Elevated Lipoprotein “little a”. What's the best treatment for Lp(a)?

well welcome everyone to the healthspan podcast  where we talk about the science of increasing   your health span so I'm your host uh Dr Robert  Todd Hurst I'm a board-certified preventive   cardiologist and founder of healthspan MD a  medical practice that delivers Health Care as   it should be with a comprehensive and connected  approach to helping our patients live a long and   vital life so today's topic is a special one maybe  a little bit technical a little bit more clinical   than usual we are going to talk about lipoprotein  little a and lipoprotein little a may be something   that you haven't heard of but my guess is you  will hear about lipoprotein little a in the   coming years because it's becoming more recognized  the impact this lipoprotein little a has on our   health so first of all this talk about what is  lipoprotein little a so it is just a part a type   of cholesterol it's a certain protein attached  to a cholesterol molecule and it's been called A   lipoprotein a little a so um why is this important  well lipoprotein little a impacts our heart health   it increases the chances of having a heart attack  in some Studies by up to 300 percent it also is a   strong risk factor for an increased risk or stroke  for heart failure for blood clot problems and also   for narrowing of the aortic valve which is called  aortic valve stenosis so the reason lipoprotein   little a is becoming more commonly discussed among  doctors and also among patients is because it is   the most common genetic cholesterol problem that  increases the risk of heart disease you know in   in medicine we commonly talk about another  type of genetic cholesterol problem called   familial hypercholesterolemia that just means a  genetic predisposition to having a very high LDL   cholesterol and this is a big clinical problem but  it's uncommon only about one in 250 people have a   elevated or have familial hypercholesterolemia um  but lipoprotein Lily elevated lipoprotein little   a is is seen in May in up to 20 to 30 percent  of people um so you know the one it's a really   common thing but number two we are increasingly  knowing what to do with this we have we're having   tools that we didn't have in the past and so it's  becoming more prominent uh but also likely going   to be more of an important Target for future  Therapies in helping people lower their risk of   heart disease and you know lipoprotein little  a among Physicians is still a thing that's   burgeoning meaning you know people are starting  to figure this out but I know it when I give talks   to Physicians that uh CME or continuing medical  education events where there's you know doctors in   the audience when I talk about lipoprotein level a  that's one of the topics I get the most questions   on from a physician so I think Physicians have  a lot of uncertainty around lipoprotein level   a and patients of course have uncertainty around  lipoprotein little a so um why are people starting   to know more about lipoprotein little a well  another reason is that we're testing for it more   frequently more advanced lipid test analysis are  including lipoprotein lla so people are getting   that surprise they get their cholesterol you know  a standard cholesterol profile doesn't test for   lipoprotein Olay these more advanced tests can  test for that and they're finding out oh my gosh   I have this elevated lipoprotein level a and I  don't know what it is and or what what does it   mean another way people are increasingly finding  out that they have a elevated lipoprotein level   a is genetic testing so getting you know genetic  tests like the 23andMe and other forms of genetic   testing people can be identified as having a high  likelihood for an elevated lipoprotein little a   and they're trying to figure out what that is so  um one you know place to start too is what is the   definition of elevated lipoprotein delay there's  still some uncertainty about this some different   guidelines give different values but generally  A lipoprotein little a that is greater than 50   milligrams per deciliter or 125 nanomolars per  liter that's considered elevated so it depends   on the lab tests what units that they use so  lipoprotein little a another important thing to   mention about this if you have lipoprotein little  a is that it is almost all genetic about nine   ninety percent of your level of lipoproteinola a  is determined by your genes not by your lifestyle   choices so in general people can't impact their  lipoprotein little a by doing anything lifestyle   wise that would be beneficial however as we'll  talk about there is an important opportunity to   lower your risk so maybe not make the lab tests  look better but certainly to lower your risk so   um you know lipoprotein a little a in in the  healthspan MD practice we look at this as four   principles for addressing an elevated lipoprotein  level and before I start should say that none of   what I'm talking about is meant to be medical  advice this isn't a doctor-patient relationship   these are things to talk with your doctor about to  determine what would be the best treatment for the   elevated lipoprotein little a if that is your  uh if you've been identified