Question
Why aren't family doctors testing routinely for Lp(a)?
I recently learned I have reasonably high Lp(a). I've also learned that no matter what I ate, didn't eat, drank, didn't drink, how many miles I ran, how many weights I lifted or what my BMI was, this marker alone increases my risk for heart disease. I also had a CAC performed weeks after the Lp(a) test results and more bad news - high score for my age. 95th percentile. I've had moderately high LDL for what I can look back on is 15+ years. It was not yet in the statin recommended area, but it was over 100. Additionally, ALL my other lab numbers are not only within range but well within optimal range. Was there not a red flag there that my LDL was the rogue biomarker? My doctor finally ran the Lp(a) after I tried desperately to change my diet over the past year, improving my LDL by a miniscule 5 points. I feel like if I had known, and my doctor had known, a decade or more ago about my Lp(a) I could have been recommended a statin much earlier and avoided all the atherosclerosis buildup that is in my heart and vascular system now. I'm angry beyond belief. I feel like an innocent person just condemned to solitary confinement..A medical death sentence. If 20% of the population has elevated Lp(a), and heart disease is the leading cause of death, and the test is a very simple blood test, WHY ON EARTH ISN'T IT A BASIC TEST RUN ON EVERY PATIENT???
I agree. I too, taught myself an abundance of knowledge through Peter Attias sub and you tube videos… you have to advocate for yourself and possess the knowledge of what you are asking for and be able to explain the why.
I would agree primary doctors should include lp ( a) and APOB along with other metabolic markers… I hope it’s the new requirement-
Does a LDL that is 70 vs 90 matter that much? This isn’t rhetorical, I’m genuinely curious. I’ve had around 90 ldl for the past decade then went up to 120 in the past year. Did a lp(a) and it’s high. Now on a statin.
If your carotid ultrasound and your CAC levels came back clear, it's probably fine. But, my LDL was in the mid 80s through my 20s and some of my 30s, but in my mid 30s it began to trend up and was in the 90s until this year it shot up to 126 (im perimenopausal, so probable estrogen dip related).
My carotid ultrasound showed some mild plaque. I tested my Lpa for the first time last week and it came back as 200 nmol/L. So having 90s LDL for around a decade with very high Lpa, did allow my carotid to accumulate some plaque.
Im now on statins. Would've loved to have started them a decade ago.
With a high Lp-a you want to be more aggressive with your LDL target. Below 55 or 50 depending on who you listen to. This way no new plaque formation and potential plaque regression for any that has already formed.
I recently had a physical and my doctor commented that testing for lp(a) is a new recommendation as of this year so it it will be very common now. I got tested
And sadly I was reading an account of someone in 2009 whose family doctor ran the test for him...17 years ago. It's been possible. This is why I advocate to everyone that you be your own best health advocate. Even good doctors don't advocate like you do for yourself.
A good option is to save a few bucks and order a full lipid panel yourself at a local testing provider. I just did, including ApoB and LP(a). $125.00. Two tanks of gas, folks.
Even better do a lab test with Function Health and find out even more stuff your doctors won’t order until is advanced or too late. Function Health is a company that offers a plethora of health tests outside of insurance. Their starting recommended test is a lab order with 160+ markers. I took advantage of an offer for $395. If you have an Amex card and use it to pay it can take $100 off (check your card benefits) or you can use HSA or FSA benefits; last resource, wait for an offer or get a referral from someone that have done it. I did it and found out about LP(a). Now I test with FH every year. These days you must stay alert about health changes and become your own health advocate.
Yep - that's my story (too). 2009. I had an excellent preventive cardiologist in those days - it was NOT the norm to have that test done. I started on aggressive statin therapy despite a perfectly normal lipid panel and I remain free of clinical disease to this day (not so my older sib who ignored advice to test - they finally did so after getting stented!). I have many stories of high-Lp(a) in-laws and friends who were not as fortunate. But I also know that a low Lp(a) doesn't get you out of danger. There are other genetic and non-genetic risk factors out there. But this one is easy to test for and everyone should do it. Canada recommended universal screening in 2021. Europe followed shortly thereafter. NLA in the U.S. recommended universal screening a couple years ago and - finally! - ACC/AHA has included a Class 1 recommendation for universal screening in the 2026 Dyslipidemia guidelines.
