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.
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.