TC, HDL, LDL: There is an alphabet soup of cholesterol types to know. LP (A) or lipoprotein (A) is relatively new on the stage. Although it was described for the first time by a Norwegian doctor in 1963, this unique form of “bad” cholesterol remained under the radar until recently. Now it is discussed and measured in people’s blood on a more widespread basis.
“Over the past decade, new scientific knowledge has improved our understanding of the role of LP (A) in the risk of heart disease,” said Dr. Ahmet Afsin Oktay, cardiologist of the Rush for Health University System in Chicago. “Consequently, providers have become more aware of how LP levels measure (A) can help form a more personalized risk assessment for heart disease.”
Here is what you need to know about the LP (A) and the new medical advances bringing us closer to the treatment of high levels.
What is LP (A), and why is it important?
It is similar in structure with lipoprotein to low density lipoproteins (LDL), often called “bad” cholesterol. And like LDL cholesterol, “LP (A) is involved in the creation of the plate in our arteries, [thus] Contributing to atherosclerosis, and he has inflammatory properties, “said Dr. Tamara Horwich, Cardiology Clinical Professor and Medical Director of Cardiac Rehabilitation at UCLA.
Research has shown a strong association between high LP (A) levels and increased risk of cardiovascular disease, including heart attacks, strokes, heart failure, blood clots and peripheral arterial disease. The LP (A) measure “can help identify a person who should pay more attention to their cardiovascular risks,” says Horwich.
What factors affect LP (A) levels?
Unlike most forms of cholesterol, “LP (A) is not really affected by diet, exercise or even statin therapy”, explains Dr. Wesley Milks, cardiologist and Associate Professor of Internal Medicine at Ohio State University College of Medicine. “The levels are approximately 90% determined by genetics alone, so we can see elevations that take place strongly in families and are often correlated with the risk of heart disease and premature vascular diseases.”
Learn more:: What if your high cholesterol is genetic
This is particularly important because “there are people who have heart disease in the family and [other] The number of cholesterol does not seem so bad – these people can have LP (A) as a risk factor, “explains Dr. Janet O’Mahony, internal medicine doctor with Mercy Medical Center in Baltimore.
It is estimated that 20% of people around the world have high levels of LP (A). Women usually have slightly higher LP levels (A) than men, and sex fracture increases even more after menopause, says Horvath. Research has revealed that lipoprotein concentrations (A) are around 17% higher in menopausal women than in men of the same age.
How can you measure it?
Your LP (A) level can be checked with a specific blood test that is not part of the routine cholesterol tests and does not require fasting, explains Oktay. It is now recommended that each adult has their LP (A) is checked at least once in their life. At this point, doing the measured once is considered to be sufficient because the levels of LP (A) do not respond to changes in lifestyle, and there is currently no medication widely used to treat high levels.
Generally, LP (A) levels vary from 0.1 mg / dl to> 300 mg / dl. A normal level is less than 30 mg / dl and a level of 50 mg / dl or more is considered high, according to American centers for the control and prevention of diseases.
How do you treat abnormal levels?
For most people, the objective is not to reduce the LP (a) itself but to consider it as part of their overall cardiovascular risk profile. Because there is not yet a dedicated drug that is used to reduce high levels of LP (A), attention moves to concerted effort to reduce other risk factors for heart disease such as high blood pressure, diabetes and high LDL cholesterol. How? According to experts, not smoking, moving, managing your weight and pulling you a healthy diet (like the Mediterranean diet). Each of these measures can reduce the risk of heart disease independently, says O’Mahony.
In some cases, someone’s LP level (A) could help guide medication decisions. “If I have an average age patient, suffers from hypertension but which is a non-smoking and without diabetes, the expected estimate of the risk of 10-year heart disease will probably be below the standard start-up threshold of a statine,” explains Milks. “However, if the LP (A) is high, the presence of high LP (a) may be enough to push The decision to implement the therapy before statins. »»
Learn more:: Are protein shakes good for you?
Statins will not lower LP (A), but they can reduce LDL cholesterol, reducing the risk of heart attack and stroke, says Horvath. For people with high LDL who do not respond enough for statins and run a very high risk of cardiovascular disease, strong cholesterol medications called PCSK9 inhibitors have proven to reduce high levels of LP (A) by 20 to 25%.
Meanwhile, clinical trials examine if specially targeted drugs – including development -based drugs such as Pelacarsen, Olpasiran, SLN360 and Lepodisiran – can lower LP (A) levels. Even if they are not yet available, these promising advances help generate more widespread LP (A) tests.
If they are effective, these would directly address the source of the LP (A) problem. “There is enthusiasm for the measure of LP (A), in particular now that we are so close to having approved therapies which directly inhibit LP production (A) in the body,” explains Milks.
