Lipoprotein(a) | Lp(a) test

[Seaton]

Had a Lp(a) blood test the other day. (You only need to get it tested once in your life.)
Got the results this morning. All looks good and in range. Good information to have.

Thanks to @Chuck C for the initial Lp(a) pointer.

Had been watching this also, while awaiting results. An interesting topic for those with cardiovascular disease.

 

[Chuck C]

Had a Lp(a) blood test the other day. (You only need to get it tested once in your life.).
Got the results this morning. All looks good and in range. Good information to have.

View attachment 890098
Thanks to @Chuck C for the initial Lp(a) pointer.

Had been watching this also, while awaiting results. An interesting topic for those with cardiovascular disease.

At 32.7 nmol/L your Lp(a) level is totally normal. Thanks for sharing this.

You only need to get it tested once in your life.

Yes, this is true for people who have normal levels of Lp(a). It remains almost completely unchanged during our lifetimes. The one exception is for people who are elevated and getting treatment. In such cases it is good to see how effective the treament is. I'm on PCSK9-I to treat my Lp(a) so I've taken a few additional measurements to compare against baseline. I'm also on a relatively high dose of EPA, found in fish oil. The high EPA gives a small lowering for some folks- lowered mine about 5%. However, I got about another 40% reduction when I went on PCSK9-I. This still leaves me at about double the reference range, however.

The real good news for those with high Lp(a) is that there are several powerful therapeutics in the pipeline, with approval expected in the next 5 years. There is one treatment which lowers Lp(a) about 80% that is far along in the Phase III trial, with FDA approval anticipated sometime in 2025.

 

[Seaton]

Seaton: "You only need to get it tested once in your life."

Yes, this is true for people who have normal levels of Lp(a). It remains almost completely unchanged during our lifetimes. The one exception is for people who are elevated and getting treatment. In such cases it is good to see how effective the treament is.

Ah, good to know that, Chuck. Thanks.
Excellent news on the pipelined therapeutics. A lowering of 80% is an amazing figure. Hope you'll be eligible for that and a radical lowering. Would be good news indeed.
Best to you.

 

[tommyboy14]

@Seaton

great news on the Lp(a). I think that this means your elevated aortic valve gradients are probably because you heart is really strong. That can cause the leaflets to wear out prematurely. I am sorry that your valve is wearing out prematurely, but I think it just means that your heart is in really good shape for your age group. I know you would rather not have another intervention, but that is probably be glass half full version.

I do hope that your valve continues to last for a bit longer though.

 

[pellicle]

Had a Lp(a) blood test the other day

So now we have a bit of a mystery as to why your valve didn't last ten years.

I have no better theory than that posited by nobog some time back about natural materials variability.

¯\_(ツ)_/¯

Good news about the result of the test though

Best wishes

 

[Erwitchin]

Well, now I am confused. I just got my LPa results (20.7) which is below the "normal" range, but then this states that 15-31 is borderline. https://www.ncbi.nlm.nih.gov/books/NBK570621/#:~:text=The desirable and optimal test,is >50 mg/dl.

 

[pellicle]

Well, now I am confused. I just got my LPa results (20.7) which is below the "normal" range, but then this states that 15-31 is borderline.

if the confusion is "what is borderline" I think that the issue is that for Lp(a) to have an effect on valve life it has to be much higher than your score.

However this is pretty new and we don't have good statistics on levels (to the best of my knowledge). @Chuck C is the one with these numbers on the tip of his tongue.

In the meantime some viewing






HTH

 

[newarrior]

Well, now I am confused. I just got my LPa results (20.7) which is below the "normal" range, but then this states that 15-31 is borderline. https://www.ncbi.nlm.nih.gov/books/NBK570621/#:~:text=The desirable and optimal test,is >50 mg/dl.

Wasn't worried about it you're overthinking of my number is 89 I'm in the highest risk imaginable you're going to be fine

 

[newarrior]

At 32.7 nmol/L your Lp(a) level is totally normal. Thanks for sharing this.


Yes, this is true for people who have normal levels of Lp(a). It remains almost completely unchanged during our lifetimes. The one exception is for people who are elevated and getting treatment. In such cases it is good to see how effective the treament is. I'm on PCSK9-I to treat my Lp(a) so I've taken a few additional measurements to compare against baseline. I'm also on a relatively high dose of EPA, found in fish oil. The high EPA gives a small lowering for some folks- lowered mine about 5%. However, I got about another 40% reduction when I went on PCSK9-I. This still leaves me at about double the reference range, however.

The real good news for those with high Lp(a) is that there are several powerful therapeutics in the pipeline, with approval expected in the next 5 years. There is one treatment which lowers Lp(a) about 80% that is far along in the Phase III trial, with FDA approval anticipated sometime in 2025.

Chuck. Interesting about EPA I never heard anything about that what about niacin 500 mg? I didn't know that 2025 was a potential Target date for release of therapeutic drugs. I'm currently sitting at 89. My calcification scores are in the thousands. I'm surprised I'm not dead. That's great you've got a 40% reduction with PC ks9 I just found somebody here in Thailand who will do that for me.

 

[Chuck C]

Well, now I am confused. I just got my LPa results (20.7) which is below the "normal" range, but then this states that 15-31 is borderline. https://www.ncbi.nlm.nih.gov/books/NBK570621/#:~:text=The desirable and optimal test,is >50 mg/dl.

Hi Erwitchin.

Thanks for your questions about Lp(a).

This is a classic example of why I always encourage people to give the units when discussing their Lp(a) levels, and this is likely why you might have some confussion about this.
Lp(a) is measured in either mg/dL or nmol/L. They vary by an approximate factor of 2.4x for most people, so units of measurement are important here.

