Managing patients with high Lp(a) | Peter Attia, M.D. & Benoît Arsenault, Ph.D.

[Music] welcome to the drive podcast i'm your host peter attea if you like this video please let me know by subscribing to the channel or visiting my website to become a member for more exclusive content and so is one interpretation of the fact that um pcsk9 inhibitors can lower lp little a by 30 but that might not be sufficient to ameliorate the lp little a risk specifically is that it's just simply not enough it gets back to what you said earlier yeah it you're going to have to eliminate lp little a and and it becomes a bit more of a step function than the gradient we see with apo b yeah i i don't know if we need to eliminate lp little a but we need to take we need to get it probably bring it down yeah yeah yeah to a lower level so that point that's what they're testing yeah so that brings us to where we are today right so what's the state of the art today in 2022 with my patients who have elevated lp little a i take a two two prong effect uh when it comes to lipid management obviously there's many things we're doing outside of lipid management the first is absolutely eradicating apob so we're very aggressive on this because it's very clear that you can do this safely and effectively we target an apo b of about 30 to 40 milligrams per deciliter so we target an apo b at what we would call a physiologic level so the level that a child would have it's clear that a child can have an apob of 30 and have no problems with development which is the most cholesterol demanding period of their life so there's absolutely no reason that we shouldn't be able to take an adult there without side effects meaning provided we can do it without side effects from the medications but the second thing we do is we're very liberal in the use of pcsk9 inhibitors because even though we don't know the answer yet our belief is even if it whacks it 30 which is about what we see we see on average about a 30 reduction lp little a it's worth it until we get to antisense oligonucleotides so let's talk about antisense oligonucleotides what are they yeah now before we get into that uh i i'll tell you that i do the same thing i mean uh i'm going to turn 40 this year so i decide i decided to had to have a lipid check and have my lpa remeasured and it's very high it's at 200 nanomolars i knew that because i had my genotype done with a direct to consumer company and and they let you look at your own data so they they send you all of your snip information so i went and looked at my favorite snip in lpa and i was uh a carrier of one of the most famous mutation variants in the in lpa so and that's exactly what i decided to do so my ldl was a bit higher than than average my lpa was i so i just started to uh to take a statin and of course i've been on [Music] close to vegetarian dairy diet for more than three years i act i'm physically active but you know at some point you have to look at at your at your labs and say well there's i need to do more so so even i started taking a statin even though i'm not 40 yet because i i i see those studies and i see the importance of going after ldl very early and very aggressively now i'm not on super high dose i need to have it to check it after three months but um but if it doesn't go down i'll increase the dose so so and that's i think what people who have high lpa should do [Music] you

Channel: Peter Attia MD

Views: 30,588

Keywords: heart disease, lp(a), lipoprotein(a), coronary heart disease, ASCVD, CVD, cholesterol, heart disease prevention, disease prevention, LPA, cardiovascular disease

Id: khEmSILELjE

Length: 3min 53sec (233 seconds)

Published: Wed Jun 15 2022