Unlocking the Mystery of Lp(a): A Hidden Genetic Risk for Heart Disease

Heart disease takes more lives in the United States than any other cause of death, yet a significant genetic risk factor often goes unnoticed by many Americans. Lipoprotein(a), or Lp(a), is a protein that, when found in high levels in the blood, can significantly increase the chances of a heart attack.

We had a conversation with Dr. Seth Baum, a cardiologist and chief scientific officer at Flourish Research in Boca Raton, Florida, to shed light on the importance of understanding this often overlooked red flag.

What is Lp(a)?

Working alongside low-density lipoprotein (LDL) and high-density lipoprotein (HDL), Lp(a) plays a vital role in transporting cholesterol through the blood. Dr. Baum emphasized that higher levels of Lp(a) increase the risk of cholesterol buildup in blood vessels, raising the potential for heart attacks or strokes.

Dr. Baum explained that Lp(a) poses a triple threat, causing atherosclerosis (the buildup of fats and cholesterol in arteries), inflammation (a crucial aspect of plaque progression), and increased clotting, potentially blocking arteries. Brett Sealove, M.D., chief of cardiology at Jersey Shore University Medical Center, affirmed that Lp(a) signals a serious threat, resulting in plaque buildup in arteries and reduced blood flow to vital organs.

Who is at Risk?

Approximately 20% of the population is at risk due to Lp(a), with higher prevalence in certain genetic groups, particularly among Black and South Asian Americans. Despite this, only a negligible percentage of Americans are aware of their Lp(a) levels.

Dr. Bradley Serwer, a cardiologist and chief medical officer at VitalSolution, noted that the cost and limited access to Lp(a) testing pose challenges. Current risk screening tools often exclude Lp(a), affecting testing availability.

Why Check Lp(a) Levels?

Although therapeutic options to directly reduce Lp(a) levels are unavailable, Dr. Baum stressed that addressing other cardiovascular risk factors can mitigate overall risk. While Europe and Canada advocate universal screening for Lp(a) levels, the U.S. typically tests higher-risk patients.

Dr. Baum and others recommend broader testing, believing that knowledge of Lp(a) levels can prompt individuals to address additional cardiovascular risks.

Testing and Future Therapies

You can check Lp(a) levels with a basic blood test. The levels tend to remain stable throughout a person's lifetime, but certain factors, such as menopause, low thyroid, or kidney disease, can influence them. Dr. Baum recommends checking Lp(a) levels at least once, and more frequently in response to specific health changes.

Sealove suggested screening Lp(a) at least once as a screening test, especially for those with a family history of heart disease.

Dr. Serwer believes the decision to test Lp(a) levels is personal and should be discussed with a medical provider. Regardless of Lp(a) levels, Dr. Serwer strongly advocates reducing cardiovascular risk factors through lifestyle, diet, and exercise.

The Future of Lp(a) Therapy

One existing therapy, lipoprotein apheresis, involves removing Lp(a) from the blood using IVs. Dr. Baum, actively engaged in clinical research, anticipates the development of drugs to treat high Lp(a). Several clinical trials are underway, offering hope for future therapeutics.

Conclusion

understanding Lp(a) and its impact on cardiovascular health is crucial. While treatments are evolving, focusing on lifestyle modifications remains the primary strategy for reducing cardiovascular risks.