One of the key pillars of understanding your own personal risk of heart disease is doing the right tests.
If you’ve never had your Lp(a) checked, I think that you should.
The importance of Lp(a) in the cardiac risk assessment is something that I’ve written about and podcasted about many times before.
So for today’s newsletter, I’m sharing a podcast that I was interviewed on that gets into the weeds about Lp(a).
Here’s an overview of what I think is important to know about this test:
Lp(a) is a blood test that should be done once in everyone’s life. You don’t need to keep checking it
High Lp(a) increases the risk of heart attack, stroke, and calcific aortic valve stenosis
Risk increases as levels rise - it’s not positive or negative, Lp(a) risk exists on a spectrum
The direct treatments for Lp(a) aren’t ready for primetime - they are still in clinical trials - so we don’t have a specific way of treating this issue
Even though there are no Lp(a)-specific treatments, I still think that checking levels makes sense1 because it’s actionable in other ways
High Lp(a) means that we should be treating other aspects of your heart disease more aggressively - if you have high Lp(a) and we’re on the fence about lowering your LDL-C, it pushes me towards treatment. If we’re debating the importance of quitting smoking, it makes me push the conversation a little bit harder.
In that way, I think of high Lp(a) as a tiebreaker for deciding on treatment in a 50/50 clinical situation
High Lp(a) also pushes me to do imaging tests like calcium scores or coronary CTAs earlier on so that we can be more precise in our application of other preventive medications
Lp(a) is mainly governed by genetics - it’s not high because you eat too many seed oils
Lp(a) increases cardiac risk because it accelerates cardiovascular disease, increases oxidation, and increases blood clotting
There is some data that aspirin may make sense for preventing a first heart attack or stroke in patients with elevated Lp(a), but the quality of the data isn’t high enough to make a blanket recommendation.2
Knowledge is power and understanding your Lp(a) will help you frame your overall cardiac risk.
I hope you enjoy the podcast - and there’s a transcript at this link if you prefer reading to listening.
A lot of people in medicine think that if you don’t have a treatment for something, there’s no point in checking it. I think that’s wrong with regards to Lp(a).
The data comes for subgroup analysis from clinical trials. Subgroup analysis is notoriously unreliable and unreproducible. But when I see the interaction between very high Lp(a) levels and strong family history of early heart disease, that’s when I think about aspirin as a preventive measure.
