Lipoprotein(a) and Me
I KNEW IT!
I always knew there was more to the topic of lipoprotein(a) elevation than the fact it merely placed me in the extreme risk category for heart disease. Lipoprotein(a) is the most cholesterol-rich lipoprotein in human blood, promoting the formation of fatty plaques in the arteries.
That, in itself, does not sound good, yet there is something good in every bad situation, right!?
And now I found it!
I have spent hours researching lipoprotein(a) – what it is, what it means, how I can lower it, and how it will affect my life and my children’s and grandchildren’s lives. And then, the facts emerge on a website called “The Heart Scan Blog” – the “Track Your Plaque” program by Dr. William Davis, a cardiologist from Milwaukee, WI. I find his words add a glimmer of hope for tomorrow and a resiliency to my spirit as I make my way through what, at first, appears a mind-numbing and hopeless topic. This buoyancy provides a needed entity in a situation that is perceived as imminent, threatening and life changing.
“ People with lipoprotein(a), or Lp(a), are, with only occasional exceptions:
–Very intelligent. I know many people with this genetic pattern with IQs of 130, 140, even 160+.
–Good at math–This is true more for the male expression of the pattern, only occasionally female. It means that men with Lp(a) gravitate towards careers in math, accounting, financial analysis, physics, and engineering.
–Athletic–Many are marathon runners, triathletes, long-distance bicyclists, and other endurance athletes. I tell my patients that, if they want to meet other people with Lp(a), go to a triathlon.
–Poor at hydrating. People with Lp(a) have a defective thirst mechanism and often go for many hours without drinking water. This is why many Lp(a) people experience the pain of kidney stones: Prolonged and repeated dehydration causes crystals to form in the kidneys, leading to stone formation over time.
–Tolerant to dehydration–Related to the previous item, people with Lp(a) can go for extended periods without even thinking about water.
–Tolerant to periods of food deprivation or starvation–More so than other people, those with Lp(a) are uncommonly tolerant to days without food, as would occur in a wild setting.
In short, people with Lp(a) are intelligent, athletic, and possess many other favorable characteristics…” How can I feel badly about that?
Aha! Suddenly the dim outlook brightens. And for some odd reason, I feel so much better! I already knew that lipoprotein(a), also known as Lp-(a), is both a marker and a genetic mediator of increased cardiac risk, including heart attack, stroke and peripheral arterial disease. Lp(a) is the strongest genetic risk factor for coronary artery disease.
Knowing my father had his first heart coronary bypass surgery (CABG) at age 41 and died at age 52, following his second CABG, I suspect I inherited my elevated lipoprotein(a) gene from him.
The International Journal of Cardiology reported in 1997: “Usually, the Lp(a) familial excess represents the most frequent lipoprotein abnormality observed in patients with premature myocardial infarction.”
My mind has a need to unravel the mystery of this strange and threatening word: LIPOPROTEIN(a). Lp(a) is inherited from a parent and then passed onto children with each child exposed to 50% likelihood of inheritance. What measures do I need to take and what impact does this have on my children and grandchildren? What changes should we be making in our lives? It pays to be vigilant now as we cannot correct it later.
The American Academy of Pediatrics (AAP) recommends a cholesterol test (fasting lipid panel) for all children between the ages of 9 and 11. Cholesterol plaques build up in the arteries on the heart in the first and second decades of like. Screening starting at age 20 is too late. The AAP also recommends screening for children as young as 1 who have a known family history of high cholesterol or premature coronary artery disease. Additionally lipoprotein(a) levels should be considered particularly in children with a family history of early heart disease or hypercholesterolemia.
The December 2010 European Heart Journal entitled “Lipoprotein(a) as a cardiovascular risk factor: current status” confirms that there is “a strong correlation between elevated Lp(a) and heart disease. This corroborates that Lp(a) is an important, independent predictor of cardiovascular disease. Animal studies have shown that Lp(a) may directly contribute to atherosclerotic damage by increasing plaque size, inflammation, instability, and smooth muscle cell growth.