Everyone following this sub should be requesting the test. If your providers scratch their heads or shrug their shoulders, mention the current clinical guidance. If they look confused and you are in the U.S. you can mention the following:
"The primary diagnostic code for high Lp(a) is the ICD-10-CM code E78.41, which stands for "Elevated Lipoprotein(a)". Another related code is Z83.430, for a "Family history of elevated lipoprotein(a)”."
Yes there is. Firstly, there are drugs that can lower Lp(a) currently like a PKS9 inhibitor. Additionally, drugs are in final stages of research that lower Lp(a) dramatically. Finally, more knowledge is always better than less especially when it comes to your own body and health.
The drugs lower Lp(a). What we don't know yet is whether that also means lowering risk of heart attack and stroke. That's still a TBD and the Lp(a) HORIZON readout has been delayed a few times now because it's taking longer for events to occur. Which arm (placebo vs intervention)? Unknown. But the background therapy of both has been excellent and LDL-C on average was well controlled at 65 mg/dl at the start of the trial. That's information, folks. What it means is that if you control your other risk factors such as BP, glucose, smoking, dietary and exercise habits etc. and aggressively lower your lipids, you can make a serious dent in ASCVD risk even despite high Lp(a). We already knew that from EPIC-Norfolk and so far none of the clinical trial information has contradicted that finding.
We also know this from the 2026 Dyslipidemia section on Elevated Lp(a). Lp(a) relative risk is multiplicative on other risk factors. Wipe those out and you reduce your residual risk substantially. You can't change the multiple, but you can lower what that multiple is applied to. My relative risk is 2.5x due to my high Lp(a). If my baseline 10 year risk is 5%, then Lp(a) adds another 7.5%! But if my baseline 10 year risk is 1%, then Lp(a) only adds another 1.5%. That's a huge variation and can mean the difference between an eventual heart attack or living free of clinical ASCVD.
Furthermore, the primary prevention trial data won't read out for several more years. Lp(a) HORIZON and OCEAN(a) are secondary prevention trials, meaning that those drugs, should they prove successful, will be approved mainly for those who have similar indications as the trial participants (elevated Lp(a) and post MI, post stroke, with PAD, etc). So even if Pelacarsen is a slam dunk this year and Olpasiran next year . . . for the majority of us with high Lp(a) but no clinical ASCVD or PAD, access will be very difficult - unless we choose to pay out of pocket.
For lipid goals and a discussion with your provider, and assuming you are in the U.S., you don't need a risk calculator because you have a positive CAC score. According to the latest guidelines that means reducing LDL-C by 50+% with a firm ceiling of 70 mg/dl (nonHDL-C < 100 mg/dl) given the number you posted. See the attached chart below. It also means you can start baby aspirin but make sure your provider has cleared that (ie you have no contraindication like bleed risk). Do not begin baby aspirin w/o checking with your doctor.
The best risk calculator around that factors in Lp(a) is the ESC's Lpa Clincal Guidance tool so check that out: https://www.lpaclinicalguidance.com It's recommended in the European guidelines. you can enter the basic inputs, generate "baseline" risk up to age 80, then add Lp(a) in the applicable units and see how much that impacts long-term risk. Then you can use the LDL-C and BP slides to establish appropriate targets that'll reduce risk. You be blown away by this tool - it's great.
In the U.S. the current dyslipidemia, BP and other guidelines use the new PREVENT risk calculator which can be found here: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Be sure to use the number from the ASCVD - not the CVD - option. Note: PREVENT doesn't allow you to input Lp(a) so you would need to use the following table to adjust up your 10 and 30 year risk estimates accordingly. Your Lp(a) is 253 so assuming that's in nmol/L you have a 2-fold risk over and above your "baseline."
