Articles
Your Health Alert
Week 6
Tuesday, November 25th,, 2008
Daily Camera, Boulder, CO
Lp(a) THE HEART ATTACK CHOLESTEROL
Ever heard of Lp(a), or “L p little A”? Probably not, yet 22% of us have an elevated level of it which can mean a four times higher risk of heart attack or stroke. And, elevated Lp(a) combined with high cholesterol increases the risk 14 times! Needless to say, Lp(a) is extremely dangerous.
An elevated Lp(a) is caused by genetic factors, and diet and exercise will not do anything to lower it. It is passed down to the next generation fifty percent of the time. This is one of the abnormalities we see in otherwise seemingly healthy and athletic individuals. This is one of the main reasons that extremely healthy looking people have heart attacks and strokes. But it can be tested for, and it can be treated.
I have a patient who is a super endurance athlete and a vegetarian who thought he was perfectly healthy. Yet, at age 47, his arteries were so clogged that he needed four vessel bypass surgery. His regular cholesterol tests were fine when he took medication. But when we ran his Lp(a) test it was 280% above normal.
The Lp(a) level can only be determined by an in-depth blood test. It is not tested for in a regular, routine cholesterol panel. That is unfortunate. It must be specially ordered through the advanced lipid tests such as the VAP cholesterol panel, the Berkeley HeartLabs panel, or the LipoScience NMR panel.
And while we cannot change the genes that cause the Lp(a) problem, we can successfully treat it. A few almonds a day will lower it. 8 grams of fish oil a day will lower it an average of 25%. So will an aspirin a day. The best drug we have for lowering this dangerous cholesterol particle is prescription niacin. Over-the-counter niacin should not be used, more on that in another column. Prescription niacin can lower Lp(a) 30% to 40%.
Another drug type, the fenofibrates, can lower it 20%. Avoid the statin drug Lipitor because it can raise the Lp(a) concentration. When I see an elevated Lp(a), I also aggressively treat any other lipid abnormalities that are present, such as elevated LDL , high triglycerides, and low HDL (the good cholesterol). Of course, all other known risk factors, such as high blood pressure, diabetes, tobacco use and obesity must be recognized and dealt with as well.
Joe Turnbow, M.D.
Copyright 2008, Heart Attack Prevention Strategies P.C. All rights reserved.