as having that so   principle number one is to optimize heart health  so as we talked about already having an elevated   lipoprodinal a does increase the risk for heart  attacks for strokes for heart failure for blood   clot problems for aortic stenosis and to lower the  risk particularly about of heart attack and stroke   the goal is to optimize all other factors that we  know are important so you know there are over 200   independent risk factors for artery disease or  heart attack risk and all of those can you know   uniquely interact with your genetics to give you  your risk but there are 10 factors that are most   powerful in predicting risk for heart disease for  for heart attacks oh interestingly these same same   10 factors are most important in predicting  risk for cancer for dementia for a stroke and   for just how long you live in our practice we call  these the health span 10 and they are 10 factors   that most powerfully predict risk in somebody who  has high risk including if they have an elevated   lipoprotein La then optimizing these 10 factors  is where we start so the first four of these are   outcome goals these are the ones that we want  to get right and that is to have normal blood   pressure normal blood sugar levels healthy  cholesterol levels and then a healthy body   weight or body composition and then the other 6  are the tools we use to move those four outcome   goals so that is nutrition physical activity sleep  stress avoiding toxins and then staying connected   connected socially connected to your purpose when  we optimize those 10 things that's the people   that get the most benefit in some studies people  that do the best at those 10 factors have over 90   percent less heart disease about 50 percent less  stroke risk about 50 percent less heart cancer   risk and about 40 percent less dementia and add  12 to 14 years of life so optimizing the health   span 10 that's principle number one in approaching  somebody who has an elevated lipoprotein level a   principle number two is aggressive lowering of the  LDL levels or more specifically the apoprotein B   uh levels but in general most uh people get their  LDL levels it's kind of a surrogate for April B uh   levels but for people that are at the highest risk  that's one thing that we know can mitigate that   risk is to get that LDL into optimal ranges most  doctors feel like this is as at least less than 70   milligrams per deciliter even more aggressive for  people at highest risk may be indicated so that's   where you would talk to your physician about what  would be an optimal LDL or apob level to get to to   lower to get to the lowest risk of future heart  disease without causing you any adverse effects   principle number three is lower lipoprotein  level a levels and the reason that we don't   start that is principle number one is because we  don't have currently great ways or easy ways to   lower lipoprotein little a levels um niacin is a  vitamin that has been shown to impact cholesterol   and it lowers LDL it raises HDL it raises or  I'm sorry lowers triglycerides and it also can   lower lipoprotein little a levels although in  my experience when I I used to use this in my   practice when that was kind of the way that we  were doing things um I I found it to be quite   variable sometimes it works sometimes it didn't  niacin the prescription form is Nia span tends   to have a lot of adverse effects particularly  flushing for people that that for some are it's   intolerant tolerable but the main reason we don't  use niacin or niac span particularly much anymore   is because we've had large outcome trials that  showed no clinical benefits so it looks like   niacin Niaspan makes the labs look better but  doesn't change outcome doesn't change the risk of   heart attacks and strokes and in one study there  was even a slight increase in bleeding in the   brain which was a secondary outcome and certainly  not cause and effect but at least enough of a risk   to say if there's not much benefit here or no  benefit here why would we accept any risk now   we have some new therapies that do work that are  available right now one is a procedure it's called   LVL aphoresis this is a procedure it's basically  like dialysis for your cholesterol people at   really high risk really high cholesterol can come  in every two to four weeks and they're hooked up   to a machine their blood is filtered it takes a  couple of hours and they get their cholesterol   cleaned out of the bloodstream the cholesterol  lowered dramatically this is a infrequent there's   not many places that do this not many people that  need to do this but it can be life-saving for some   people to have really really high risk and really  high cholesterol tends to be also really expensive   but can lower LPL lipoprotein a little A Levels by  up to 70 percent and you know this this data it's   being done in Europe more than it is in the United  States or at least the research studies have been   done more commonly in Europe and there's some  evidence that lowering lipoprotein little A Levels   by ldla pherasis improves outcomes and and this is  a really important point and one that we we still   don't know is you know for sure does lowering  lipoprotein little a actually change outcomes   change