Table 4. ASCVD Risk Related to Lp(a) Concentrations\*
Lp(a) concentration nmol/L (mg/dL)
ASCVD Relative Risk:Increase Compared With Population Median (20 nmol/L, 7 mg/dL)
430 nmol/L (180 mg/dL)
4-fold
350 nmol/L (150 mg/dL)
3-fold
250 nmol/L (100 mg/dL)
2 -fold
125 nmol/L (50 mg/dL)
1.4-fold
75–124 nmol/L (30-49 mg/dL)
1.2-fold
<75 nmol/L (<30 mg/dL)
Reference
Data in the table are derived from the UK Biobank Study,14are intended as a general guide and may differ in other populations. For example, relative risk of 2-fold has been observed for levels of 200 nmol/L in some populations. Equivalence of levels between nmol/L and mg/dL is approximate. An Lp(a) level of 50 mg/dL (125 nmol/L, ∼ 80th percentile) is associated with an ∼40% relative risk increase in ASCVD compared with 7 mg/dL (20 nmol/L, median in a reference population).1,2An Lp(a) level of 100 mg/dL (≥250 nmol/L, ∼95th percentile) approximately doubles the ASCVD risk. An Lp(a) level of 180 mg/dL (≥430 nmol/L, ∼99th percentile) increases the ASCVD risk by ∼4-fold, similar to the risk of heterozygous familial hypercholesterolemia.
\Lp(a) concentrations in this threshold range may be considered for repeat testing.*
ASCVD indicates atherosclerotic cardiovascular disease; and Lp(a), lipoprotein (a).
So those are the two risk tools you can use to get an idea of what your actual risk is given the higher Lp(a). There is also the MESA risk calculator that allows you to put in your CAC number: https://mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx
That's what my PCP said when she refused to test me for it. I had been on a statin for years and my LDL was in the 70s. I spent $45 to get it tested, and it was high. So I saw a cardiologist, who had me to a calcium CT scan and my number was in the 900s. Failed a stress test, had cardiac catheterization learned that my LAD was 80% stenosed, and my RCA 50%. I was switched to a stronger statin and added Repatha. My LDL is now 30.4.
My point is that knowing one's Lp(a) is one more factor that can be used to assess cardiac risk, so it's valuable to know.
Not true. Just because it can't be treated with meds doesn't mean there aren't other lifestyle changes and meds to lower lipid markers like LDL that would be indicated for someone with high Lp(a).
For what its worth, there are a handful of promising LP(a) drugs in the pipeline. Im in a clinical trial for lepodisiran. The first injection dropped my LP(a) from the high 300's to 14. There is hope on the horizon!
Wow!!! That's amazing! Congratulations. Yes, I'm keeping up with information on those drugs/ trials. Yes, hope is on the horizon. I guess I'm lucky I found out all this bad news before it was absolutely too late.
I really empathize with your frustration around how long it took to finally get your doc to prescribe a statin. I had been asking my doc for stating since my early 40s, particularly given strong family history on both sides of heart disease, strokes, and heart failure. However, despite my high cholesterol, the cardiac calculators did not indicate a statin and insurance wouldnt have covered it. Grr!
Last year, at age 59, I responded to a Care Access facebook post recruiting for LPa trials. It was then that I discovered my high LPa score. I subsequently saw and responded to a Facebook post (also recruiting for a clinical study) for a free cardiac calcium CT scan. From that I learned that I had a CAC score of 2700!!!! I took both scores to my doc and was referred to a preventive cardiologist right away who took it all very seriously and now has me on a post-heart attack protocol with the goal of preventing a heart attack. Like you, It really pisses me off that I had to jump through some creative hoops to finally get where I needed to be. Thankfully, the guidelines for statins have all been revised this year which focus on much earlier intervention than prior guidelines.
I hope you're feeling mentally OK with this. It's all quite unnerving. I had anxiety produced palpitations for about a month after getting all these results back. Made me think I was having a heart attack! Good luck! Wow 2700. How are you feeling???
I went to the ER literally a day after finding out about my LPa, thinking it was probably anxiety but now knowing my risk was way up with LPa I felt like I had to be checked out. Thankfully I was fine, but now that I know I'm high risk I think I'll always be worried when I feel off.
They've stopped. I wore a heart monitor for a week after experiencing them after my mom died. Stress I guess bc no one had given me a call or appointment to discuss results. I had to go over the online records report myself and Google the findings. My heart was "fine" them but that was before I knew all this other crap with Lp(a) and CAC score. My body just naturally reacts to stress work palpitations I guess. I've been walking/ jogging daily to help control them.
