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Lipoprotein A and Hidden Heart Disease (Updated Research)

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You may have heard about cholesterol but what about lipoproteins? They are more tied to genes than lifestyle and can completely change how much cholesterol is safe.

Lipoproteins carry fat in the blood and are made up of triglycerides and cholesterol, and if you do not have your lipoproteins in order, you may be putting yourself at risk of heart disease. Let’s look into what you can do about it today.

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Hyperlipidemia: Defined

First, we need to cover what we call hyperlipidemia. This is an accumulation of lipids also known as fats in the blood, such as cholesterol and triglycerides. Cholesterol is a waxy material that is a part of cell membranes.

There are different types of cholesterol, such as:

  • HDL (known as the “good”)
  • LDL (known as the “bad”)
  • Lipoproteins

Bottom Line: Lipoprotein, otherwise known as Lp (a), is of major concern to your body, as elevations in it can increase your risk of developing cardiovascular disease (CVD).

Understanding Lipoprotein A

The truth is that cholesterol is both endogenously made in the liver and exogenously obtained via diet. It plays an extremely important role in hormone production as it is the precursor to estrogen, testosterone, DHEA, and progesterone.

Key Insight: How does cholesterol get around? It travels in the blood, by way of lipoproteins.

Lp(a) is a type of LDL particle and is a sphere-shaped protein that has been shown to increase the risk for CVD, such as heart attacks and stroke.

The Lp(a) structure appears to be sphere shaped with a “corkscrew” tail. The tail is long and contains sections on it known as “repeat kringle areas”.

Key Insight: These areas on the tail have been hypothesized to be the reason why Lp(a) can increase the risk of heart attacks due to its involvement with the immune system.

More research is underway to get better understandings of this Lipoprotein and ways to treat it effectively. At this point in time, not much treatment is clinically proven to lower Lp(a); some options include:

  • Medications
  • Supplements (such as Niacin and apheresis) procedures

Does This Apply To You?

How do you know if you should be checking your lipoprotein a levels? If you have a family history of heart disease, then checking for Lp(a) is recommended (1).

There are also those who might be most especially affected by this, and these include:

  • Diabetics
  • People with high blood pressure
  • Smokers
  • Family history of heart disease
  • African Americans
  • Pre- and Post-menopausal women
  • Men

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Bottom line: You should also consider asking your doctor to run the test for Lp(a) as it is not generally part of a routine lipid panel.

Why Is Your Lipoprotein A Important?

If you happen to have a family history of heart disease, then it is important to know if you have a positive Lp (a) as this marker is genetically influenced.

Key Insight: Even if a person is generally physically active, eats a healthy diet, they can still be at risk for heart disease if Lp (a) is elevated.

The most startling part about hyperlipidemia is that it is asymptomatic, which means that it does not reveal itself in any noticeable symptoms. What it does, though, is:

  • Lp(a) causes plaque to form (atherogenic)
  • Lp(a) causes inflammation
  • Lp(a) causes clot formation (thrombogenic)

Case Study: Roy

Roy is a 65-year-old male with a medical history of asthma, hypertension, obesity and COPD. He had been on multiple medications for the above conditions, including:

  • Prednisone
  • Steroid inhalers
  • Nebulizer treatments
  • Multiple supplements

He returned to the clinic in January 2018 to follow up on his symptoms of shortness of breath and inability to exercise. He had been struggling for years with this condition.

I inquired about his cardiac health and past work up which included chest CT calcium score done in the past, which was unremarkable. He had mildly elevated lipids and blood pressure.

I recommended that he repeat CT calcium score imaging and get Lp(a) completed with his next set of lab work. When he returned for his follow up appointment, his CT calcium score showed a total score of 504, which put the patient in the 77% percentile of asymptomatic males between 60-64.

He had extensive plaque and a high likelihood of at least one coronary artery narrowing. His lab work revealed that Lp(a) was 365 (the normal amount is < 74 nmol/L).

Urgently, he was referred to a cardiologist and the patient ended up having an angiogram (a procedure that uses x-rays to photograph blood vessels) and this showed he had 99% blockage in his right coronary artery.

As a result, Roy ended up needing a cardiac stent. Post-procedure, he was discharged with two blood thinner prescriptions and a statin prescription.

At our next follow up in June 2018, he had discontinued one blood thinner and statin medication due to side effects. His blood work showed that Lp(a) had lowered to 265 and his LDL cholesterol was improved from 143 to 121.

