Thank you for this Unicusp. It is super important that awareness of Lp(a) is spread. It is particularly important for those with valve disease, as elevated Lp(a) is associated with significanly increased risk of aortic stenosis, in addition to the significantly increased risk of coronary artery disease (CAD).
20% of the population has elevated Lp(a). Given the causal nature between elevated Lp(a) and aortic stenosis, this % is almost certainly going to be higher in our community and for some it is likely very high. Anecdotally, I have encouraged many people here to get tested and several have been found to not only have elevated Lp(a) levels, but very elevated levels. This makes sense, because it is usually not the ones who are slightly elevated who develop aortic stenosis but more common that their levels are very elevated.
Why is getting tested for Lp(a) important for everyone, but especially those with valve disease?
-Although there is currently no pharmaceutical approved specifically to lower lower Lp(a), there are steps that can be taken to mitigate the risks. Also, there are several therapeutics in the pipeline which target Lp(a). One very promising one is well into phase III trials with FDA approval expected this year.
-As noted above, Lp(a) is causal for heart disease and valve disease and it is important to know if yours is elevated.
-Lp(a) is almost completely genetic and is almost completely unaffected by diet and exercise. (unlike LDL). This means that if yours in elevated, your siblings and children will probably have elevated Lp(a). It runs in families. It will very often run in families which have a history of early onset heart disease and valve disease. My family is one such family with a history of early heart disease mortality. I was the first one in my family to be tested and found that I am in the top 5%- super high Lp(a). I had my family tested. My one sibling also is elevated at the same top 5% as me. One of my two biological children has very elevated Lp(a). My mother also has high Lp(a) and her side of the family is the one in which there is a history of people dying in their 40s and 50s of heart disease. Up until now it has been a mystery as to why this was happening.
-I suspect that my aortic stenosis may have been caused by my very elevated Lp(a). I was BAV, and this was thought to be the cause of my AS, but recent research has shown that in the vast majority of BAV patients the fusing of aortic cusps occurs after birth, not before birth, as was previously believed. This means that it is possible, perhaps likely, that for me and others with such high levels of Lp(a), that our high levels of Lp(a) caused aortic calcification, which led to fusing of the cusps, not the other way around. The research is still onging in this area.
-A study published last year found that elevated Lp(a) appears to cause faster development of SVD in those with bioprosthetic aortic valves. Some experts in the Lp(a) field have long suspected this ( my cardiologist for one) and there is now published data suggesting that this is, in fact, the case. This means that one's Lp(a) level should probably be taken into account when facing valve choice, especially for individuals who are in the gray area in which either valve choice is considered reasonable.
-The test is cheap and can be done when you get your annual doctor appointment, along with any other blood work. If you join the study linked by Unicusp, it may be free.
-It is now recommended that individuals be tested for Lp(a) at least once in their lifetime. See link below:
Consensus and guidelines on lipoprotein(a) – seeing the forest through the trees
"Multiple large epidemiological and genetic studies have provided strong evidence for a causal association between Lp(a) concentrations and atherosclerotic cardiovascular disease (ASCVD)
and aortic valve stenosis."
"Summary
Since the contribution of high Lp(a) concentrations to global ASCVD risk has been underestimated in the past, a clear recommendation to measure Lp(a) at least once in a person's lifetime is imperative. Recent expert consensus recommendations provide clinicians with direction on how to manage the excess risk associated with elevated Lp(a) concentration by comprehensive and individualized management of modifiable ASCVD risk factors while awaiting the results of clinical trials of Lp(a) targeted therapies."
https://journals.lww.com/co-lipidol...sus_and_guidelines_on_lipoprotein_a___.7.aspx
