New and More Dangerous Cholesterol Found In Your Blood (Lipoprotein(a) - LPa)

all right we have something new or a new way to think about your cholesterol we have Dr Mike ke and cardiologist here joining us thank you very much I'm Dr Paul zzza welcome to talking with docs I'm Dr Brad wings today we're talking about LP little a you've seen it around you don't know what it is you don't know why it matters and you don't even know if it matters to you specifically maybe you like me thought LP little a was a rapper I didn't know apparently not these jokes are getting worse worse they are worse not a joke um so you want me to talk about LP L 100% all right um so LPA is ll's evil cousin okay best description for this right um okay so we have we need cholesterol in our body right right so we need cholesterol for the cell membranes that we've got throughout our body for the hormone steroid synthesis but we don't need everything that we have and we have remnants of these the cholesterol production that is toxic right um most of them contain a protein called apob right apob is not great um but apob sticks on these cholesterol um kind of globules if they will and allow it to attach to the arterial walls in our body and kind of migrate in and start to form plaque which makes them atherogenic which makes them arthrogenic got it and if you think about like the drywall in your house if you had something that went inside the drywall and just started to expand and grow and grow and grow until the drywall cracks and bursts that's the kind of thing that can happen in your arterial wall okay so one of these bad molecules one that most people are kind of familiar with is LDL so LDL is small it has this apob protein on it and and it's not good and so all our treatments and our recommendations for patients is to try and keep the LDL low because that will reduce your future risk of events right fine um but LDL has a evil cousin called LP a right and so LP little a looks exactly like LDL it has this Apo protein on it but it has another protein another protein called lipoprotein a right and so the issue about lipoprotein a is that it has some bad features um it is atherogenic so it will get into the arterial wall it is also inflammatory so this molecule has these little nasty spark plugs on it called oxidized phospholipids that are inflammatory for the arterial wall which is not nice and then the final part is this lipo protein a protein is kind of like a clotting Factor right like plasminogen right it's like plasminogen and so it promotes clotting so this thing does three not so good things okay uh promotes inflammation promotes clotting and is arthrogenic right um so that's LP little a would you also say that LP a is responsible for this calcification of the valve is that a totally independent risk you know when they talk about tic stenosis where they increases some type of bone or calcium depositing Factor that preferentially goes at your aortic so that's a fantastic question and so we'll do another talk at some other time about aortic stenosis but the the thing that LPA has been most associated with is myocard infrction if you have high levels you're more likely to have a myocard infrction or heart attack and when we say higher like how much higher are we talking about like 4% or like orders of magnitude like two and three times magnitudes like two or three times higher above Baseline for instance um and the other signal was aortic stenosis to everyone prise higher levels associated with aortic stenosis which is a narrowing of the last valve in our heart before the blood leaves the heart called the aortic valve okay there is a signal definitely for stroke uh and for heart failure but the strongest signals are for heart attack and aortic stenosis okay okay so now we've got this thing lipoprotein little a which you'd think might have been named in Canada it's not because of the a It's actually an international thing lipoprotein little a and something we can measure in your bloodstream can measure and has a association with these cardiovascular events right now is it is it causitive or is it an association do we know that if we alter the lipoprotein a we can alter those events those cardiovascular events or is it just oh because you have the genes that make lipoprotein a you also have the genes that cause heart attack iosis and stroke so I think we we're at the point now where we consider it causitive okay um in order to kind of get causitive we like the idea is our population studies so we've got population studies and this is a good one just to know right off 80% of us have a normal value right so so four out of five of your listeners are not going to have a high LP lay but one out of five will right um there's some Regional variations as well so in Canada the United States Australia Europe about 20% of the population will have a higher value okay okay highest values on the African continent and Southeast Asia maybe on the order of 30% lowest values South America and Asia proper and so there's some global variations um but you alluded to it because it's genetic right um You can't change your value um by diet and exercise and currently we don't have any medications on the market that are available to lower it although these are being actively studied so there are clinical trials ongoing um that will lower your LP ltil a on the order of 50 or 60% and we're trying to figure out okay so you have a high LP little a you've had a heart attack in the past um lower it and show me that you're going to have reduction in events so that's what we're going to try and prove okay and and this is interesting if you're one of those viewers who really hates big Pharma you're you're watching the process now there's been something identified in biology that is harmful for your health there are people now actively trying to find a way to alter that and that takes money and that's a business right and that's sort of the overlap between Healthcare and Industry because these pharmacological companies are going going to be like yeah we're going to try and find a way to lower that so that people have less heart attacks strokes and aortic stenosis but that's going to translate into a drug or a product that's going to cost money so that's the process you're watching it in its earlier stages unfolding now