Lipoprotein(a) | Lp(a) test

[newarrior]

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

I read this as well this study just came out in 2024 it's making me increasingly nervous about getting a tissue valve because I've got triple the Baseline level for somebody with problematic lipoprotein. I'm a traditional tricuspid valve guy yet my valve started becoming highly degraded as soon as my 40s if not earlier. It has to be from lipoprotein. PC ks9-1 the truck has been talking about which is a Statin used for all labor treatment of lipoprotein is the only known treatment at this point. There's antisense drugs put in development that may be released as soon as next year.

 

[newarrior]

How excess niacin may promote cardiovascular disease

I've never heard of that I've heard the opposite that high amounts of niacin

I do. The manufactures simply have no way to validate the tissue. Here's an example:

Porcine leaflets: You can have variation from paper thin to 5x that thickness on one leaflet - you would think the tissue that is 5x thicker would last longer - well, there is no correlation between leaflet thickness and durability. Then there is the basic valve design - and then there is the "assembly" and then ... what does the body do to this thing (calcification, blood pressure)?

Pericardial: Looks like a smooth sheet but is full of veins with a grain - that can be random.

Some valves go 200 million cycles (5 years) on an accelerated life tester, the same exact valve (different serial number) might go billions. The only thing a manufacturer can do is to make a robust valve design - where "most" last a "long" time.

So... thats the nature of tissue and until the state-of-the-art can figure out all the variables, a tissue valve will last 2 years - or 15 years. That's why I cringe as people younger and younger are opting for tissue valves.

I have personally seen a tissue valve last 6 months - and I have personally seen a tissue valve last 20 years - which one will you get?

For you statisticians out there, it's called +/- 3 standard deviation.

can lower your LPA score

 

[MdaPA]

PC ks9-1 the truck has been talking about which is a Statin used for all labor treatment of lipoprotein is the only known treatment at this point.

Not understanding this but if you are trying to say here that a PCSK9 Inhibitor "is a Statin", that is not correct. Also, Lipoprotein apheresis is another known treatment to lower Lp(a).

 

[Erwitchin]

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.

Sadly, most insurance (US) doesn't cover an LPa test, so it may contribute to his reluctance to order one. (It makes no sense to me - that are going to pay for minimally invasive open heart surgery for me, but balk at a $100 blood test; but no one made a rule that insurance has to pass my logic test).

 

[Chuck C]

Also, Lipoprotein apheresis is another known treatment to lower Lp(a).

Correct. I am aware of one individual currently receiving apheresis to lower his Lp(a).

He had a heart attack in his early 40s. His doctor and cardiologist were baffled, as he had no risk factors that they were aware of, was not overweight, exercised regularly and ate healthy. His LDL was in the normal range. After months of his medical team being puzzled, his father, a friend of mine, had him tested for Lp(a). It turns out that it was sky high. This is often the case when people without other risk factors have a heart attack at a young age. He is now being treated with apheresis and PCSK9-I to lower his Lp(a). Apheresis is very expensive and it's hard to get insurance to pay for it. It is also extremely effective. He was lucky- his insurance carrier approved the treatment, as well as the PCSK9-I.

 

[Chuck C]

Sadly, most insurance (US) doesn't cover an LPa test, so it may contribute to his reluctance to order one. (It makes no sense to me - that are going to pay for minimally invasive open heart surgery for me, but balk at a $100 blood test; but no one made a rule that insurance has to pass my logic test).

I have never seen insurance deny the test when it is ordered by a physician. If they specifically do not allow for Lp(a) testing, one can order an advanced lipid panel offered by Quest Diagnostics called CardioIQ. The other main lab in the US, Labcorp, does not include Lp(a) in their advanced lipid panel, so it is important to get the one offered by Quest.

Alternatively, patients can order the test themselves if they choose not to go through insurance. It is currently $45 + $6 physician fee at Quest and they sometimes run specials with 20% off. See link below:

https://www.questhealth.com/product...xj1aszJAvwksVHkyyE-RL7vY6vnp2G0IaAk5_EALw_wcB

 

[Survived03]

I asked my doctor to add Lp(a) to some follow-up labs I'm having drawn next month. I'm highly curious. I have never had a calcium score conducted but via other CT scans outside of thoracic views, the only small presumed plaque "spots" were lower in my abdomen. Otherwise clear coronaries.

