Lipoprotein (a) | Recorded Live at the 2026 ACVS

Presented By: Harsh Patel, DO, FACC

Is Lp(a) the missing piece in cardiovascular risk? > Modern lipidology is changing fast. In this episode, recorded live at the 2026 Atlanta Cardiovascular Symposium, interventional cardiologist Dr. Patel breaks down one of the biggest shifts in heart health: the critical and evolving role of Lipoprotein(a).

Transcript

SPEAKER_01 0:03

Welcome to put your heart into it. A podcast centered on education providers and staff about common clinical scenarios so that we can better treat our patients. If you have any clinical symptoms or medical questions, please consult a licensed healthcare provider.

SPEAKER_00 0:30

So my name is Harsh Patel. I have the honor of being a cardiologist with HVC. And today I'll be talking about a topic that Dr. Kakar kind of touched on, lipoprotein A. So there's actually a very good tool in our tool belt and just an additional kind of data point that we can use to manage our patients and kind of risk stratify them and really try to reduce the, you know, their atheroskelotic uh risk. I have no uh financial disclosures. Um so what is uh what is lipoprotein A? Lipoprotein A is it's basically like an LDL-like particle. So it's kind of like LDL, not exactly the same. Um has a couple other components to it, apolipoprotein A and the apoliprotein B10, uh B100. It has a lipid core and then an outer uh shell. So one of my colleagues, uh Dr. Cherrian, really wanted me to get into like the nitty-gritty and the molecular structure, kind of go over the covalent bonds and all that. Um but I told him it was a kind of an overkill, so he's a little bit upset with me today. So uh you can find him outside. Uh he will go over it with you. So lipoprotein A, majority of it is inherited. It's about 70 to 90 percent of it's inherited. And your number, you have one number, it's set by the age by five years old. Um, so really it's something you brought with you, um, really unaffected by your lifestyle choices, diet, exercise, smoking, all those things. Um, so that is one of the things about it. And then uh prevalence about one in five people have an elevated uh LP little A. It's a very, very atherogenic, sticky particle. So that's really why it causes the risk that it does, um, heart attack, stroke, things like that. Um very uh pro-inflammatory, thrombotic, um, things like that. So really an independent risk factor for heart disease, including myocardial infarction, um stroke, uh, aridic valve stenosis, even um, really an independent risk factor. Dr. Ahmad, emergency? Where'd he go? That's an emergency. Dr. Maleka's on call. So LP little A, it's a uh it's a blood test. It's um something I actually check. Dr. Kakar mentioned as well. I check almost now in every patient. Uh the uh guidelines just came out, recommend at least a one-time uh check in all adults. Um the normal levels really less than 30 in the milligram setting and then less than 75 in the nanomole setting. Um if your levels are more than 50 milligrams or 125 nanomoles, uh your your risk level is much higher, much uh higher for atherosclerotic events. Um so it is something, it is a very, very uh good tool, as I said in our uh in our practice. So some myths and facts about it. Um if my LDL is good, I don't have to worry about my LP little A. Um, not true. LDL and hypoprotein A, as I said, are similar but not the same. You can have a normal LDL. As I said, the LP little A is an independent risk factor for um atherosclerotic disease as well as aortic stenosis. Um so even if you have a normal LDL, checking your LP little A, kind of you know, identifying your risk is a good idea. Um LP little A does not affect my heart health. It does. It it as I said, it's an independent risk factor for heart disease, stroke, uh, micro infarction, um, and such. If I don't have any symptoms, my LPA may be fine. Just like a couple other things that we check, not true, right? Asymptomatic things like blood pressure, your blood pressure could be high, you could be asymptomatic. So, really, um, every adult tested at least once in their lifetime, at least per the recent guidelines, um, which is a very good, very good idea. Um, if you're a family history of heart disease, family history of high LP little A, um, again, a good idea to get uh get it tested. LP little A not passed down in families, that's a myth. Um, we know that 70 to 90 percent of it is inherited. Um so and then it doesn't affect every everyone else the same, including me. Um, some factors, as I said, can uh you know change your levels, um, but um usually it is a kind of that set number that you get. Um, certain things that may affect it, um pregnancy, um, menopause, and uh thyroid disease, kidney disease are a couple other things that can uh affect it. So, what do we do about it? Um, lifestyle modifications. Uh, we went into this extensively in the earlier talks. Um, but eating a healthy diet, exercising, not