yeah that's fair there um women and men have similar values right um women postmenopausal women tend to have a value it's a little bit higher so there aren't a lot of Lifestyle things that change LP littlea but but that's one of them right so so now we know about this molecule is the average family doctor or the average cardiologist are they ordering a is there an LP little a blood test that we can do so you get that one value obviously if you can't change it you just need to know it once then for those people hey you're good or you're not good there is okay um and so in Canada it's covered in every Province now um it's free it's an insured service we pay for it with our taxes to be sure it's nice to know it's nice to know so yeah and and so but a lot of people forget to do it so it's not become all our our guidelines say somebody should have it measured at least once in their lifetime starting at what age like I mean obviously because if it's genetic like maybe maybe earlier would be better well generally what we say is look order it when you're ordering the other cholesterol parameters so in Canada in generally it's kind of age 30 or so where you were measuring cholesterol numbers in the United States it might be a little bit younger but if you're ordering the cholesterol just add on on LPA got it um so the canadi so the Canadian guidelines and the European guidelines both recommend this needs to done at least once in somebody's lifetime eventually I think the American guidelines are going to uh catch up and include it in theirs as well um it just makes sense okay so easily measured here is the $60,000 question is it is it here's the million doll how much is that question at right now it's going up I'm sure here's the billion dooll question I have an elevated LP little a what can I do about it right so that's fair that's a fair question or or why are you even measuring this because you're telling me you haven't got any way of treating it anyway now I'm just nervous now I'm just nervous basically I'm going to get my Affairs in order if I have an elevated LP little a that's all I'm getting so far so the answer to that and what we tell the family doctors because they ask us the same thing is look you've flagged somebody in your chart or in your practice that is at higher risk so it gives you a chance to then explore the lifestyle things that we actually just talked about in the blood pressure video like healthy weight if they're smoking don't smoke um if they're not exercising regularly exercise regularly do all the things that you can do to just lower your risk anyway y um and and you'll be in better shape okay so that's the start the second one intuitively if this is related to LDL and it's kind of like LDL and we have class of drugs that are good at lowering LDL regardless of what people feel about them what what are the role of statens in in in LP little a zero zero and this is surprising that we can say this cuz L people like oh yeah he's going to say give a 10 so even though it's like a cousin to LDL lowering your LDL does not affect your lpay measurements that's noide okay but now um the the fact that you have a high LP little a will it may indirectly affect your stat and intake because it will make you say okay well then you better aggressively lower your LDL in that risk factor or is that sort of not a thing so so that can be a thing and that's where you know it comes into the art of medicine rather than just purely guideline based and so if you had somebody that had an LDL value when you did the calculation that was okay but not great you know that might be where you have a really thoughtful conversation with the patient saying look this value is on the on the edge but your LP little a value Flags you as somebody that's pretty high risk why don't we try and lower your RIS your high normal really is high we're going to get you down to normal yeah so I think we were talking just before we came on air that there is one class of medications that is uh on the market that does lower LDL called the whole class is called the pcsk9 Inhibitors and they're injectable medications that we use to lower LDL and people you know with really high values of LDL that's hard to get down right interestingly it actually lowers LPA about 30 or 40% so there is something yeah nobody nobody really knows why but I also can't tell you if lowering LP L is actually going to make it'll lower their LDL but I don't know if it's going to reduce their their LP little a risk that's why you have to do clinical studies to figure it out and these are I'm assuming being done right now there's actually two that are ongoing right now okay yeah W will stay tuned because we will as soon as those clinical studies show some results we'll let you know about those results because now I'm a little nervous about LP littlea and I'm going to go get mine checked I think if my family doctor yeah is into that and so the take on message today then is obviously continue to do all the lifestyle things that we just talked about for your blood pressure for your cholesterol normally so eat healthy exercise get rid of your bad habits but if you do have an elevated El little a that just encourages you to do these more than average cuz you are at slightly high risk of a bunch of different things yep all right I should have called it LP big a cuz it's it's a big problem an exclamation mark maybe little a sort of undermines it a little bit leave your comments if you had this blood test done if you know anything about it or want to talk about it more leave it in the comments and if you like this video please like it subscribe to our Channel thanks little be and remember you are in charge of your own health we'll see you next time thanks

Channel: Talking With Docs

Views: 128,519

Keywords: cholesterol, high cholesterol, ldl cholesterol, bad cholesterol, good cholesterol, how to lower cholesterol, how to reduce cholesterol, lower cholesterol, cholesterol levels, hdl cholesterol, foods that lower cholesterol, cholesterol lowering foods, is cholesterol bad, low cholesterol diet, cholesterol control, low cholesterol foods, cholesterol symptoms, ldl cholesterol levels, foods to lower cholesterol, lower cholesterol naturally, cholesterol diet

Id: DFm-HmSc9Ak

Length: 11min 28sec (688 seconds)

Published: Wed Nov 29 2023