Episode Overview

Podcast: Healthier World with Quest Diagnostics
Episode: Instant Insights: Lipoprotein (a)
Host/Speaker: Dr. Mason Latsko, Clinical Specialist, Cardiometabolic Center of Excellence at Cleveland Heart Lab
Date: September 24, 2024
Runtime: 6 minutes

This episode offers a concise yet comprehensive look into the use of lipoprotein(a) [Lp(a)] for cardiovascular risk assessment. Dr. Mason Latsko delivers essential insights on Lp(a)’s biological role, its clinical significance, risk stratification, testing methods, and current recommendations for its evaluation in practice.

Key Discussion Points and Insights

1. What is Lipoprotein(a)? (00:40)

• Definition: Lp(a) is an LDL-like particle that transports cholesterol in the blood but has a unique additional protein, apolipoprotein(a) [apo(a)], attached to its apoB subunit.
• Genetic Determination: The length of apo(a), and thus the amount of Lp(a) produced, is genetically determined and differs person to person.
• Quote [Dr. Latsko, 01:00]:
  “The length of the apo(a) protein is genetically determined and it varies from person to person…LP levels are approximately 90% genetically determined.”

2. Lp(a) as a Causal Risk Factor (01:20)

• Clinical Impact: Elevated Lp(a) is a lifelong causal factor for:
  • Coronary artery stenosis
  • Ischemic stroke
  • Myocardial infarction
  • Cardiovascular mortality
• Mechanisms: Lp(a) is highly:
  • Proatherogenic (promotes fatty plaques in arteries)
  • Prothrombotic (increases risk of blood clots)
  • Proinflammatory (attracts immune cells and causes inflammation)
• Prevalence: “One in five people have high Lp(a); that’s more than 1 billion people globally.” [Dr. Latsko, 01:55]

3. Screening and Measurement (02:15)

• Screening Recommendation:
  • National Lipid Association recommends Lp(a) testing in every adult at least once for cardiovascular risk assessment.
• Measurement Methods:
  • Mass (mg/dL): Dependent on size of apo(a), varies individually.
  • Particle Count (nmol/L): Preferred method—reflects particle quantity more accurately; mass-to-count conversion not recommended.
• Institutional Practice: Quest Diagnostics and Cleveland Heart Lab measure Lp(a) using nmol/L.

4. Interpreting Lp(a) Levels and Risk Categories (03:00)

• Risk Continuum: Cardiovascular risk increases continuously with Lp(a) level.
• Cut Points:
  • Low Risk: <75 nmol/L (or <30 mg/dL)
  • Intermediate Risk: 75–125 nmol/L (or 30–50 mg/dL)
  • High Risk: >125 nmol/L (or >50 mg/dL)
• Factors Influencing Lp(a): Although largely genetic, Lp(a) can be increased by:
  • Menopause
  • Chronic kidney disease (CKD) and proteinuria
  • Hypothyroidism
    Quote [Dr. Latsko, 04:08]:
    “There are certain conditions that can influence LP levels, including menopause, CKD and proteinuria and hypothyroidism.”

5. Updated Guidelines and Repeat Testing (04:10)

• 2024 Guidelines: Updated National Lipid Association recommendations:
  • Repeat testing in individuals with intermediate risk and conditions above, to monitor changes in Lp(a) levels.

6. Managing Elevated Lp(a) (04:40)

• Lifestyle First: Healthy lifestyle is foundational for all patients.
• Medical Management:
  • Providers may use global risk reduction strategies, such as statins or other therapies, to manage overall CVD risk even though Lp(a) itself isn’t the primary target for most existing meds.
• Future Directions:
  • Novel therapies specifically targeting Lp(a) are in development and showing promise.

7. Key Takeaway and Call to Action (05:20)

• Education & Prevention: Increasing clinician and patient awareness is vital for identifying at-risk individuals and acting early to prevent cardiovascular and metabolic diseases.

Notable Quotes & Memorable Moments

• Genetic Determination:
  “LP levels are approximately 90% genetically determined.” [01:15]
• Prevalence:
  “One in five people have high LP. That's more than 1 billion people globally.” [01:55]
• Risk Guidance:
  “The risk between ASCVD and LP is continuous, with increased risk correlating with higher LP.” [03:05]
• Future Therapies:
  “Excitingly, novel therapeutic options are on the horizon that will directly target and lower LP levels.” [05:00]

Important Segment Timestamps

• 00:40 – What is Lipoprotein(a)?
• 01:20 – Why Lp(a) Matters for Cardiovascular Risk
• 02:15 – Who Should Be Screened and How Lp(a) is Measured
• 03:00 – Risk Categories According to Lp(a) Levels
• 04:10 – Conditions That Warrant Repeat Testing
• 04:40 – Treatment Landscape and Future Therapies
• 05:20 – Summary & Call to Action

Summary

This episode serves as a quick yet thorough guide for clinicians and patients on the emerging importance of Lp(a) in cardiovascular risk. Dr. Latsko emphasizes its strong genetic base, high prevalence, and new recommendations for universal screening. While current treatment centers on lifestyle and global risk reduction, upcoming therapies are likely to directly target Lp(a), adding an important dimension to cardiovascular prevention. The episode closes on the need for awareness, timely assessment, and ongoing education as central to improving patient outcomes.