April 25, 2024 – A typical cholesterol screening may soon require one other blood test that has been done for many years but is never used, as growing evidence shows the extra evaluation can reveal otherwise unknown risks of dangerous heart problems as a result of plaque buildup within the arteries.
The test looks for a particle called lipoprotein(a) and is offered for lower than $100. An estimated one in five people have dangerously high levels of the protein, also known as Lp(a), normally as a result of genetic predisposition.
“It is not uncommon for someone to have elevated Lp(a) levels despite normal total cholesterol or LDL cholesterol levels,” said Nathan D. Wong, PhD, lead creator of a new study on Lp(a) in Journal of the American College of Cardiology.
The latest study by Wong and colleagues is the biggest and most ethnically diverse study of Lp(a) within the United States to this point and located that folks with very high levels can have as much as twice the chance of significant heart problems. This month also marked the primary time knowledgeable medical group within the United States has called for each adult to have their Lp(a) levels checked at the very least once of their lifetime.
“So far, Lp(a) has been discussed mainly among specialists, but it has hardly penetrated to laypeople and primary care physicians. But that is likely to change,” says Gregory G. Schwartz, MD, PhD, chief of the cardiology division on the Rocky Mountain Regional VA Medical Center and professor of drugs on the University of Colorado in Aurora, CO.
Schwartz said it's his occupation's responsibility to teach the broader health community and the general public about Lp(a).
“I don't think we're quite there yet, but we're getting closer and learning more about this particle that was discovered and first identified in 1963,” he said.
Potentially groundbreaking treatments for prime Lp(a) levels may very well be available in a yr or two. In the meantime, experts are urging their colleagues to assist patients work out in the event that they need to deal with an increased risk. Because high levels are likely to run in families, it's vital that those affected raise awareness amongst their children and relatives who may additionally be in danger.
The evidence is so compelling that patients don't should wait for his or her doctor to suggest the test, said P. Barton Duell, MD, a professor of drugs and Lp(a) expert at Oregon Health & Science University.
“They should insist on having their Lp(a) levels measured,” said Duell, who sits on the board of the National Lipid Association, which this month recommended that everybody gets tested.
Without testing, Lp(a) is a hidden threat
This latest Lp(a) study by Wong and colleagues examined the connection between Lp(a) levels and the likelihood of a serious cardiac event in 27,000 individuals who had not previously been diagnosed with what doctors call atherosclerotic cardiovascular diseasesor ASCVD. Types of ASCVD range from heart attack and stroke to chest pain and include probably the most common and deadly forms of heart disease within the United States and worldwide.
Conditions equivalent to heart attack and stroke normally result from the buildup of plaque within the arteries, which is thought to be linked to high levels of LDL cholesterol, also generally known as “bad” cholesterol. Other aspects that may contribute include hypertension, tobacco smoking and diabetes. Lp(a) is one other cholesterol-containing particle within the blood that is usually a hidden risk factor since it shouldn't be often included in standard laboratory tests.
A Study earlier this year A study conducted by European researchers found that Lp(a) is as much as six times more atherogenic than LDL cholesterol, meaning it might probably be a really effective consider plaque formation within the arteries.
Other studies have shown that some persons are more prone to have elevated Lp(a) levels, equivalent to blacks, whose levels might be 30% higher on average than whites, while people of East Asian descent often have lower levels than whites, Schwartz said. Menopausal women also are likely to have elevated levels.
But despite many years of research into lipoprotein(a), there was a lack of understanding about whether elevated levels affect cardiovascular risk – that's, the chance to the guts and blood vessels – in a different way in people of various genders or different ethnic groups. The people in Wong's study were 55% women and 36% black. This suggests that the chance of developing ASCVD is analogous in all individuals with elevated Lp(a) levels.
“I think this study by Wong, which summarizes several previous studies that included data on lipoprotein(a) and cardiovascular events, shows that – as I titled my editorial – this may be largely an equal risk factor if your lipoprotein(a) level is high. That's important,” said Schwartz, the creator of a comment published along with Wong's study in JACC.
Overall, the study showed that folks with extremely high Lp(a) levels (within the ninetieth percentile) over a period of about 20 years were 46% more prone to develop ASCVD than individuals with average Lp(a) levels.
The people within the study who had type 2 diabetes and intensely high Lp(a) levels were at the best risk for ASCVD. They were almost twice as prone to have ASCVD problems as individuals with moderate levels.
“This underscores again the importance of people treating patients with diabetes incorporating this into their assessments in addition to the standard lipid profile,” Wong said.
An indication to scale back other risk aspects
Duell, a specialist in preventive cardiology and lipid metabolism, said it shouldn't be unusual for him to see patients with an extended list of heart problems who've never had an Lp(a) test done.
“I see patients who come in and have had two heart attacks, maybe even stents or bypass surgery, and nobody understands what's going on. We measure Lp(a) and it's super high,” Duell said, mentioning that a standard level is as much as 30 mg/dL.
“For example, I have a patient whose level is 450 mg/dL. That's astronomically high,” Duell continued. “That's a very compelling explanation for why this patient has such severe heart disease and had to undergo bypass surgery.”
The patient was in his late 50s, and Duell suggested that the person's children even have their levels of cholesterol tested, since elevated levels often run in families. Half of his children also had elevated levels, and Duell really helpful that they take medication and work on lowering their LDL levels of cholesterol to scale back their overall risk.
“These patients are also very motivated to do other things” after witnessing their father suffer from life-threatening heart problems, Duell said.
Major medical associations in Canada and Europe now recommend universal Lp(a) testing, nevertheless it stays extremely rare within the United States. treasure Using data from the University of California Health System, it found that only 0.3% of all adults screened from 2012 to 2021 had an Lp(a) test. Among individuals who had a lipid profile (which looks at cholesterol and triglycerides), lower than 2% were tested, and between 2% and 6% of individuals with heart problems had their Lp(a) levels checked.
Along with its suggestion for universal testing of adults within the United States, the National Lipid Association publishes a paper in its Journal of Clinical Lipidology with detailed explanations of how doctors can evaluate test results and consider treatments.
A challenge in studying the results of Lp(a) on ASCVD risk is that, despite knowing in regards to the Lp(a) gene for the reason that Sixties, scientists haven't yet been capable of determine whether lowering Lp(a) levels also reduces the chance of cardiovascular problems.
The Lp(a) level stays relatively constant throughout life, which is why it is suggested to perform the test just once in a lifetime.
“The values don't fluctuate that much,” Schwartz said. “When the value is indisputably high, it's high, and when the value is indisputably low, it's low, and that's not going to change.”
Experts say that in the event you know that somebody has elevated Lp(a), you may goal your overall cardiovascular risk, for instance by lowering LDL cholesterol and possibly taking medications to treat other related problems.
“If you have high LDL and Lp(a) levels, it’s worse than if you have just one of them,” Duell explained.
One complex factor is that statins can barely increase Lp(a) levels. But statins have been shown to supply the advantage of reducing overall cardiovascular risk by lowering LDL levels of cholesterol, Schwartz said.
Duell said options shown to lower Lp(a) levels include aspirin and, in older women, postmenopausal estrogen substitute therapy.
Various treatments which have already been shown to dramatically reduce Lp(a) are in development. A drug called Pelacarsen is currently in the ultimate phase of a study to seek out out whether individuals with high Lp(a) levels have a lower risk of heart problems over a 4-year period. Results are expected in mid-2025.
“The unanswered question is whether lowering Lp(a) levels with these drugs reduces cardiovascular risk as much as genetically elevated Lp(a) levels increase risk, and whether the benefits come with safety concerns. So stay tuned,” Schwartz said.