A Heart Risk Factor Doctors Are Still Learning About.

This is a synopsis of an article published in the New York Times.

Last February, when Bob Harper, the celebrity fitness trainer on “The Biggest Loser” had a massive heart attack, he and his doctors were shocked; Bob Harper was the poster boy for good health.

How did this happen to someone in optimal health?

After testing, his doctors discovered that a fatty particle in the blood, lipoprotein(a), was the cause of his attack. Although doctors regularly test for lipoproteins such as HDL and LDL cholesterol, very few test specifically for lipoprotein(a) (lp(a)). High levels of lp(a) (which are predominantly determined by genetics), triple the risk of having a heart attack or stroke at an early age.

One in five Americans have dangerously high levels of lp(a). Unfortunately, as in Mr. Harper’s case (52 years of age), diet and exercise have no impact on lp(a) levels and cholesterol-lowering drugs only moderately lower lp(a).

According to Dr. Henry N. Ginsberg, Irving Professor of Medicine at Columbia University and a leading expert on lp(a), “the threshold for high lp(a) begins around 30 milligrams per deciliter of blood. Heart disease risk jumps for those in the 80th percentile, with lp(a) levels above 60, and climbs sharply for the 5 percent of the population with lp(a) levels between 150 and 300.”

It is unclear what role lp(a) serves in the body. Some scientists maintain that it may help in repairing cells while prevent infections by binding to pathogens in the blood. Although the benefits of lp(a) are unknown, it is clear how excessive lp(a) levels affect the body. Lipoprotein(a) accelerates “the formation of plaque in the arteries, and it promotes blood clots.”

Dr. Lloyd-Jones at Northwestern explains that people with early-onset cardiovascular disease should be tested for lp(a), which includes men younger than 50 years of age and women younger than 60 years of age or have a family history of high lp(a) levels, or have a first-degree relative who has suffered from a heart attack or stroke at a young age.

If a patient has high lp(a) levels, doctors will treat and lower the patient’s LDL cholesterol while maintaining optimal blood pressure and blood sugar (through a consistent, healthy diet and exercise routine). There are medications that have successfully (modestly) reduced lp(a) levels, but have drawbacks. Niacin, a B vitamin, which is known to have many side effects, and PCSK9 inhibitors, which are not covered by insurance or approved for lowering lp(a) while costing upwards of $14,000 a year. Akcea Therapeutics is currently developing a drug to lower lp(a), however, it is years from being approved and released in the market.

“People don’t know about it, physicians don’t know about it, and we have to get an education program out there, but that’s expensive. I would say that somewhere between 15 to 20 percent of the population would clearly benefit from knowing that this is their problem.” ~ Dr. Henry N. Ginsberg, Irving Professor of Medicine at Columbia University and a leading expert on lp(a)

Read the full article here.

**For more information on lp(a), visit the Lipoprotein(a) Foundation.

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