But can you name a patient who has had their Lipoprotein (a) measured and is being managed for this by their GP?
So while the controversy and contention surrounding the “curse” cholesterol places on our cardiovascular health continues to rage, general practice guidelines are full of green lights for statin prescriptions but what if I told you that there’s another lipoprotein that is more atherogenic, more directly implicated in arterial disease & whose levels are more powerfully predictive of atherosclerotic disease and valvular aortic stenosis…than any other biomarker we have? Well, I just did. And so did all these global authorities!!!
But you and your statin-saturated patients are unlikely to hear about this lipoprotein because there’s ‘no drug for that’, right? In fact, up until recently we’ve all been told there’s nothing you can do to lower an elevated level and accordingly reduce the associated risk…guess what…new research says we can! Yes, it’s finally time to switch off the snooze function on this one and tune into what could be the most important test your patient takes.
”If there’s no pill there’s no ill”, is a cynical saying about how the availability of pharmaceutical-fixes determines the practice of mainstream medicine. In the case of Lipoprotein (a), reported to exhibit the strongest independent correlation with both atherosclerosis and valvular aortic stenosis causation, in the face of its complete omission in general practice guidelines, this would seem particularly apt. Instead, the fixation in prevention and management of cardiovascular disease has almost exclusively been on things we have drugs for: like cholesterol. But at long last national and international heart health authorities are conceding this is a biomarker that offers insight &, especially given its independence from all traditional risk factors (hyperlipidaemia, diabetes, smoking etc), helps to identify and avert the CVD “no one saw coming”!
You can purchase A New Era in Cardiovascular Risk: Lp(a) here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Cracking the Case: Uncovering Cardiovascular Risk – Elevated Lipoprotein (a)
How do you conduct a comprehensive cardiovascular risk assessment? It should always include a Lipoprotein (a) result, having been declared the biomarker with the strongest indication of causality in both atherosclerosis & valvular aortic stenosis. But what use is getting this tested, if, when we identify increased risk due to elevated results, we have no means to lower it? Until now. This is a 57 year old female with a striking personal and family medical history, a peachy coronary calcium score, mildly elevated LDL-C but significantly elevated Lp(a). We describe in detail the meaningfulness of this, as one element in our understanding of her overall inter-connected health story and reveal the prescription and approach that got results. We also discuss the challenge that is inherent in both ‘uncovering risk’ in someone while remaining on the right side of hope vs despair and of the nature of CVD risk reduction which requires lifelong management.
You can purchase this Cracking the Case episode: Uncovering Cardiovascular Risk: Elevated Lipoprotein (a) here.