Lipoprotein(a): What You Should Know About This Key Protein

Did you know that, according to the NIH, close to 2.4 billion people in the world have high LP(a) right now? That's 20% to 30% of people around the world. High LP (a) is not an obvious disease but a silent killer that continues to affect the lives and health of billions of people. Don't believe us?

How much literature have you read on diabetes, Cancer, AIDS, Covid, high blood pressure, low blood pressure and other cardiovascular diseases? With most of the emphasis being placed on the 'important stuff', LP (a) often goes under the radar.

Do not make the mistake of thinking that high Lp(a) is not essential. While lifestyle diseases like diabetes, CADs, Hypertension, etc., are more widely publicised, Lp(a) gets away with a lot more. LP(a) is like the Carlo Gambino of cardiovascular diseases. He was involved in every illegal activity (the diseases) but never accused of anything significant, continuing to fool everyone with his gentle grandfather's charade.

Increased Lp(a) levels in the blood can cause more cholesterol, which can clog your arteries and cause cardiac issues. You're living your best life, breathing fresh air and eating all the food you can set your greedy eyes on. Suddenly, one fine day, you get a heart attack. Now that the world is slowly increasing its awareness towards healthier living, LP(a) is starting to get the attention it has always deserved.

Intrigued by the sudden rise to fame of this new kid? Let's look at what Lipoprotein A actually is and why your test report says, 'high LP(a) needs attention'.

We need to know more about it to understand how it slowly decays the body from the inside.

Etymology:

Guess what? Another scientific name has its roots in the land of Aristotle. SHOCKING! Lipid comes from the Greek word "lips," which roughly translates into "fat" or "grease." Proteios, which means "primary" or "of first importance," gave birth to the name Protein.

Definition:

Lipoprotein A, known by its abbreviation Lp(a), is found in our blood and shares its density with low-density lipoprotein, or LDL, commonly known as "bad cholesterol", but with a twist. Lp(a) has apolipoprotein(a) attached to its LDL-like core.

Too much scientific yapping? Simply put, imagine that your blood is like a river flowing through your body. This river contains tiny boats carrying essential nutrients and oxygen to keep you healthy. Lp(a) is one of those whose primary job is to aid with repair and healing. LP(a)s helps fix and heal your blood vessels when they get damaged.

Sometimes, these boats work really well. However, too many of them or if they get stuck, make it tougher for the river (your blood) to flow smoothly. That is when you press the alarm bell because if your blood isn't flowing smoothly, it means you are at risk from cardiovascular diseases like heart attacks. You wouldn't want a boat wreck inside your blood vessels, right?

Its primary function is to repair blood vessels. It helps repair and heal the lining of blood vessels, which get damaged regularly for many reasons. Lp(a) comprises a protein-containing core of lipids (fats). The main protein is called apolipoprotein(a) (apo(a)), which is attached to another protein called apolipoprotein B (apoB) on the surface of the lipoprotein.

The protein apo(a) binds to other components in the blood to aid this repair process. Lp(a) is also involved in the clotting process, making blood clot more effectively. This is vital when you get a cut or an injury—it helps arrest the bleeding.

So, as you can see, LP(a) helps blood clots. If someone has too much LP(a), his blood will naturally start to clot more readily. Since blood vessels require repairs daily, too much LP(a) bears the risk of over-clotting. That's why if you have elevated Lp(a) levels, you are at risk of cardiovascular diseases.

According to research, having 30 mg/dL LP(a) to 50 mg/dL is considered healthy. Of course, this range changes according to age. Kids are expected to have 10 mg/dL to 30 mg/dL. The number varies significantly depending on genetics, body type, blood type, race or gender, but the basics remain the same. Your insurance premiums will increase if you have more LP(a) in your blood.

Lipoprotein is a kind of LDL or low-density lipoprotein. They carry cholesterol to the blood cells in your arteries. Elevated LDL particles lead to cholesterol build-up in your arteries, forming a plaque blockage. The condition is called "hardening of the arteries" or atherosclerosis. Once your arteries harden, this can lead to many severe medical conditions. High levels of lipoprotein means you have a high risk for the following -

Coronary heart disease- According to the World Health Organization (WHO), cardiovascular diseases, including coronary heart disease, are the leading cause of death globally. In 2019, cardiovascular diseases were responsible for 17.9 million deaths, which is about 32% of all global deaths.

Narrow or blocked arteries in your heart - Approximately 6% of adults worldwide are estimated to have coronary artery disease. This includes varying degrees of artery narrowing or blockage. That's basically the population of the USA and Russia COMBINED.

Heart attack- It's estimated that close to 7.4 million people worldwide suffer from heart attacks each year. Over 32,000 people died of heart attacks in India in 2022, and the situation doesn't get better in other countries either.

Stroke- Stroke accounts for roughly 11% of total deaths globally, making it a significant public health concern.

Peripheral Arterial Disease- PAD affects an estimated 200 million people globally. This figure includes both diagnosed cases and those who may be undiagnosed or asymptomatic.

