Utilizing Lipoprotein(a) in Cardiovascular Risk Assessment

QUEST WEBINAR:

Utilizing Lipoprotein(a) in Cardiovascular Risk Assessment - Transcript

Presenter: Maeson Latsko

[00:00:00] Hello. Today we will be discussing the utilization of lipoprotein A in cardiovascular risk assessment. I'm Dr. Maeson Latsko, clinical specialist with Quest's Cardiometabolic Center of Excellence at Cleveland Heart Lab.

[00:00:14] Excess lipoprotein A, or Lp(a), represents a lifelong causal factor for cardiovascular disease related events like coronary artery stenosis, ischemic stroke, myocardial infarction, and cardiovascular mortality.

[00:00:29] Lp(a) can contribute to poor cardiovascular outcomes in a number of ways.

[00:00:34] It is pro athergenic, promoting fatty plaques in arteries, pro thrombotic, increasing the likelihood of venous thrombosis, And pro-inflammatory recruiting immune cells that promote inflammation.

[00:00:46] Lp(a) is an LDL like particle with the addition of a protein called apolipoprotein a or apo-a attached to the APO B subunit. The length of apo-a is genetically determined based on the number of cringle repeats or the number of re clusters shown here that can vary from person to person and influence the amount of Lp(a) produced in the liver and measured in the blood.

[00:01:11] In this way, Lp(a) is approximately 90 percent genetically determined.

[00:01:17] 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.

[00:01:37] Lp(a) can be quantified in two ways, using mass units in milligrams per deciliter, which can measure the weight of Lp(a) particles, or using particle count, or nanomoles per liter, which can measure the amount or quantity of Lp(a) particles. Both methods are acceptable ways of measuring Lp(a).

[00:01:58] Mass is dependent on the size of the apo-a protein that is attached to the Lp(a), which can vary drastically from person to person. Therefore, particle count isthe preferred method of measurement for Lp(a). And converting between units is not recommended.

[00:02:14] Lp(a) a assessment can fall into three categories. individuals with low risk attributable to LP A, have levels below 75 MLEs per liter or 30 milligrams per deciliter.

[00:02:26] Individuals with high risk attributable to Lp(a) have levels greater than 125 nanomoles per liter or 50 milligrams per deciliter. individuals with levels between these cut points are considered at intermediate risk. Although Lp(a) is mostly genetically determined, there are certain conditions levels.

[00:02:48] These conditions include menopause, CKD and proteinuria, and hypothyroidism. Thus, the focused update to the 2019 NLA scientific statement recommends repeat testing of Lp(a) and individuals with these conditions that fall into the intermediate risk category.

[00:03:06] Importantly, the risk between ASCVD and Lp(a) is continuous with increased risk correlating with higher Lp(a). Also, while there is significant difference between races and Lp(a) with black individuals having significantly higher Lp(a), the ASCVD risk attributable to Lp(a) was similar among ethnicities.

[00:03:27] Finally, although Lp(a) is an independent risk marker for cardiovascular disease, other chronic conditions such as type two diabetes can exacerbate risk for ASCVD. The treatment landscape for Lp(a) is continuing to evolve. First and foremost, ensuring healthy lifestyle should be recommended for all patients and a global risk reduction strategy to lower overall risk for cardiovascular disease can be implemented at the discretion of a provider using a statin or other pharmaceutical therapy.

[00:03:58] Excitingly, novel therapeutic options are on the horizon that will directly target and decrease Lp(a). At Quest Diagnostics, we aim to increase awareness and education in order to identify patients at risk for cardiometabolic conditions and act to treat root causes to prevent the development and progression of cardiometabolic disease to improve patient outcomes.

[00:04:21] the following order information can be used to order Lp(a) through Quest Diagnostics Center of Excellence at Cleveland Heart Lab.

[00:04:30] Thank you.