As a patient, demand to know your LP(a) levels, especially if you have a family history of atherosclerotic disease, as this is a non-negotiable step in understanding your risk.
Prioritize knowing your LDL particle number (LDL-P) or APO-B, as these are more accurate predictors of atherosclerotic risk than traditional LDL cholesterol levels.
For the most accurate assessment of LP(a) risk, request an LP(a) particle number test, or as a proxy, measure the amount of oxidized phospholipid normalized for APOB.
If you have elevated LP(a), aim for an LDL particle number (LDLP) at the 10th percentile or lower, which often requires statin therapy, in addition to considering other risk factors.
If you have elevated LP(a), you should likely take a statin, but understand its purpose is to control APOB and lower LDL particle number, not to directly lower LP(a).
If you have elevated LP(a), especially at a young age, proactively screen for aortic stenosis using an echocardiogram (echo) at minimum, or preferably a cardiac MRI for more accurate assessment of the aortic valve.
If you have elevated LP(a) and are taking long flights, discuss deep vein thrombosis (DVT) prophylaxis with your doctor, which may include pharmacologic agents or over-the-counter options like “flight tabs” to reduce risk.
If you are on a high-fat diet (e.g., ketogenic) and experience a significant increase in LDL particle number, consider replacing saturated fats with monounsaturated fats (like those from olives, olive oil, macadamia nuts) to potentially lower LDL-P, even while maintaining a high-fat intake.
Monitor your oxidized LDL levels (aiming for below 40) and LPPLA2 as these are important local markers of vascular inflammation, providing a clearer picture than general inflammatory markers like CRP.
You can significantly lower triglycerides, which are highly sensitive to dietary intervention, through specific dietary changes, potentially within a month.
Avoid misunderstanding “LDL cholesterol” as simply “bad cholesterol” by understanding that LDL stands for “low-density lipoprotein,” indicating it’s a macro structure carrying cholesterol, not cholesterol itself.
If LP(a) particle number is unavailable, consider assessing both LP(a) mass and LP(a) cholesterol; if both are high, it indicates high particle number and risk, if both are low, risk is low, and if one is high and one is low, further follow-up may be needed.
Physicians on the front lines of medicine, including family physicians and GYNs, should understand LP(a) to effectively help patients lower their cardiovascular disease risk.
If you are a physician and this is your first introduction to LP(a), commit to learning more about it to better serve your patients and understand cardiovascular risk factors.
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