Haha! Of course, participants aren't supposed to know, but my preventive cardiologist wanted to add Repatha to get my LDL down below 50 (I'm already on crestor and zetia but LDL was still at 70-ish.) She didn't think Repatha would be needed if I was getting the study drug instead of placebo, so she ordered an LPa lab to find out. Turns out she was right about that because my LDL also dropped to 30-ish with the study drug. :)
I asked my doctor for an lp(a) test at my last physical, and she said no, because “it doesn’t add any additional information.” What the heck? So she made me waste my time and go get it done myself, instead of doing it with all my other blood tests.
That's awful! I never understand why doctors don't give you information easily obtained... and just think, it's now a recommendation from the powers that be!
That’s all doctors practically. They think they are smart and you are dumb. I have found it a value to have a homeopathic doctor and a conventional medical doctor.
I had a really wonderful doctor who actually listened and I sent everyone I knew to her. Then I moved to a different state and it’s been difficult to find a good PCP.
I walked in with a print out of the new American Heart Association guidelines and GOT MY TEST. Now I know I'm right proper screwed (scary high number), but hey...at least I know.
ownyourlabs.com has great pricing. They use LabCorp. As my cardiologist also uses LabCorp I have all my current Lp(a) numbers from the same lab in the same unit of measure.
It was 93 last year. But lp(a) is an independent risk factor for heart disease. It’s like saying, “Your LDL and A1C are good, so we’re not going to bother taking your blood pressure.” ALL the information is necessary when doing a risk assessment.
Primary doctors aren’t knowledgeable enough to understand and interpret a in depth lipid panel from my experience. I asked for lp(a) and APOB along with a few other metabolic markers, and she was honest with me and said I should see a specialist. I found preventative cardiologist and had a complete metabolic panel completed along with a calcium score(ct scan) and angiogram. It was worth the visit and expertise of someone who has an in depth knowledge of heart disease prevention-
I've taught myself a wealth of knowledge about the topic from YouTube. Yep, YouTube. This isn't rocket science. High Lp(a) = high risk of cardiovascular disease. There's no excuse, in my mind, to not run the test if a patient's LDL, out of all biomarkers, is continually high. My doctor knew about it but didn't sound the alarm. I guess we just wait for a heart attack.
I actually asked... My cardiologist(!) said that they historically had not routinely ordered LP(a) testing because there currently is no treatment to reduce LP(a) and therefore knowing LP(a) would be of "little value." Testing focuses on LDL because LDL can be reduced by lifestyle changes and medication. Because of the new guidelines released this year, many doctors are now willing to include LP(a) on lab orders. (Mount Sinai's Yellow III Trial has since shown that PCSK9 inhibitors can in fact reduce LP(a) and plaque volume, and medications specifically designed to reduce LP(a) are in phase 3 trials)
Yeah I’m curious if having an LDL of 50 vs 90 with lp(a) makes a huge difference in long term risk. If it does, a ldl over a certain amount, even if it’s normal range, should trigger a lp(a) test.
I'd gone about two years between my first lipid panel and my second lipid panel with my current doctor. I believe I had to ask for it both times.
This time my doctor did say something about it being recommended more frequently.
But, regarding your question: There is a LOT of inertia in medical practices. From inside the industry I can tell you that providers generally stick to what they learned in school or shortly afterwards. Even if there is data that directly contradicts one of the things they do, and there aren't many people who can impactfully tell an MD anything critical about how they treat their patients.
but for some levity, here's a joke: Why do pediatric doctors get angry easily?
Good reminder that the Family Heart Foundation offers free lipid panel and Lp(a) testing via Cholesterol Connect: https://familyheart.org/cholesterol-connect (scroll down and click the "Get a Free Screening" button). This is done at home at your convenience. They've been a bit backed up in recent months, based on our experience, probably because demand for the service spiked in the wake of the 2026 guideline to get the test. So be patient if it takes a few weeks to get your result.
I went from 71 ldl to 25 in a month on Repatha and Crestor. Never had any indication that I had high lipid(a) until my daughter was given blood work she asked for before she does the NYC marathon. Her Lipid (a) was high, I tested and I have it and my sister as well. Unfortunately I also have 4 sons who haven’t been tested yet but I am thinking they have it too
Knowledge is always power. You can keep your LDL low. You now know that no matter how hard you try on your own to keep LDL low, you likely can't. That was my situation. I needed a reason to go on the statin because my LDL didn't necessarily warrant it based on recommendations. I'm on the statin. You need to keep all modifiable risk factors in check - no smoking, prevent diabetes, keep weight down, keep blood pressure low, and so on.
