Summary

• Get your Lp(a) tested. Lp(a) is a biomarker that has significant implications for your cardiovascular health. You measure it through a blood test you can ask your doctor for. We also include it in the Ray Wu MD system. Apply for the beta by emailing [email protected].
• High Lp(a) is the most common cause of heart attack at a young age.
• Your Lp(a) is genetically determined, meaning your DNA controls if your level is low, medium or high.
• 20% of people have "high" levels of Lp(a) .
• People with "high" levels have 3x higher risk for early heart attack or stroke.
  
• There is currently no good way to lower Lp(a).
• If you have a "high" level, you can lower your risk of cardiovascular disease by 67% by optimizing your cholesterol, metabolic health, and fitness level. This should be top priority!

I want to prevent heart disease.

Ray's Take

Everyone should get their Lp(a) tested. It's not an expensive test and it's important to know if you're part of the 20% of the population that has high Lp(a), and thus at higher risk for cardiovascular disease. My dad had a heart attack at 39, so this test was particularly important for me personally.

To me, it's way better to know I'm at risk for something, so I can do something about it. So I highly recommend getting the test!

If you have high Lp(a), don't panic. You'll just know you need to pay special attention to the other causes of heart attack and optimize them as much as possible - lower cholesterol (ApoB is the best measure) as much as possible, do not have high blood pressure, do not smoke, and increase insulin sensitivity through eating well and exercise. This can lower your risk by 67%.

It's important to know that if you do have high Lp(a), it does not mean you will get a heart attack or stroke.

If you are older, you should also get tested for "aortic stenosis" which can be done painlessly with an echocardiogram. Aortic stenosis is when your aorta (main heart artery) gets blocked.

Unfortunately, exercise, diet and other lifestyle factors usually do not lower Lp(a), and there are no drugs that directly target Lp(a) (though PCSK-9 inhibitors can reduce by ~30%). There are many drugs that could arrive in the next 5 years directly targeting Lp(a).

Stupid Ideas

Stupid: My doctor doesn't know what Lp(a) is so I don't have to know either
RW response: Really? Let me give you some background. MDs are overworked seeing patients, and rarely have time or care to learn about the most up to date research. And by up to date, I mean things that haven't officially been included in medical guidelines that they are forced to abide by, otherwise being at risk for malpractice. The problem? It takes like decades for guidelines to update! Do you want to wait for this?

Stupid: None of my friends have been tested on Lp(a) so I don't have to get the test either
RW response: Lol. I'll give that you are right. Less than 1% of Americans have had their Lp(a) tested. But 20% of people have high Lp(a) and again these particles are 6x more atherogenic than regular LDL. It's literally the most common cause for early heart attack. The test isn't expensive, and you only need to get it once. If you know, you can do something about it and prevent heart attack.

Stupid: I don't want to get the test because there is nothing I can do about it
RW response: Not true. You can optimize all the factors you can optimize, even more diligently, and reduce your risk by 3x. Lower apoB, be metabolically healthy (through nutrition, exercise), don't smoke, have good blood pressure. All of these are in your control.

Cool knowledge for normal people

Review: LDL cholesterol is a lipoprotein, and every LDL particle has one apoB on it's surface.

Apo(a) binds to apoB on some LDL particles. This converts the LDL to a Lp(a).

Image: Structure of Lp(a) LDL particle wrapped by one ApoB, with an Apo(a) attached

Your genetics determine how much apo(a) is produced, which thus determines how much Lp(a) you have.

Lp(a) particles are really dangerous because they cause inflammation, accelerate the formation of plaque in the arteries, and promote blood clots.

The result is that having high Lp(a) gives you a 3x higher chance of having an early heart attack.

Keep in mind early heart attack means having a heart attack under 65. The average age of heart attack for men is 65, and women is 72.

If someone gets a heart attack or stroke at a very early age (<50) there is almost always a genetic cause, and high Lp(a) is by far the most common.

I want to prevent heart disease.

Optional info for nerding out

From JACC (Journal of the American College of Cardiology)
A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies

Image: Pathogenic Mechanisms of Lp(a)

From Circulation
Oxidized Phospholipids on Lipoprotein(a) Elicit Arterial Wall Inflammation and an Inflammatory Monocyte Response in Humans.

From Peter Attia's "The Drive" podcast (really good, very detailed)
#210 – Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D