heart attack risk and change stroke  heart failure aortic stenosis risk that's to   be determined we we you know it makes sense that  it would be beneficial but we don't know that for   sure yet and that's important to keep in mind as  we're exploring these new therapies for lowering   protein little a another thing that is makes  this uh timely to talk about lipoprotein little   a is just in the last uh several months there has  been a report in the New England Journal medicine   the most prestigious medical journal in in the  world of a new medication not available not FDA   approved yet but a new medication is called a  small interfering RNA medication that lowers   lipoprotein little A Levels by over 95 so this  is an exciting development uh we you know it's   still early in this process but something on the  horizon and that would be you know a medication   that if it passes through the FDA approval it  meets uh safety criteria and is tested that might   be our first fight where we find out does lowering  lipoprotein level a change outcomes for people and   as we talked about in the beginning up to 20 to 30  percent of people have elevated lipoprotein Level   A Levels so this could be an important medication  for our in our battle to decrease heart attacks   to lower heart disease from being the number  one cause of death and disability and bring   it down to being the preventable disease that  we we know it can be and should be and then the   last principle I want to talk about is the idea of  lipoprotein little a increasing the risk of blood   clot problems so lipoprotein little a has some uh  similarities to another Factor called plasminogen   that is involved in the clotting Cascade and  so it's been talked about for years that maybe   people with elevated lipoprotein little a should  take aspirin to lower their risk of forming blood   clots well there's been no evidence that that  was of benefit and in my practice I did not   make that recommendation and there still isn't  definitive evidence about this but there was a   recent study that showed that in people who have a  genetic testing that shows that they would have a   lipoprotein little a so important to note that not  this this research study did not assess if they   had elevated lipoprotein level 8 just looked at  whether they had the genetics for elevated lipopro   like those people that took aspirin did better  than those people who did not this is this is   preliminary this does not mean that any everybody  with elevated lipoprotein little a should take   Aspirin because aspirin does have adverse effects  as bleeding risks we generally don't use aspirin   and primary prevention meaning somebody who's  not had a heart attack or stroke not had a stent   or bypass surgery because the risks of bleeding  are about the same or maybe even a little higher   than the the benefits of lowering the risk  of heart attacks but in people with elevated   lipoprotein little a it's worth that discussion  with the physician and I think that that decision   has to be made with your physician what is your  bleeding risk what is the heart disease risk would   taking an aspirin make sense that's something  else that should be discussed between you and   your physician so that's lipoprotein little a  our practice has been MD is specializes in the   comprehensive connected approach to get people  that have higher risk for heart disease for a   higher risk for cancer higher risk for stroke  they have evidence of metabolic disease blood   pressure cholesterol pre-diabetes give them the  connected comprehensive care that we know is   effective in lowering the risk for these diseases  so they can live a long and vital life so I if you   have an elevated lipoprotein level a you'd like to  learn more about our practice we'd love for you to   schedule appointment just go to healthspanmd.com  and uh and just submit a request for employment   we'd love to see you okay so uh thank you all for  joining us uh today it's been a pleasure to to be   here we look forward to seeing you back in the  new year to continue to talk about the topics   important the science in increasing your health  span have a great day everybody thank you so   this information is for educational purposes  only and is not medical advice don't make any   decisions about your medical treatment without  first talking to your doctor thanks for watching   and if you want to learn more about living  a long healthy life you love click the link   below to learn more about how we help people  increase their health span and if you like this   video hit the like button below share it with your  friends and be sure to hit the bell and subscribe

Channel: HealthspanMD

Views: 39,374

Keywords: Elevated Lp(a)Elevated Lipoprotein “little a”. What's the best treatment for Lp(a)?, Lp(a) causes, Lp(a) risks, Genetic heart disease, Heart disease prevention, HealthspanMD, Lowering Lp(a) levels, Lp(a) detection, Advanced lipid tests, Genetic testing for heart disease, Aspirin for heart health, Proactive heart health, Managing high Lp(a), Cardiovascular risk factors, New treatments for Lp(a), Heart disease education, Holistic heart care, Preventing heart disease

Id: xZzkNJ0e5J0

Length: 18min 19sec (1099 seconds)

Published: Fri Dec 30 2022