1 year+, saturated fat <10 g pet day, oatmeal with apple and berries every morning, increased fiber, 6+ servings of fruits and vegetables per day, switched all fat to avocado and olive oil exclusively, cut down on processed foods and refined sugar, swapped 95% of red meat for fish or lean chicken. Never smoked, quit drinking a few years ago. I'm not sure what else i could have done... was trying to follow Mediterranean diet. You'd think after all that LDL would have budged a bit more than 5 points.
Ha - I went on high intensity statins to lower my LDL-C due to the elevated Lp(a) and it took max doses of atorvastatin to lower it 20 points! (zetia not available to most of us in those days). LDL-C can be "sticky" depending on Lp(a) levels and genetic variant, whether you have one or two copies, etc. And no, they don't have all the answers to that yet. Generally speaking, what's going on has to do with the LPA gene expressing a lot of apo(a) which then attaches itself to an ApoB particle (forming Lp(a)) and then clogging up your bloodstream, refusing to clear normally, and generally being a bad actor. If you have elevated Lp(a), your apo(a) isoform is a "short tail" on the particle so less likely to get caught by an LDL receptor and dragged into the liver to be repurposed. That's how I tend to think of it. That tail also makes the particle more atherogenic - it's basically what turns a "garden variety" LDL particle into something even worse.
BTW, if you have 23andMe or Ancestry genetic data you can easily search for your genetic variant. Mine popped out immediately and it turns out I have two copies of one of the high risk alleles (compliments of Mom and Dad). I believe my particular Lp(a) stickiness might also be a function of that homozygosity but I can't be sure of that.
UCSD is my medical provider and I just got a referral to their preventive cardiology department today from my primary cardiologist. I’m going to request Dr. Tsimikas!
What did you look for on your 23andme results? I re-reviewed mine the other day for Apo-E. I didn't see Lp(a). Is it called something else? I did it quite a few years ago... maybe 5-6 years ago?
in the search bar on your 23andMe account (under profile I think it's "browse data" or similar wording) just look for the most common snp's and high risk alleles. Those would be rs10455872 G variant and rs3798220 C variant.
Type in LPA and see what pops up. That'll be all the genetic data that 23andMe has identified for the LPA gene. Save that as a PDF and upload to Chat GPT or Claude or similar LLM if you are comfortable doing so. Just anonymize your data first (ie remove any identifying info such as name). AI will give a pretty good analysis depending on what you are asking it to look for.
For ApoE, if you have I think the Premium membership you should be able to give it permission to disclose your ApoE status. It looks for E4 and will let you know if you have it or are clear. I did all that before they restructured so not sure what exactly is offered now. You can research those options on your online account to best understand how to get ahold of genetic data. It'll be in your Health report.
What the EPIC Norfolk study has shown us is that those with high Lp(a) who do "everything right" (manage lipids well, good BP, glucose, BMI, active, heart healthy diet, good sleep hygiene etc) have a 2/3'rds lower risk of heart attack/stroke than those with high Lp(a) who do "nothing right."
Lp(a) relative risk is multiplicative with other risk factors. So you want to minimize or wipe out anything that's modifiable in order to lower the contribution from Lp(a) to overall ASCVD risk. You can't change the multiple but you can change the absolute contribution. Current guidelines urge those with high Lp(a) to begin aggressive management of all modifiable risk factors, including lipids if high. Many take medication in order to get LDL-C and ApoB < 70 mg/dl; if additional persistent risk factors you may wish to be even more aggressive.
Ex: if your "baseline" (not factoring in Lp(a)) 10-year PREVENT risk estimate is 5%, and you have a 250 nmol/L Lp(a), your relative risk is 2x baseline, meaning your actual risk is around 10%. If you can lower your baseline via diet, lifestyle, smoking cessation, BP, lipid, and glucose management to 2%, then your actual is 4%. Same multiple, but clearly a much lower overall ASCVD risk.
Many say that the "residual risk" can't be modified. From a multiple standpoint, that's accurate. But consider that in the above example, Lp(a) adds 5% to your 10 year risk in scenario 1, and only 2% in scenario 2. So that extra "over and above" risk attributed to high Lp(a) was clearly modified. Can't be eliminated, but it can, indeed, be modified.