The good news is that your level of 20.7 should not pose an elevated risk, whether or not that is a mg/dL value or nmol/L value.

In mg/dl elevated risk generally starts at about >30mg/dl. So, 20.7mg/dl would be well below this threshold and should not be of any concern to you, if in fact your measurement was in mg/dL.

In nmol/L elevated risk generally starts at 75nmol/L. If your 20.7 measurement was in nmol/L, you are very far below the threshold at which it would be of concern. So, either way, you are good.

but then this states that 15-31 is borderline.

I would not worry about that. The short online Lp(a) book that you linked was quirky in many respects. It is far from the best source on Lp(a) and actually contradicts itself in a couple of places. For example, in the introduction they state: "To date, no specific therapy exists for the treatment of elevated Lp(a)". A few paragraphs below this, they go on to list several specific treatment options for elevated Lp(a). It had me wondering if the book was in part AI generated.

If one has borderline LDL, there would be an indication to keep an eye on it and possibly to incorporate some lifestyle choices that could move you below the "borderline" level. However, with Lp(a), there is really nothing you can do to lower it, in terms of lifestyle, so no action is needed on your part. And, by the same token, if you had a 2 week vacation in which you indulged in cheeseburgers and pizza, it is not something that will push your Lp(a) above the "borderline" into increased risk.

So, once again, units matter when it comes to Lp(a) measurement,, But in your case, 20.7 is not of concern, regardless of which unit measurement your lab is using.

 

[Erwitchin]

Wasn't worried about it you're overthinking of my number is 89 I'm in the highest risk imaginable you're going to be fine

Thanks... I am just using it to factor into my valve choice.

 

[Erwitchin]

Hi Erwitchin.

Thanks for your questions about Lp(a).

This is a classic example of why I always encourage people to give the units when discussing their Lp(a) levels, and this is likely why you might have some confussion about this.

In mg/dl elevated risk generally starts at about >30mg/dl. So, 20.7mg/dl would be well below this threshold and should not be of any concern to you, if in fact your measurement was in mg/dL.

In nmol/L elevated risk generally starts at 75nmol/L. If your 20.7 measurement was in nmol/L, you are very far below the threshold at which it would be of concern. So, either way, you are good.


So, once again, units matter when it comes to Lp(a) measurement,, But in your case, 20.7 is not of concern, regardless of which unit measurement your lab is using.

 

[Erwitchin]

Hi Erwitchin.

Thanks for your questions about Lp(a).

This is a classic example of why I always encourage people to give the units .

Units are nmol/L. So reassuring. Thanks for the clarification.

 

[Seaton]

Another talk on cholesterol and Lipoprotein (a), for anyone interested...

Cholesterol: The Good, The Bad, and Lipoprotein (a)​

(Main lecture starts just over the 7 minute mark.)

 

[MdaPA]

what about niacin 500 mg?

How excess niacin may promote cardiovascular disease

 

[Gail in Ca]

Last week I saw my cardiologist and asked him about this Lp(a) testing and if I should have it done. His opinion was that the research isn’t there and so he didn’t order this for me. He’s a well respected, recommended cardiologist at Cedars-Sinai.

 

[Chuck C]

Last week I saw my cardiologist and asked him about this Lp(a) testing and if I should have it done. His opinion was that the research isn’t there and so he didn’t order this for me. He’s a well respected, recommended cardiologist at Cedars-Sinai.

The research is there. The American College of Cardiology, the European Society of Cardiology, and every national cardiology organization that I am aware of, recognize the increased risks for cardio vascular events and aortic stenosis posed by elevated Lp(a).

Is your cardiologist the type of individual who would be open to discussing this? I'd be happy to send him the medical literature on this.

Perhaps I am not understanding what he means when you say that "the research isn't there yet" ?

There is consensus in lipidology that Lp(a) is causal for heat disease and strongly associated, and likely causal, for aortic valve disease. Does he perhaps mean that the research isn't there in terms of treatment for high Lp(a)?

 

[Gail in Ca]

We were discussing a mitral valve replacement for me and I had said the surgeon suggested bovine but I wondered about a mechanical since I already have an aortic mechanical.
I’m not sure if I was specifically asking about how long bovine would last and related it to that test, or if I just asked whether I should just be tested.
He’s a young guy, so not old and stuck in his ways.

 

[Chuck C]

We were discussing a mitral valve replacement for me and I had said the surgeon suggested bovine but I wondered about a mechanical since I already have an aortic mechanical.
I’m not sure if I was specifically asking about how long bovine would last and related it to that test, or if I just asked whether I should just be tested.
He’s a young guy, so not old and stuck in his ways.

Understood.

There are dozens of medical papers published monthly in cardiology, and it is understandably hard for a physician to keep up with all of the literature.

He might not have read the paper published in February 2024 about this topic. If you feel so inclined, you might forward it to him and ask his thoughts.

Role of lipoprotein(a) concentrations in bioprostheticaortic valve degeneration

https://heart.bmj.com/content/heartjnl/110/4/299.full.pdf

 

[newarrior]

Last week I saw my cardiologist and asked him about this Lp(a) testing and if I should have it done. His opinion was that the research isn’t there and so he didn’t order this for me. He’s a well respected, recommended cardiologist at Cedars-Sinai.

Unfortunately I've learned not to trust even the best doctors. I've got studies as recently as this year that indicate elevated lipoprotein not only degrades tissue valves faster but also degrades your cardiac system in its entirety: the heart the valves and all the arteries.