For years, cholesterol (LDL, HDL, triglycerides) has been the primary concern in cardiovascular prevention. However, a new contender has surfaced in recent times: lipoprotein(a), or Lp(a).
Numerous patients are unfamiliar with it, yet studies indicate it could be one of the most significant genetic risk factors associated with heart disease.
**What is lipoprotein(a)?**
Lipoprotein(a) is a component in the bloodstream resembling LDL cholesterol, but it has an additional protein known as apolipoprotein(a). This composition increases its propensity to aid in plaque accumulation, inflammation, and clot development within arteries.
In contrast to LDL cholesterol, which is greatly affected by dietary choices and lifestyle, Lp(a) levels are primarily determined by genetics.
**What the research shows**
– **Independent risk factor:** Extensive cohort studies, featuring data from the European Atherosclerosis Society and Framingham Heart Study, validate that heightened Lp(a) elevates the risk for heart attacks, strokes, and aortic stenosis, irrespective of normal LDL and other cholesterol levels.
– **Prevalence:** Approximately 20 percent of the population exhibits elevated Lp(a). Many individuals remain unaware as it is not included in standard lipid panels.
– **Treatment limitations:** Present-day statins do not significantly reduce Lp(a). New therapies, such as antisense oligonucleotides (e.g., pelacarsen), are currently in advanced clinical trials and show potential in drastically lowering Lp(a) levels.
**Why this matters for patients**
Since Lp(a) is passed down genetically, a family history often serves as an indicator. A patient with a notable background of early heart disease may present with normal cholesterol but still have an increased risk due to elevated Lp(a). Recognizing this aids in understanding risk and customizing prevention strategies more effectively.
**What patients can do**
– **Request the test:** Lp(a) can be evaluated through a straightforward blood test, typically done once in a lifetime, as levels tend to be stable.
– **Emphasize overall risk reduction:** Even though direct treatment for high Lp(a) is not yet available, aggressively lowering LDL cholesterol, managing blood pressure, avoiding smoking, and leading a healthy lifestyle can help mitigate the risk.
– **Family awareness:** If a person has elevated Lp(a), family members might also benefit from undergoing testing.
**Conclusion: a new frontier in prevention**
Cholesterol will always be significant, but Lp(a) highlights that cardiovascular risk encompasses more than just a single figure. By incorporating this test into standard preventive care, particularly for patients with a familial history of early heart disease, we advance towards genuinely personalized medicine.
For the time being, information is empowerment: understanding your Lp(a) status can inform a more intelligent prevention strategy until targeted treatments become available.
Monzur Morshed is a cardiologist. Kaysan Morshed is a medical student.