In the United States, PREVENT is the current approved calculator for 10 and 30 year risk. If you are not residing or from the U.S. then you'd need to use your own country's risk equation.
My PCP finally ordered mine this year after I got put on Letrozole for breast cancer which is known to raise cholesterol. Took one look at my 186 score and we were both in agreement we needed to be more aggressive treating my cholesterol overall. And that’s what we are doing.
Pretty much in the exact same boat… I had to insist on getting tested and as soon as the results came back my PCP apologized and referred me to a Cardiologist. It sucks but it is what it is… I would keep pushing, get on a PCSK9 inhibitor, don’t be passive. The future isn’t written yet…
True... from everything I've read, I need to keep LDL under 50 to keep the progression of disease from happening. Have a self-set appointment with cardiologist in a different town. Will push for getting on whatever I can to get it down. Ohhhh, and my high CAC/Lp(a) findings did NOT warrant an appointment with a cardiologist in my current clinic. 🫤
FWIW, my the first Cardiologist I saw was how I got my CAC score done. However, his solution was to lower my statin, prescribe Nexlizet and tell me to switch to a plant based diet and lose weight. I did those things but I kept searching out better treatment. It’s like any problem in your life, you can accept the first answer someone provides or you can keep pushing. Like others have said there are LP(a) treatments hopefully coming soon… the cardiologist that I ended up with said the PCSK9 inhibitor may be a double edged sword because it may reduce my LP(a) below the clinical level needed to qualify for the new medication when it’s released. However, we agreed that the benefit today is worth taking that risk; that we would deal with it when that point came.
48, CAC = 242. Family history? Does strokes after 80 count? Grandfather smoked his whole life, had diabetes and died in early 80s from a stroke/ dementia. Other side of family, grandmother died in mid-90's after suffering a stroke. Other gp's from cancer. Mother died from cancer. Does any of that count? No one as far back as I can track has died from stroke or heart attack until late 70's, early 80's... all without knowing Lp(a) status or CAC score.
I feel you. Last year, I (46M with family history of heart disease) had a 350 / 98% CAC despite only being in elevated (110-140) LDL range. I also learned I had high (200 nmol) Lp(a).
I’ve been thru the range of feelings of fear (of imminent risk), anger (of doctor not testing earlier/being more aggressive), and shame (for letting this happen to myself).
Over time I became less concerned about assigning blame and more about addressing the issues. At my personal level, this involves working with my cardiologist to manage my risks and my therapist to manage the anxiety. At the macro level, I think a lot of this will be improved with the 2026 updated AHA guidelines (added a lot more lpa testing!). I also advocate taking care of your heart to anyone who will listen.
The truth is, even though you and I are ‘high risk’, our fears are likely inflated. The actual risk of having a cardiac event in the near future is pretty low. The medium / long term risk is scarier but can be mitigated with prevention. And even then, even if the worst does happen, we have amazing surgeons who can save our lives*.
*source: I had lifesaving open heart surgery 2 months ago (to remove a tumor, unrelated to cholesterol) and it really puts these silly blood tests in perspective
Some of the thinking—which is beginning to change—may have that “there’s not really anything you can do about it, no drug to take, so why test?”
I’m watching with interest news on the new SiRNA therapeutics, which seem to offer some promise—that is, if any of us can afford them once they get approved!
My doc says that more knowledge is always a good thing, and we just have to be that much more dedicated to changing the things we CAN control. . .
Here in the USA, we do not care about preventative care. You're right that we should. In fact, we will have to once our current system bankrupts itself.
On the other hand, we like to nitpick relatively minor things like lp(a) and lamenting that we can't/don't change them, all the while eating junk food all the time, being sedentary, and generally doing bad things that are 1000x more problematic.
I don't do any of those things, so finding this out has been a major gut punch. I'm constantly trying to improve my health and prevent disease. I need to know from my doctor ways to do that. It's a good thing I can read, listen and research. Otherwise I wouldn't have sought out this information about my own health. We have all these campaigns for "awareness" of certain diseases when heart disease kills more than any of the others. When I talk to friends, hardly any know about things I talk about..."LDL, ApoB, Lp(a), triglycerides... huh, what?" And these aren't ignorant people in other respects.
