Instant Insights: Lipoprotein(a) 

Utilizing Lipoprotein(a) in Cardiovascular Risk Assessment (PODCAST TRANSCRIPT)

[00:00:00] Welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from Insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine, and wellness medicine.

[00:00:18] Hello everyone. Thank you for joining.

[00:00:20] The goal of today's episode is to give you instant insights into the utilization of lipoprotein a for cardiovascular risk assessment. I'm Dr. Maeson Latsko. Researcher by training with a passion for learning. And I'm a clinical specialist with quests cardio-metabolic center of excellence. Cleveland heart lab. So let's dive in.

[00:00:41] access lipoprotein a or Lp(a) as in lowercase, a represents a lifelong causal factor

[00:00:48] for cardiovascular disease related events like coronary artery stenosis, ischemic stroke, myocardial infarction, and cardiovascular mortality.So what is Lp(a)?

[00:01:01] Lp(a) is an LDL like particle that carries cholesterol throughout the body,

[00:01:06] but it has an additional protein called AICPA lipoprotein a or a Bo a.attached to the AOP subunit. On the Lp(a) particle. and the length of the apo-a protein is genetically determined and it varies from person to person. So the apo-a protein can be long in one individual in short and another.

[00:01:26] And the length of the apo-a protein influences the amount or concentration of Lp(a) produced by the liver and measured in the blood. And this way, Lp(a) levels are approximately 90% genetically determined.

[00:01:41] Lp(a) can contribute to poor cardiovascular outcomes in a number of ways.

[00:01:45] It is pro atherogenic promoting fatty plaques in arteries. It's prothrombotic increasing the likelihood of venous thrombosis. And pro-inflammatory recruiting immune cells that promote inflammation.

[00:01:58] In addition to Lp(a) being highly atherogenic, it is also highly prevalent among the population. One in five people Have high Lp(a) that's more than 1 billion people globally. the national lipid association now recommends that Lp(a) be checked in every adult, at least once for cardiovascular risk assessment.

[00:02:18] Before diving into the risk categories associated with Lp(a) levels. It's important to note that Lp(a) can be quantified into ways using mass units in milligrams, per deciliter, which can measure the weight of the Lp(a) particle or using particle count in animals per liter, which can measure the amount or quantity of Lp(a) particles. both methods are acceptable Ways of measuring Lp(a). mass is dependent on the size of that apo-a protein that can vary from person to person. Therefore particle count

[00:02:52] Is the preferred method for measuring Lp(a) and converting between units is not recommended. As the cardio-metabolic center of excellence, Cleveland heart lab, and quest diagnostics using animals per liter As the method for measuring Lp(a) levels.

[00:03:08] Okay, now that we discussed the method for measuring Lp(a), let's dive into the risks. Cut points.

[00:03:15] Note that the risk between ASC DVD and Lp(a) is continuous with increased risks, correlating with Lp(a)

[00:03:24] Individuals with low risk attributable to Lp(a)  had levels below

[00:03:29] 75 nanomoles per liter or 30 milligrams per deciliter. Individuals with high risk attributable to Lp(a) have levels greater than 125 nanomoles per liter or 50 milligrams per deciliter. Whereas individuals with levels between these cut points are considered at intermediate risk. Although Lp(a) is mostly genetically determined.

[00:03:51] There are certain conditions that can influence Lp(a) levels, including menopause, CKD, and protein, urea and hypothyroidism. Thus the focused update to the 2019 NLA scientific statement, which was released in 2024. Recommends repeat testing of Lp(a) levels in individuals with these conditions that fall into the intermediate risk category. Keep in mind that although Lp(a) is an independent risk marker for cardiovascular disease, other chronic conditions such as type two diabetes can exacerbate risks for ASCVD.

[00:04:25] The strong genetic component of Lp(a) calls into question, the treatment landscape, which is continuing to evolve..

[00:04:33] First and foremost, ensuring healthy lifestyle should be recommended for all patients in a global risk reduction strategy. To lower overall risk for CVD can also be implemented at the discretion of a provider using a Staton or other pharmaceutical therapy. Excitingly novel therapeutic options are on the horizon that will directly target and lower Lp(a) levels.

That concludes your instant insight on Lp(a). At quest diagnostics, we aim to increase awareness and education in order to identify patients at risk for cardio-metabolic conditions and act to treat root causes, to prevent the development and progression of cardio-metabolic disease and improve patient outcomes.

[00:05:18] That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app, and be sure to check out Quest Diagnostics Clinical Education Center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.