← Healthier World with Quest Diagnostics
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Foreign welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from INSIGHT as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine and wellness medicine. Hello everyone. Thank you for joining. The goal of today's episode is to give you instant insights into the utilization of lipoprotein A for cardiovascular risk assessment. I'm Dr. Mason Latsko, researcher by training with a passion for learning, and I'm a clinical specialist with quest's Cardiometabolic center of Excellence at Cleveland Heart Lab. So let's dive in. Excess lipoprotein A or LP as in lowercase a, represents a lifelong causal factor for cardiovascular disease related events like coronary artery stenosis, ischemic stroke, myocardial infarction and cardiovascular mortality. So what is lp? LP is an LDL like particle that carries cholesterol throughout the body, but it has an additional protein called apolipoprotein A or apoa attached to the apob subunit on the Lp particle. And the length of the APOA protein is genetically determined and it varies from person to person. So the APOA protein could be long in one individual and short in another. And the length of the APO protein influences the amount or concentration of LP produced by the liver and measured in the blood. In this way, LP levels are approximately 90% genetically determined. LP can contribute to poor cardiovascular outcomes in a number of ways. It is pro atherogenic, promoting fatty plaques in arteries. It's prothrombotic, increasing the likelihood of venous thrombosis and pro inflammatory recruiting immune cells that promote inflammation. In addition to LP being highly atherogenic, it is also highly prevalent among the population. One in five people have high LP. That's more than 1 billion people globally. The National Lipid association now recommends that LP be checked in every adult at least once for cardiovascular risk assessment. Before diving into the risk categories associated with LP levels, it's important to note that LP can be quantified in two using mass units in milligrams per deciliter which can measure the weight of the LP particle, or using particle count in nmol, which can measure the amount or quantity of LP particles. Both methods are acceptable ways of measuring lp. Mass is dependent on the size of that APOA protein that can vary from person to person. Therefore, particle count is the preferred method for measuring LP and converting between units is not recommended as the Cardiometabolic center of Excellence, Cleveland Heart Lab and Quest Diagnostics use Nmol L as the method for measuring LP levels. Okay, now that we discussed the method for measuring lp, we let's dive into the risk cut points. Note that the risk between ASCVD and LP is continuous, with increased risk correlating with higher lp. Individuals with low risk attributable to LP have levels below 75 nanomoles per liter or 30 milligrams per deciliter. Individuals with high risk attributable to LP have levels greater than 125Nmol L or 50mg per deciliter, whereas individuals with levels between these cut points are considered at intermediate risk. Although LP is mostly genetically determined, there are certain conditions that can influence LP levels, including menopause, CKD and proteinuria and hypothyroidism. Thus, the focused update to the 2019 NLA Scientific Statement, which was released in 2024, recommends repeat testing of LP levels in individuals with these conditions that fall into the intermediate risk category. Keep in mind that although LP is an independent risk marker for cardiovascular disease, other chronic conditions such as type 2 diabetes, can exacerbate risk for ASCVD. The strong genetic component of LP calls into question the treatment landscape, which is continuing to evolve. First and foremost, ensuring a healthy lifestyle should be recommended for all patients. Then, a global risk reduction strategy to lower overall risks for CVD can also be implemented at the discretion of a provider using a statin or other pharmaceutical therapy. Excitingly novel therapeutic options are on the horizon that will directly target and lower LP levels. That concludes your instant insight on lp. At Quest Diagnostics, we aim to increase awareness and education in order to identify patients at risk for cardiometabolic conditions and act to treat root causes to prevent the development and progression of cardiometabolic disease and improve patient outcomes. That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.