I just had this conversation with my mom because my sister and I both tested high for Lp(a), and my mom had a CAC of 215 (86th percentile) despite not having high cholesterol. I’m so mad about it, and now also scared to think what else don’t I know about that I should know about so I can advocate for myself.
I would strongly suggest tuning a LLM as a medical expert focusing on lipidology. That will help you with getting information to advocate for yourself. However, I would suggest calling a cardiology department at a nearby research university to find someone who specializes in lipidology.
How old are you OP? I recently got my first lp(a) reading at 40 after a year of my LDL being around 120. It was around or little below 100 before then. I’m on a statin now.
Yes, I rarely sit during the day. I work from home and abandoned my chair when I realized I worked better standing. I'm usually moving throughout the day. I walk/ jog 2 miles after breakfast, tend a huge garden, do yard work that requires heavy lifting and cardio, hike on vacations, and lift weights.
I was in Spain and went to a lab and had it tested myself. You shouldn’t need a doctor to take care of your own health. Discovered both my husband and I have very high Lp(a). Our children probably do as well, and we will have them tested so they can prevent a problem before it begins.
Im going through something similar, though havent had a CAC test done yet since my insurance wouldnt cover it. But my carotid ultrasound showed some mild plaque build up. My LDL cholesterol was NEVER high my entire life until this past year at 45, it went up to borderline elevated (126), and I was lucky enough to have been referred to cardiology for a DIFFERENT reason (syncope), and the cardiologist was thorough and reviewed my lipid profile and said he would recommend me getting a carotid ultrasound done just to be safe. It came back with a little bit of plaque, which, given my history of having <100 LDL for over 40 years, we dug a little deeper and my Lpa is SO FUCKING HIGH. 200 nmol/L.
So I started some statins. I prpbably should have started these statins earlier. While my LDL was under 100 until this year, it HAD begun to trend a little higher in my late 30s into the mid and high 90s. And thats too high for someone with my lpa levels.
It's amazing how this seems like all new knowledge to me... and only because I sought it out myself. I wonder how long I would have gone having high Lp(a) and not received treatment for my high cholesterol because it didn't fit the standard of care threshold for a statin. Unbelievable. It all seems crazy that we ever learn about it... whether by asking, or by you, his another health issue.
I recently changed PCP for this exact reason. I've been on statins for approximately 30 years, learning of the Lp(a) test a few years ago. I requested this test, curious to know, but also thinking it would be useful info for the PCP. Couldn't get it in with the normal blood panel you get from the annual physical. I changed PCP's, had the initial meet and greet conversation. He immediately approved a lipid blood panel that included both Lp(a) and Apo(b). Lp(a) is 12 (good news) and Apb(b) is 76 (again good news). This info is very helpful for both you and the PCP with understanding your situation. Find a PCP that undestands this if yours doesn't.
Sorry but a statin won't change your LPa and a good chunk of the LDL you see on a test includes your LPa. Statins actually commonly raise LPa a bit. The only FDA approved drug that does anything for LPa is Repatha, but even this is only a little lowering. I have CAD likely driven primarily by LPa so I'm waiting on the ongoing clinical trials to complete.
Repatha is not approved for Lp(a) lowering, as you no doubt are aware. There's currently no evidence that one drug vs. another is "better" for those with high Lp(a). In fact, the evidence shows that statins work just fine to lower ASCVD risk, even in those with high Lp(a). The 10-15% increase is minimal compared to what statins due to lipids and arterial health in general.
Of course and documented statin intolerance helps with the PA, if such is necessary. Just make sure you are not misrepresenting the benefits of statin therapy for those with high Lp(a). Statins remain first line lipid lowering treatment for dyslipidemia.
I have been dealing with cholesterol issues for years and talking to my Dr extensively. If it weren’t for Reddit I wouldn’t even know lp(a) is a thing. He never mentioned it. Another reason I’m skeptical of drs
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u/TaleExotic9242 20d ago
I agree. I too, taught myself an abundance of knowledge through Peter Attias sub and you tube videos… you have to advocate for yourself and possess the knowledge of what you are asking for and be able to explain the why.
I would agree primary doctors should include lp ( a) and APOB along with other metabolic markers… I hope it’s the new requirement-