 

[Chuck C]

I asked my doctor to add Lp(a) to some follow-up labs I'm having drawn next month. I'm highly curious. I have never had a calcium score conducted but via other CT scans outside of thoracic views, the only small presumed plaque "spots" were lower in my abdomen. Otherwise clear coronaries.

Good plan. All should get it checked at least once in their lives. Not all who have high Lp(a) will present with a high calcium score. My brother and I both have sky high Lp(a) and low calcium scores. I know others with high Lp(a) whose CAC scores are through the roof. One friend is at about 4,000, which is off the charts.

 

[Survived03]

...and I will take note of the units used

 

[pellicle]

Otherwise clear coronaries.

I recall reading that people with BAV and aneurysm seem to have clear coronaries...

 

[Survived03]

I recall reading that people with BAV and aneurysm seem to have clear coronaries...

Yes, you recall correctly. I posted it!

 

[pellicle]

I posted it!

that part I suspected but wasn't sure enough ;-)

 

[Survived03]

Good plan. All should get it checked at least once in their lives

Got my results back. Lp(a) was 17.3 nmol/L. Maybe I will succeed in getting more mileage out of my biovalve, but who knows.

 

[Chuck C]

Got my results back. Lp(a) was 17.3 nmol/L

That's great news! Totally normal. Thanks for sharing.

As a frame of reference, mine is 243 nmol/L at baseline. So, 14x as high as yours. With PCSK9-I it gets down to 128 to 160 nmol/L. Still very high.

 

[tjay]

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.


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.

Chuck,
After reading various posts on Lp(a), I just got mine tested. It's 35 nmol/L. Am I correct in its conversion to ~16 mg/dL (= 35/2.15)?
Does it mean that I may be a good candidate for a tissue valve?

PS: My LDL, HDL etc which they test every year in the standard cholesterol panel have always been super favorable too.....

 

[Chuck C]

Chuck,
After reading various posts on Lp(a), I just got mine tested. It's 35 nmol/L. Am I correct in its conversion to ~16 mg/dL (= 35/2.15)?

Hi TJay.
I think you put this same question out there on another thread as well, so I will answer both the same.

Yes, that is about correct. The conversion factor that is often used is 2.4, and it does not surprise me if some use 2.15, because it is not an exact conversion- depends on an individual's particle size. Your level of Lp(a) is ideal.

Does it mean that I may be a good candidate for a tissue valve?

I don't think that this would be how I would put it. Lp(a) is not the only factor to consider. Age would be arguably the biggest factor for most people.

If you had very high levels of Lp(a), that might be a reason to consider avoiding a tissue valve, as suggested by the recent study, which found more rapid development of SVD for these folks.

But, that does not then convert to people who have normal Lp(a) are "good" candidates. It would just mean that when you do make your decision between tissue and mechanical that you should not bring Lp(a) into the discussion as you don't have a lipid condition which has been shown to cause more rapid SVD. You still are young and that is usually a big factor in how long a tissue valve is expected to last.

 

[tjay]

Hi TJay.
I think you put this same question out there on another thread as well, so I will answer both the same.

Yes, that is about correct. The conversion factor that is often used is 2.4, and it does not surprise me if some use 2.15, because it is not an exact conversion- depends on an individual's particle size. Your level of Lp(a) is ideal.


I don't think that this would be how I would put it. Lp(a) is not the only factor to consider. Age would be arguably the biggest factor for most people.

If you had very high levels of Lp(a), that might be a reason to consider avoiding a tissue valve, as suggested by the recent study, which found more rapid development of SVD for these folks.

But, that does not then convert to people who have normal Lp(a) are "good" candidates. It would just mean that when you do make your decision between tissue and mechanical that you should not bring Lp(a) into the discussion as you don't have a lipid condition which has been shown to cause more rapid SVD. You still are young and that is usually a big factor in how long a tissue valve is expected to last.

Thanks Chuck.