<p class="p2"><span class="s1"><a href="https://peterattiamd.com/benoitarsenault/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220613-pod-benoitarsenault&utm_content=220613-pod-benoitarsenault-podfeed"> View the Show Notes Page for This Episode</a></span></p> <p class="p2"><span class="s1"><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220613-pod-benoitarsenault&utm_content=220613-pod-benoitarsenault-podfeed"> Become a Member to Receive Exclusive Content</a></span></p> <p class="p2"><span class="s1"><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220613-pod-benoitarsenault&utm_content=220613-pod-benoitarsenault-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></span></p> <p class="p3">Benoît Arsenault is a research scientist focused on understanding how lifestyle and genetic factors contribute to cardiovascular disease risk. In this episode, the discussion casts a spotlight on Lp(a)—the single most important genetically-inherited trait when it comes to atherosclerotic cardiovascular disease (ASCVD) risk. Benoît explains the biology of Lp(a), how it's inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a). He dives into data on the possible treatments for lowering Lp(a) such niacin, statins, and PCSK9 inhibitors, as well as the most exciting new potential therapeutic—antisense oligonucleotides.</p> <p class="p3">We discuss:</p> <ul class="ul1"> <li class="li3">How Benoît came to study Lp(a)—a new marker for cardiovascular risk [3:15];</li> <li class="li3">The relationship between Lp(a) and CVD risk [6:45];</li> <li class="li3">What genome-wide association studies (GWAS) revealed about Lp(a) [16:00];</li> <li class="li3">Clinical tests to measure Lp(a) [22:00];</li> <li class="li3">The biology of Lp(a) [25:45];</li> <li class="li3">How statins lower LDL-cholesterol and why this doesn't work for an Lp(a) [29:15];</li> <li class="li3">The structure of LDL-p and Lp(a) and what makes Lp(a) more atherogenic than an equivalent LDL particle [34:00];</li> <li class="li3">The role of Lp(a) in aortic valve disease [42:45];</li> <li class="li3">How greater numbers of Lp(a) particles are associated with increased risk of disease [48:00];</li> <li class="li3">The genetics and inheritance of Lp(a) and how and when to measure Lp(a) levels [52:00];</li> <li class="li3">Niacin and other proposed therapies to lower Lp(a), apoB, and CVD risk [1:00:45];</li> <li class="li3">Why awareness of Lp(a) among physicians remains low despite the importance of managing risk factors for ASCVD [1:14:00];</li> <li class="li3">The variability of disease in patients with high Lp(a) [1:19:00];</li> <li class="li3">Diseases most associated with high Lp(a) [1:26:30];</li> <li class="li3">The biology of PCSK9 protein, familial hypercholesterolemia, and the case for inhibiting PCSK9 [1:35:00];</li> <li class="li3">The variability in PCSK9 inhibitors' ability to lower Lp(a) and why we need more research on individuals with high levels of Lp(a) [1:50:30];</li> <li class="li3">Peter's approach to managing patients with high Lp(a), and Benoît's personal approach to managing his risk [1:54:45];</li> <li class="li3">Antisense oligonucleotides—a potential new therapeutic for Lp(a) [1:57:15]; and</li> <li class="li3">More.</li> </ul> <p class="p3">Connect With Peter on <a href="https://twitter.com/PeterAttiaMD"><span class="s3">Twitter</span></a>, <a href="https://www.instagram.com/peterattiamd/"><span class="s3">Instagram</span></a>, <a href="https://www.facebook.com/peterattiamd/"><span class="s3">Facebook</span></a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg"><span class="s3">YouTube</span></a></p>
Actionable Insights
1. Demand LP(a) Test
Demand your physician checks your LP(a) level, as there’s a significant chance it’s elevated (10-20% of the population) and many doctors don’t routinely test it. A milligram per deciliter mass measurement is likely sufficient if nanomoles/L is not available, as both methods will identify high-risk levels.
2. Aggressively Manage All CV Risk Factors
If you have high LP(a), aggressively manage all other cardiovascular risk factors (smoking, diet, physical activity, body weight, LDL cholesterol, diabetes, blood pressure) to significantly reduce your overall risk of events by up to two-thirds.
3. Aggressive ApoB Lowering & PCSK9
For patients with elevated LP(a), aggressively lower ApoB to a physiological level (30-40 mg/dL) and liberally use PCSK9 inhibitors, which can reduce LP(a) by approximately 30% on average, as part of a comprehensive lipid management strategy.
4. Screen Aortic Valve for Stenosis
If you have elevated LP(a), get a baseline echocardiogram or cardiac MRI to check for early signs of aortic stenosis, as early identification and intervention lead to better outcomes.
5. Measure LP(a) in Children
Measure LP(a) levels in children by age two to five, especially if there’s a family history of early heart attack or stroke, as the gene is fully expressed by age two and levels are stable from age five into adulthood.
6. Avoid Niacin for LP(a) Lowering
Do not use niacin to lower LP(a) levels, despite its ability to reduce LP(a) by 20-30%, because large cardiovascular outcome trials have shown no cardiovascular benefits and significant side effects.
7. Do Not Avoid Statins for High LP(a)
Do not avoid prescribing or taking statins if you have high LP(a), as statin treatment is beneficial in patients with high LP(a) levels, potentially even more so than in those with low LP(a), despite a small potential increase in LP(a) levels.
8. Prefer Nanomole/Liter LP(a) Measurement
When measuring LP(a), ideally seek a lab that provides results in nanomoles per liter, as this gives a more accurate sense of the number of LP(a) particles, which is the most important risk factor.
9. LP(a) Measurement Once in Lifetime
Measure LP(a) once in a lifetime, as its levels are remarkably stable over time and do not require repeated testing for risk assessment.
10. Advocate for Physician Education on LP(a)
Advocate for increased physician education and awareness regarding LP(a) measurement and management, as it is a highly prevalent and important driver of cardiovascular disease often overlooked.
11. Join Podcast Membership
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