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 ;-)