The European Atherosclerosis Society currently recommends that patients with a moderate or high risk of cardiovascular disease have their lipoprotein (a) levels checked. Any patient with one of the following risk factors should be screened;
- premature cardiovascular disease
- familial hypercholesterolaemia
- family history of premature cardiovascular disease
- family history of elevated lipoprotein (a)
- recurrent cardiovascular disease despite statin treatment
- ≥3% 10-year risk of fatal cardiovascular disease according to the European guidelines
- ≥10% 10-year risk of fatal and/or non-fatal cardiovascular disease according to the US guidelines
- If the level is elevated, treatment should be initiated with a goal of bringing the level below 50 mg/dL. In addition, the patient’s other cardiovascular risk factors (including LDL levels) should be optimally managed.[
Mayo Clinic laboratories state that approximately 85% of the population have concentrations <30 mg/dL – a normal value.
They reference values >30 mg/dL as suggestive of increased risk of coronary heart disease.
Treatment for lowering lipoprotein(a) appears controversial and debatable. Lp(a) is a genetically wired determination and over time, it does not change much. Overall, there are limited options for lowering elevated levels.
I remember my cardiologist stating succinctly: “Of most importance in the patient’s lab values is that the LDL cholesterol appeared excellent at 61 mg/dL, but the lipoprotein(a) was quite high at 135. I suspect this explains some of her family history. I recommend keeping the LDL cholesterol less than 60 mg/dL with the elevated lipoprotein(a).”
This Mayo Clinic Rochester cardiologist is following the advice I found on the Cleveland Clinic website as well. Lowering your LDL levels also lowers level of risk caused by high Lp(a). This is related to the fact that Lp(a) is carried on the LDL particle, and does its damage in the blood stream bound to LDL. The less LDL there is to bind to, the lower the risk.
The Cleveland Clinic stated:
“When we see high levels of Lp(a) in a patient, we set even stricter LDL goals. In fact, in a recent study of 5,000 patients that came through our Preventive Cardiology Clinic, we noted that overall mortality was increased in patients with higher Lp(a), but that if we could lower their LDL by a certain amount, the incremental increase in mortality due to the Lp(a) was negligible.”
I read that the current recommended treatment for an elevated lipoprotein(a) is niacin, 1-3 grams daily, generally in an extended release form. Then the next reading reveals that Niacin is totally ineffective. Cleveland Clinic states:
“While niacin has been shown to be slightly effective in lowering Lp(a), it would not be prescribed for Lp(a) alone. We prefer to go after LDL with statins as the first line agent. The data for reduction in cardiac events is strongest in statin therapy.”
Other options include:
- Aspirin may be beneficial to lowering lipoprotein(a).
- A 2012 meta-analysis in The International Journal of Cardiology suggests that atorvastatin may also lower Lp(a) levels.
- The effect of estrogen on lipoprotein(a) levels is controversial.
- Many readings I encountered appear to indicate that lifestyle appears to have little impact on Lp(a) levels.
Common sense dictates that we need to start early and eat right and exercise more. Simple is simple! One in five Americans have elevated lipoprotein(a) levels, as reported by the Lipoprotein Foundation. The adults need to set a good example by how you eat and how you get active each and every day.
Know your numbers. Make your family aware of your genetic history and what it means. Even though your cholesterol levels are normal during your annual exam, your lipoprotein(a) may be elevated, putting you at dangerous risk for cardiovascular disease.
It is our hope that a medication will be found that will permanently lower Lp(a) levels. Currently, there are four medications in the process of development.
The Lipoprotein a Foundation is a new non-profit foundation that “empowers the 30% of Americans at risk for cardiovascular disease to be advocates for their cardiovascular health.” Sandra Revill Tremulis, Founder of the Lipoprotein(a) Foundation knows firsthand the impact an elevated Lp(a) level has. Although Sandra had a normal LDL cholesterol and almost died of a heart attack at 39 years of age because of her history of high Lp(a).
“Now more than ever, Americans need to understand their inherited risk for cardiovascular disease and advocate for their own health.”
Sandra’s personal and powerful heart survival Youtube story:
Know the importance of knowing your genetic risk factors.
It matters for you. It matters for your children and grandchildren.
Take care of your heart. ♥