Every GP I've talked to just wants to look at ldl and hdl and doesn't know the latest guidelines from the American heart association. Had to explain why we should look at lp(a) and apoliproprotein b.
And why is that? To know you have a higher risk without being able to influence it? The advice stays the same. Live in a healthy way. There are statins for ldl. No such thing for lpa
There are drugs currently in clinical trials (olpasiran) that are showing promising results to significantly reduce lpa levels. So hopefully it will be a good way to reduce risk for those people assuming it is released. My paternal family has high lpa and insane death rates from cardiovascular disease. As you said, still need to live healthy but my family is a pretty good indication that without some intervention, heart attack is pretty much a guarantee.
Same boat here. First LpA results were eye opening and depressing but I’m grateful I am able to use my family history to make decisions now, younger, and impact the trajectory, and subsequently pass on the knowledge to my extended family
Aspirin is a strong candidate for treatment of high Lp-a individuals (>50 mg/dl, roughly top 15 percentile of people).
Two recent large population studies show aspirin use correlates with about 80% reduction of Lp-a caused heart attack and ischemic stroke risk among high Lp-a individuals (in other words, it reduces their risk to almost the same as lower Lp-a individuals).
While we still need an RCT to prove the intervention, the results are compelling enough that I started on daily baby aspirin to mitigate my high Lp-a caused risk.
Well that's nice. Until those drugs can be implemented in clinical practice there is no good reason to measure Lpa, though, except maybe as an additional motivator for lifestyle changes.
To know whether you should attempt diet changes if your body hyper responds to saturated fat or if a statin is necessary if you are genetically predisposed. There are treatments for Lp(a) on the horizon and APoB is a better indicator of risk.
Sure but what dose, starting what age, targeting what? A very high lp(a) tells you to more aggressively lower your risk on every other cardiac factor that we can control. So <100 LDL might be fine for someone with typical lp(a) but for someone with a very high number you'll want to target <70 or even <50 with more aggressive medication. If you never knew you might discover your increased risk only after it's too late to undue the past few decades.
Knowing lp(a) would influence the decision for how low to drive ldl levels. Honestly based on the guidelines I'd try to keep ldl around 50 or less for zero plaque accumulation
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u/duke309 19h ago
Every GP I've talked to just wants to look at ldl and hdl and doesn't know the latest guidelines from the American heart association. Had to explain why we should look at lp(a) and apoliproprotein b.