25% of people continue to die from cardiovascular and heart disease.
Despite better modern management of risks like high blood pressure and cholesterol. Researchers suspected that there must be other things causing cardiovascular disease. Studies led to the discovery of a substance in the blood called lipoprotein (a). The level of lipoprotein (a) in the blood is different for everyone. Recent genetic studies proved that you inherit most of your high lipoprotein (a) levels. Your liver manufactures lipoproteins. They are a combination of fat and protein. Their job is to transport fats around the body in the blood. Lipoprotein (a) is a special combination, it includes a lipoprotein like LDL cholesterol, plus two more proteins, apolipoproteins A and B. The combination is very sticky and easily passes into the wall of the artery. This inevitably causes blockages of your blood vessels. So high lipoprotein (a) levels equal a high risk of cardiovascular disease.
Even people with amazing lifestyles and diets can have high levels. If you are reading this then there is at least a 10 to 20% chance you have a high lipoprotein (a) level. The only way to know your level is through a blood test. Most people only need to check once in their lifetime. High levels mean you are at high risk for heart attacks and stroke. This is true even if your blood pressure and cholesterol levels are “ok”.
Knowing you are at high risk we can then help you reduce that risk. We will look at all your cardiovascular risk factors and make a plan to optimise these. Knowing about a high lipoprotein (a) level can completely change treatment plans. We need to track your cholesterol measurements. The goals for your cholesterol need to be much lower to reduce your risk. This might mean using medicines to reduce targets like non-HDL cholesterol.
Ongoing drug trials show great promise. In the future, drugs might directly reduce lipoprotein (a) levels.
The European Society of Cardiology recommends measuring every adult’s lipoprotein (a) level. Unfortunately in 2022 the British Journal of Cardiology said “most clinicians are unaware of it”. We are passionate about the power of health screening to prevent disease. We recommend testing lipoprotein (a) levels for all adults. Because levels are mostly genetically determined, it only needs to be checked once. This helps our patients prevent cardiovascular disease. Because prevention is better than cure.
If you’re interested in learning more about lipoprotein (a) then check out Dr Hugh’s deep dive on lipids here.
Dr Lucy Hooper
October 2022