Everything you need to know about Lp(a) | ft. Dr. Tom Dayspring | Summary and Q&A

TL;DR

Learn about lp(a), a subtype of LDL cholesterol, its impact on cardiovascular health, and strategies for managing high levels.

Key Insights

• 🔐 LP(a) is an important topic in clinical lipidology, and expert Dr. Tom Dayspring provided valuable insights in a conversation spanning four hours over zoom.
• 🩺 LP(a) is a subtype of LDL and carries its own special tag called apoprotein(a), making it more atherogenic than regular LDL particles due to its contribution to atherosclerosis.
• 🌡️ Elevated levels of LP(a) can increase the risk of atherosclerotic and atherothrombotic events, making it the most prevalent genetic lipoprotein abnormality associated with atherosclerosis.
• 💉 Lp(a) concentrations should be measured in nanomoles per liter particle numbers for accurate assessment, and levels above 50 nanomoles per liter are concerning.
• 🔬 Oxidized phospholipids on apoB may determine the harmfulness of LP(a) particles, but further research is needed for conclusive statements.
• 💊 Pharmacological approaches like statins do not lower LP(a), while PCSK9 inhibitors can lower its concentration by 20-25% but are not currently covered by insurance for LP(a) management.
• 🍽️ While saturated fat intake may lower LP(a) by 10-20%, the overall effect on risk may be negated by its impact on ApoB levels, and no specific dietary recommendations for LP(a) management exist.
• 💡Measure LP(a) levels once in your lifetime, manage other major risk factors, and stay informed about ongoing drug trials and developments for LP(a) management.

Transcript

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Questions & Answers

Q: What is lp(a) and why is it important to understand its impact on cardiovascular health?

LP(a) is a subtype of LDL cholesterol that carries apoprotein(a), making it more atherogenic than regular LDL particles. Understanding its impact is crucial as high levels of lp(a) increase the risk of atherosclerosis and cardiovascular events.

Q: How can individuals manage high lp(a) levels?

Managing other major risk factors, such as ApoB, blood pressure, and diabetes, is essential for individuals with high lp(a) levels. Additionally, considering pharmacological approaches like PCSK9 inhibitors can help lower lp(a) levels, but these may not be widely accessible yet.

Q: Are there any dietary recommendations for managing lp(a)?

While there is no demonstrated diet specifically for lp(a) management, a healthy diet can help manage other major risk factors like ApoB and blood pressure. Saturated fat intake may have a modest impact on lp(a) levels, but trans fat intake should be minimized as it has been associated with an increase in lp(a).

Q: What are the potential solutions for lowering lp(a) in the future?

Currently, PCSK9 inhibitors are being explored as a potential treatment for lowering lp(a), but their availability is limited. Ongoing clinical trials are studying drugs that directly target lp(a) synthesis, which may provide more effective options in the future. However, it may still take several years for these drugs to be approved and accessible to the general population.

Summary & Key Takeaways

• LP(a) is an LDL particle that carries a second protein called apoprotein(a), making it a particularly atherogenic subtype of LDL.

• High levels of lp(a) increase the risk of atherosclerosis and cardiovascular events, such as heart attacks and strokes.

• Currently, there are limited treatment options for lowering lp(a), but managing other major risk factors, such as ApoB, blood pressure, and diabetes, can help mitigate the risk.