Lipoprotein (a) – What is it & why is it so important?
On January 27, an article was published in the Fairfax newspapers, discussing what was described as a marker of bad cholesterol, which could be elevated in more than 5 million Australians.
Professor Jason Kovacic, who is the executive Director of the Victor Chang Cardiac Research Institute in Sydney was quoted as saying “that there is a huge amount of data unquestionably linking higher levels of the little known cholesterol lipoprotein (a) to strokes and heart attacks.
He then went on to explain that around 20% of the population have an elevated level of lipoprotein (a) but many doctors & the public were unaware of what he called a second “bad cholesterol”.
Lipoprotein (a) is a relatively common finding amongst families who have a history of heart attacks, or in people who have suffered premature heart attack or stroke.
The article then went on to detail the case of a 47-year-old man who died suddenly whilst jogging in 2017. An autopsy revealed extensive fatty deposits in the walls of his arteries, and it was discovered he had an elevated lipoprotein (a).
The article also went on to say that he had seen doctors complaining of symptoms but had a prior coronary calcium score which was zero.
My concern about this entire subject is that it was presented as if this was a newly discovered chemical, and that the reported case should come as a shock to all those involved.
Lipoprotein (a) was first discovered in 1963 and in my own practice, I have been measuring this routinely for the last 25 years and have been discussing its importance on many media outlets over this time.
What is lipoprotein (a) ?
Lipoprotein (a) (Lp (a)) is a type of lipoprotein that is similar to low-density lipoprotein (LDL) or “bad” cholesterol. It is composed of an LDL particle with an additional protein, known as apolipoprotein (a), attached to it. Elevated levels of Lp (a) in the blood have been associated with an increased risk of cardiovascular disease, including heart attacks and strokes. However, it is not routinely measured in a lipid profile and genetic testing is the only way to determine if someone has a high level.
Lipoprotein (a) puts fat in the walls of arteries and also thickens the blood. Interestingly, not all lipoprotein (a) is created equal and around 70% of people with the molecule elevated in their bloodstream will have a vascular event unless treated whereas 30% of people with an elevated Lipoprotein (a) do not appear to have any major issues.
But the studies clearly show that the risk for a vascular event, at least, doubles in people with elevated levels of lipoprotein (a) in their bloodstream.
In the case quoted, any patient with symptoms shouldn’t only undergo a coronary calcium score and feel reassured, but should have stress echocardiography. If this is abnormal, an invasive angiogram should be performed but if the stress testing is normal, the person should at least proceed to a CT Coronary Angiogram.
A coronary calcium score is only a screening test for people without symptoms. If the person quoted in the article would’ve had the other tests mentioned above, blockages in the artery would have likely been detected, and his life may have been saved.
How to treat high lipoprotein (a)
Currently, there are no recommended treatments for lipoprotein (a), but I have been using very effectively in my own practice for many years, a combination of vitamin C, vitamin E, lysine and immediate acting nicotinic acid (which may cause significant flushing, if not use properly) with a good response in controlling the clinical status of many of my patients.
Over the past few years, there are two novel groups of therapies, which have been shown to be extremely effective in lowering lipoprotein (a). The first, an anti-sense oligonucleotide that works on the production of lipoprotein (a) in the liver, administered as a monthly injection and the second a small molecule, RNA directed therapy, which only needs to be administered every six months.
It is interesting that the medical profession is now showing interest in lipoprotein (a), because until recently, we have not effective pharmaceutical drugs to treat the problem. Up until now, it has basically been ignored by most people in the medical profession, despite the fact that it was first discovered in 1963.
Regardless, I’m delighted to see that this very important risk factor for vascular disease is now receiving the attention, in my opinion, it has deserved for the past 30 to 40 years.
About Dr Ross Walker
Dr Ross Walker is an eminent practising cardiologist with 40 years’ experience as a clinician. He has a strong passion for people and health, and has spent the past 25 years focusing on preventive cardiology, ensuring his place as one of Australia’s leading health experts.
Alongside his work as a clinician, Dr Walker is an established author of seven best-selling books, a regular health presenter in the Australian Media, and is also considered a world-leading keynote speaker and life coach.