smoking, and uh, you know, good sleep, weight management, all those things, managing your risk factors, diabetes, gold A1C, gold lipids, uh, hypertension, um, be healthy as this guy. That's actually Dr. Kim with somebody else's face on there. So 20 uh 2026 guidelines. Not really gonna harp on this too much. The handout is perfect. Um, Dr. Kakar's talk was great. Um, but universal screening, which uh I'm very, very happy about this. Um all adults at least one time uh in their lifetime should have their LP little A check, um, kind of uh stratify their risk, um, go over the LDL goals, um, less than 100, less than 70, less than 55, depending on your risk level, um, and risk reduction, all the things that we know what to do about it. Uh so therapy, um, basically, you know, the LDL goal, that's one of the main things. Uh apoliprotein B as well. Um, I also check that in a lot of my patients who have um at least intermediate to high risk of heart disease. Uh, statins are uh you know a therapy that we use for LDL gold. Um the the the verdict is still out. Uh does it really lower your LP little A levels? And some sources say it does, some sources state it doesn't. Um, but independent of lowering uh LP little A levels, we know it does lower your cardiovascular risk by um lowering the LDL and your apoleprotein B. Um niacin, niacin is known to reduce LP little A levels as much as 40%. It lowers your LDL a little bit, increases your HDL. However, really it doesn't implicate a lower risk of cardiovascular disease alone by lowering your LP little A level. Of course, it does by lowering your LDL. Um and then the big thing with it that there are some uh interactions with statins. Um, PCSK9 inhibitors, ripathine pralumin, um 20 to 30 percent reduction in your LP little A, and it implicates a lower cardiovascular risk. Um, so that's uh very very good therapy we have. Um aphoresis, kind of not very commonly done, but it definitely lowers your LP litolate levels uh 50 to 85 percent and lowers your LDL levels as well, 60 to 80 percent, um, especially in patients with functional familial hyperlipidemia. It's a very good tool. Um, and then if you have coronary artery disease, LE LDL more than 100, and your LP litullah is more than 60 milligrams per deciliter, that may be a consideration. And then the last um kind of medications that are on the market, um, 20% reduction by uh lecVio uh enclyceran. Um so just a little slide showing all the different kinds of therapies and kind of the reduction in the LP litola levels. And does it reduce your cardiovascular risk or does it not? Um there are certain therapies in uh trials currently that you know they're working on lowering LP lily levels. Um, so we're I'm kind of really looking forward to that. It's kind of a um topic that hits close to home. My LP LA, I made the mistake of checking is high. Um, so I really like my ice cream, so that may be a problem. Um, but I'm definitely tuned in to these um trials and kind of seeing how these medications come out, these therapies, and see how they reduce your LP LA levels. Uh the big question will be even by lowering your levels, does it really uh does it implicate a lower risk of cardiovascular disease? So very I'm gonna stay tuned in for that. And then in summary, um, pretty quick, um summary the LPLA is uh genetically determined. It's kind of something you brought with you. Um really no um very little uh effect on it by lifestyle choices, uh diet, exercise, smoking, you know, those kind of things. Um it's an independent risk factor for um disease, microbial infarction, stroke, and uh aertic valve stenosis. Um different medications have different lowering effects, kind of um, and then as it uh stands out in um reducing your cardiovascular risk. Um experiment experimental therapies are in progress, so we'll be staying in tune for that. Um, and then we'll by the new guideline recommendations, all adults should have it checked at least once in their lifetime. And then your LP Little A level, more than 125 nanomoles or more than 50 milligrams, um, that uh tells you a much higher risk. Um, for patients um that have a high LP Little A, I do give them this website, kind of they can go and learn about it and uh kind of show their relatives because it is something that should be tested. If you have a high LPA, your family should be tested as well.

unknown 9:39

Perfect. Any questions?

SPEAKER_01 9:42

Is there anything research-wise about aspirin therapy for LP little A?

SPEAKER_00 9:47

I think not necessarily as it pertains directly to LP little A, um, but overall your risk reduction kind of, you know, your um moderate to high risk patients that you have, they should be on aspirin. Um that can help in other ways reduce your cardiovascular risk, but not as it directly impacts LP little A, from what I know. All right. Thank you guys.

SPEAKER_01 10:12

Thanks for listening. Tune in next time for another cardiology-focused episode.