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March 24 is LP(a) Awareness Day
Lipoprotein (a) –The Hidden Foe
What is Lipoprotein(a)?
Pronounced as “Lp-little-a”, it is a unique cholesterol carrying particle that plays a major role in plaque formation in arterial walls in an aggressive manner due to its inflammatory, clogging as well as clotting properties. It is highly hereditary, passed down rather easily from one generation to the next. It is elevated in roughly one in 5 people, so highly prevalent in the population worldwide.
What is the risk associated with this Particle?
Lp(a) is considered an independent risk factor for heart attack, stroke, circulation defects in limbs as well as valve abnormalities. It is particularly associated with premature events in unsuspecting young people in the prime of their life.
How do you test for this particle?
All it takes is a simple blood test, however since it is not included in the standard “lipid panel” that is commonly drawn by providers, it is not reported automatically- It therefore needs to be ordered separately. Unfortunately it is vastly underdiagnosed and less than 5% of the U.S population has been screened for it! Testing is of course key for timely detection, so appropriate therapeutic measures can be instituted without delay. All the major U.S and global guidelines now recommend that all adults be tested at least once in their lifetime for this particle. Timely testing is obviously of paramount importance in people with personal history of early events or family history of such. Lastly, It is also equally important that family members are tested, once somebody in the family is identified as having high levels of this particle.
How do you treat this particle?
As we eagerly await specific targeted therapies to address this particle, aggressive management of all the other risk factors such as Diabetes, High blood pressure, along with lowering the LDL (bad) cholesterol alongside lifestyle optimization including tobacco cessation, will help mitigate the overall risk associated with this particle. With several therapies in clinical trials, some very close to becoming available for prime-time use, it is indeed a very promising time for people with elevated levels of Lp(a).
To summarize, Lp(a) is a highly vicious cholesterol particle, largely genetically inherited, that carries a unique combination of harmful properties that have the potential to create a perfect storm for premature heart attack and stroke. If it is detected early however and aggressive management of other risk factors are instituted in a timely manner, there is great hope especially with the emerging cutting-edge medical therapeutics. We may not be able to stop the genetic transmission of this particle, but we can certainly conquer it with confidence!
Sudha Ravilla, MD, Diplomate-American Board of Clinical Lipidology, Fellow-NLA
FSU Health Lipidology
September is National Cholesterol Education Month
September 24 is FH Awareness Day.
Familial Hypercholesterolemia or FH for short , is a rather common genetic lipid disorder with a prevalence of about 1 in 250 people. FH is inherited by autosominal dominant genes and therefore has a strong tendency to afflict multiple family members. Unfortunately FH is vastly under-diagnosed with only about a third of people being aware that they carry the gene for this condition. The good news however is that it is rather easily diagnosed by a simple blood test and if needed genetic testing as well. What further aids the diagnosis is a strong family history of premature heart attack or stroke or peripheral circulation deficits in the family. Even greater news is that we now have excellent therapies for FH including multiple drug classes as well as injectables whose dosing frequencies range anywhere from twice a month to once a month to Bi-annual shots; furthermore, additional therapeutics are emerging on the horizon including gene therapy approaches — it is indeed an exciting era for FH patients who can now expect to have a normal lifespan and fight their genes effectively, thanks to the wonderful medical advances over the years.
The purpose of raising awareness regarding this rather common but serious genetic condition is so that providers and patients alike can contribute to timely diagnosis and treatment.
The genetics behind FH may not be reversible at this time, but the catastrophic consequences can be effectively overcome through timely diagnosis and management. FH awareness day therefore symbolizes not just “hope” but “certainty” provided by therapeutic options that can help not just fight the curse imposed by genes but conquer it effectively!
Written by,
Sudha Ravilla, MD, Diplomate-ABCL, FNLA
FSU Health Lipidology