Lipoprotein(a) -Treating the Untreatable

It's important to know your numbers

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Do you know your cholesterol numbers? There goes September … and there goes National Cholesterol Education Month. National Cholesterol Education Month is a reminder that we should all get our cholesterol checked and treat high numbers.  There are still some outstanding resources out there that can tell you everything you need to know about cholesterol. (Hint: Cholesterol is a fatty substance in your blood and a major risk factor for cardiovascular disease when there’s too much of it.)

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Which reminds us, Stanley Hazen MD, PhD, recently did a web chat where a particular protein related to “bad” cholesterol was discussed. Dr. Hazen is chair of Preventive Cardiology at Cleveland Clinic. The protein he talked about is called lipoprotein(a) or Lp(a) for short. Lp(a) is one of the things your doctor is likely to test for to see if you are at risk of heart disease. The question was: Should high Lp(a) be treated. Dr. Hazen’s response was an emphatic “yes.”

But there’s one big problem. Lp(a) is not really “treatable” in the usual sense of the word. “Lp(a) is in large part genetically wired and doesn’t change very much,” says Dr. Hazen. You can, however, mitigate the danger of a high Lp(a) by going after some other risk factors for cardiac disease. Your classic LDL cholesterol, for instance.

Lowering your LDL levels also lowers level of risk caused by high Lp(a). That’s because 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. “When I see high levels of Lp(a) in a patient, I set even stricter LDL goals,” says Dr. Hazen. “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.”

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While niacin  has been shown to be slightly effective in lowering Lp(a), Dr. Hazen wouldn’t prescribe it for Lp(a) alone. He prefers to go after LDL with statins as the first line agent. “The data for reduction in cardiac events is strongest in statin therapy,” he notes.

A patient with high Lp(a) also sets off Dr. Hazen’s stroke risk alarm. To prevent stroke, he’ll monitor the patient’s blood pressure levels more closely and more ready to prescribe a low-dose aspirin as a routine stroke preventative (unless there’s a prior history of gastric bleeding or intolerance to aspirin).

Dr. Hazen would like to see Lp(a) levels included in national guidelines for assessing cardiac risk – especially since his own research has helped demonstrate that Lp(a) is both a marker and genetic mediator of increased cardiac risk. National guidelines in some other countries are well ahead of the U.S. in this regard.

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By the way – even though September has come and gone – it is not too late to get your cholesterol checked!