and who knows, perhaps the enzyme had been higher before I started my efforts, and also maybe I would be lowering it continuing to do what I was doing. Does a LP-PLA2 of 283 in the heart doc's opinion, warrant immediate going on a statin, are there alternatives, and if I go on a statin to lower the plaque could I wean off it supplanting more anti-inflammatory supplements, etc. Does the heart doc think that with otherwise improving LDL/HDL and other measures, I should still be on a statin for life given the high LP-PLA2? 

submitted by Brien from Atlanta, Georgia on 2/4/2012


by Texas Heart Institute cardiologist, Scott R. Sherron, MD  Scott R. Sherron, MD

Hi Brien, You have made a great decision to improve your lifestyle which will significantly lower your risk of heart disease and have myriad other benefits.  Congratulations! As you know, although your LDL is much improved, it is still not optimal. You may be able to lower it a little more with diet and exercise, but many people find that there is a genetically determined "floor" of LDL that cannot be surpassed by diet and exercise. This is the lower limit of a person's predetermined range of cholesterol, driven by the HMG Co-A reductase enzyme. For most people, lowering this floor can only be accomplished with the use of statins which specifically target this enzyme. 

The LP-PLA2 is a newish marker for risk for heart attack and especially stroke that is related to inflammation. It currently remains unclear if this enzyme is a direct risk factor for events or simply a marker of people at risk, so it may be premature to target treatment around this specific result.  However, as a risk stratification tool it might very well influence a person towards a more aggressive approach to control of risk factors (including taking a statin!) 

An underlying theme of your question seems to be that statins should be avoided if possible. Although they carry risks as do all chemicals (natural or man-made), the vast majority of people tolerate them well with little or no side effect. If you turn out to be among the fortunate 95% majority, you can supplement your efforts with a statin and have even more risk reduction. With careful monitoring, there is very little long-term risk of statins since the side effects are almost always reversed with stopping the drug. Of course, a decision to take this or any medication should be made in conjunction with your doctor and with assessment of your global risk. Hope this is helpful!  

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Updated February 2012
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