Roy noted that he was able to walk briskly for 1.5 miles every day and that he did not need his inhalers as his asthma had improved and his oxygen count had finally increased from 92 to 98. He also reported that he had been tracking his blood pressure and it was normal.

Our treatment plan was to keep up with daily exercise, work with a nutritionist to help with weight loss and supplements to help him decrease lipids since he was unable to tolerate the statin. We will follow up with him in 90 days to check in on his progress.

Bottom Line: The above is a typical scenario of what happens in medicine, however, since we now are aware of Lp(a), we should be using it as a screening marker in those especially with family history of heart disease.

What Can You Do?

This is what successful patients do differently to secure their health:

  1. They get tested
  2. They enjoy a healthy lifestyle

A highly lifestyle typically involves a low-glycemic Mediterranean diet, as well as regular physical activity, in order to keep their health in tip-top shape.

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What Are “Normal” Cholesterol Levels?

Here’s the breakdown of what we might consider normal in cholesterol levels1:

  • A total cholesterol level of less than 200 mg/dL (5.17 mmol/L) is normal.
  • A total cholesterol level of 200 to 239 mg/dL (5.17 to 6.18 mmol/L) is borderline high.
  • A total cholesterol level greater than or equal to 240 mg/dL (6.21 mmol/L) is high.

Key Insight: The total cholesterol level can be measured at any time of day. It is not necessary to fast (avoid eating for 12 hours) before testing.

How Can You Lower Your Lipoprotein A?

There really is not one thing that can directly lower Lp(a) but needs to work on other factors that can decrease it, such as:

  • Keep your LDL level below 70
  • Keep your blood pressure under control
  • Control your triglycerides
  • Maintain a healthy diet
  • Enjoy more resistant starch (2)

A recent study, from 2017, showed that consuming a plant-based diet reduced Lp(a) by 15% in 4 weeks. This suggests a possibility of a plant-based diet on gene alterations which influence Lp(a)2.

What About Medications?

There are two types of medications that we need to consider in these conversations, including:

  1. Statins – These are used more to clear LDL than Lp (a), and there is overall inconsistent data on their effectiveness.
  2. PCSK9 – Repatha (20 – 30%)

How About Supplements?

The one thing you might want to consider is niacin. It helps by increasing HDL, and lowering Lp (a), and has been studied in two large tests, known as:

  1. AIM HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcome)
  2. HPS2-THRIVE Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events

Niacin does come with side effects, though, including:

  • Flushing
  • Increased occurrence of diabetes complications
  • Serious infections
  • Serious bleeding
  • Gastrointestinal complications
  • Myopathy

Bottom Line: Due to these concerns, Niacin has been taken off the market in Europe (but is still available in the United States).

Here are some additional supplements to consider:

  • NAC (N-Acetyl Cysteine) – Controversial findings
  • L-Carnitine – A 10 – 20% reduction in Lp (a)
  • Lp (a) Apheresis (50 – 80% reduction) – It is effective but costly and invasive.

How Can Cholesterol Affect Your Thyroid?

If you have hypothyroidism, a condition where your thyroid does not produce enough thyroid hormones, it could be causing your lipids to increase.

How so? Thyroid hormones are involved in lipid metabolism by helping your body get rid of LDL cholesterol. According to a study from 2012, high TSH levels alone can influence cholesterol levels3.

The opposite is also true, a low TSH causing hyperthyroidism can drop cholesterol levels.

Bottom Line: It is important to work with your doctor to establish optimal levels of hormones and lipid levels so that you can ensure overall hormone and metabolic health.

Start Testing Today

Please add lipoprotein a to your next blood tests. Your doctor at Integrative Health will be happy to make sense of your findings and create a personal road back to good heart health in time.

1. https://www.uptodate.com/contents/high-cholesterol-and-lipids-hyperlipidemia-beyond-the-basics?topicRef=3433&source=see_link
2. Clin Res Cardiol Suppl. 2015; 10(Suppl 1) Published online 2015 Mar 3
3. https://www.ncbi.nlm.nih.gov/pubmed/22730515

dr-k

Written by Dr. Linda Khoshaba of Integrative Health. Dr. Linda Khoshaba has been practicing as an Associate Physician at Integrative health for 5 years. She specializes in treating Hashimoto’s and Graves thyroid disease, Adrenal Dysfunction and Hormone imbalance in both men and women.

Learn more about Dr. Khoshaba here.

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