Health Tip: Lipoprotein A - The Bad Cholesterol You Can Inherit

The New York Times recently featured a story on Bob Harper, a celebrity fitness trainer for the hit TV show, "The Biggest Loser." He is extremely fit and healthy, and yet had a massive heart attack at age 52. As it turns out, he has a fairly common genetic condition (it is estimated that 1 in 5 Americans have it) in which his body produces too much lipoprotein(a), a type of "bad cholesterol" that promotes blood clots and inflammation, affecting the heart.

It's rather surprising that 20% of Americans have a condition that predisposes for early heart attacks, and yet we don't regularly test for the condition. Why is that? The American Heart Association offers a few explanations: First of all, there is no affordable, widely-available medication available to treat high levels of lipoprotein(a). There are some very expensive monoclonal antibody drugs on the horizon, but they are still undergoing testing and are not widely available or covered by insurance. Niacin may be useful in treating high lipoprotein(a) but clinical trials have not shown a reduction in heart attacks even though it may lower blood levels of the bad cholesterol.

Secondly, lipoprotein(a)'s function in the body is not fully understood, and preliminary studies suggest that very low levels of it, as well as very high levels of it, may be bad for your health. And thirdly, since we don't have consensus about what levels are ideal, and doctors aren't sure what to do with a positive test result, there is understandable hesitation in testing for it. Nevertheless, one thing is certain: high levels of lipoprotein(a) are an independent risk factor for heart disease.

Since your total risk of heart disease increases with every independent risk factor that you have, it makes sense that current recommendations are to lower your overall risk, especially if you have high lipoprotein(a). This includes lifestyle interventions such as regular exercise, maintaining a healthy weight, eating a Mediterranean diet, limiting alcohol intake, reducing stress, quitting smoking, as well as medical options -  taking a cholesterol-lowering statin (such as Lipitor), low dose aspirin to reduce blood clotting, and keeping tight control of your blood pressure and diabetes (if you have them).

If anyone of your close relatives had a heart attack before the age of 55, you may be at higher risk for one as well. Take special care to reduce as many risk factors as you can control and ask your doctor if you may be a candidate for further testing or treatment. It's likely that lipoprotein(a) analysis will become more common in the future. Unfortunately, with unfavorable genetics, even the fittest among us can't reduce our risk of a heart attack to zero. Just ask Bob Harper.

References
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
http://www.lipoproteinafoundation.org/?page=UnderstandLpa
http://jaha.ahajournals.org/content/5/4/e003597
http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attack-Prevention_UCM_303934_Article.jsp#.Wl5_CainGHk

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