Like all things, high LP(a) has multiple treatments available. Some treatments are simple, like homoeopathy, involving popping a few pills, nothing more, while other treatment methods are a little more complex—involving filtration of your blood to get the impurities out. And then there's bariatric surgery—that's another ball game altogether. Not for the faint-hearted.

Homoeopathy

When you say homoeopathy, a warm blanket of familiarity envelops you. Homoeopathy solves all problems, and more often than not, it is the same medication. For homoeopathic enthusiasts, there are a couple of solutions to reduce elevated LPA.

• Cholesterinum: This homoeopathic remedy has been derived from cholesterol and used for many conditions; however, no robust scientific evidence supports its efficacy for lowering Lp(a) levels. Being a homoeopathic remedy, it is also based on the principle of "like cures", where substances which cause symptoms in large doses are used in highly diluted forms to treat similar symptoms. For Cholesterinum, the remedy is prepared by repeatedly diluting and succussing (shaking) a cholesterol solution, likely to help with cholesterol-related issues.

Medicinal treatment:

Statins - primarily used to lower LDL cholesterol and impact Lp(a). They don't actively reduce Lp(a) but are essential in managing cholesterol levels and reducing cardiovascular risk.

PCSK9- Inhibitors such as Alirocumab and Evolocumab primarily lower LDL cholesterol but may have a modest impact on Lp(a) levels. They are used in patients with high cardiovascular risk or those who do not achieve adequate LDL cholesterol reduction with statins alone.

Pelacarsen: Medications like antisense oligonucleotides (e.g., Pelacarsen, formerly known as AKCEA-APO(a)-LRx) are in clinical trials and have shown promise in significantly reducing Lp(a) levels. This medicine is being developed by California-based pharma company Ionis Pharmaceuticals.

The medicine is still in the final stages of development and entered human trials earlier this year. The company is monitoring its effects on 286 patients suffering from cardiovascular diseases. If it gets FDA approval in the coming days, it will massively reduce CVD and LP(a)- related casualties.

Blood Filtration

Traditional methods of combating high levels of lipoprotein in the blood involve a blood filtration process called Lipoprotein Apheresis, which essentially removes Lp(a) from the blood.

This procedure is required for patients with typically high Lp(a) levels who have not responded to other treatments.

Blood collection- A vein is found, and blood is drawn to be processed outside the body.

Separation—The collected blood is passed through a machine that breaks it down using a process called "apheresis." Filters or other methods isolate lipoproteins from the other blood components.

Lipoprotein removal - Lp(a) is selectively removed from the blood through different techniques, including affinity chromatography and other specialized filters designed to capture lipoproteins.

Return of blood - The treated blood without the lipoprotein(a) is returned to the patient's body.

Repeat Sessions - Lipoprotein apheresis is usually not a one-time procedure. Patients typically need multiple sessions over weeks or months; depending on their condition and response to the treatment, they may be called again.

Surgery

Bariatric surgery involves several procedures designed to help with weight loss by changing the digestive system. Here is an overview of the basic types.

Gastric Bypass (Roux-en-y) - In this method, the surgeon creates a small stomach pouch and reroutes the small intestine to connect to it. This little pouch has less food capacity, and bypassing part of the small intestine results in less calorie and nutrient absorption.

Gastric Sleeve (Sleeve Gastrectomy) - In this surgical procedure, a large part of the stomach is removed, resulting in a sleeve-shaped stomach. This reduces the stomach's capacity and affects hunger hormones, reducing appetite.

Adjustable Gastric Band (Lap Band)- In this procedure, a band is placed around the top part of the stomach to create a small pouch above it. You can adjust this band to control the opening size between the pouch and the rest of the stomach, thereby controlling food intake.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)—This is a complex procedure in which the surgeon removes a significant part of the stomach and reroutes the intestines to reduce nutrient absorption. It fuses elements of restrictive and malabsorptive techniques.

The main aim of such procedures is to reduce the stomach's capacity to hold food or alter the way food is processed, leading to weight loss. These surgeries are effective, no doubt, but they are also very risky. You also need to make a lot of lifestyle changes and be ready for follow-up care.

Your grandmother or someone in the neighbourhood would surely know about a home remedy that will alleviate your LP(a) stress with some easy-to-get solutions. We spoke to them and compiled a short list for you.

• Consume garlic to reduce cholesterol levels and boost circulation.

• Consume turmeric, which contains curcumin and has anti-inflammatory and antioxidant properties that contribute to heart health.

• A cup of green tea rich in antioxidants can support heart health and help manage cholesterol levels.

• Include ginger in your diet. It is known for its anti-inflammatory properties, and it helps improve overall cardiovascular health.

• Hawthorn is good for heart health and circulation.

• Ginkgo Biloba - Improves blood flow and cardiovascular health.

In conclusion, if you have elevated Lp(a) levels in your blood, you need to get your blood work done and show the results to a qualified medical professional. Unless you get an expert opinion on your test results, you will never know the intricacies of what ails you.

Effective management entails a combination of lifestyle alterations like diet and exercise alongside medical treatments tailored to individual requirements. While emerging therapies show a sliver of hope, established options like medications and procedures remain in the spotlight. Staying informed and proactive about cardiac health can make a huge difference in long-term well-being and reduce the risk of serious cardiovascular issues.