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Lipoprotein(a)

Published on November 28, 2024   20 min

A selection of talks on Biochemistry

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0:00
Hello there. My name is Jaimini Cegla. I'm a consultant in Metabolic Medicine at Imperial College Healthcare NHS Trust. I've got a special interest in lipids and cardiovascular risk. Today, I'm going to be talking about lipoprotein(a), or Lp(a) for short.
0:18
What I hope to cover over the next 20 minutes or so is the effect of lipoprotein(a) concentration on cardiovascular risk, in whom we should consider measuring Lp(a), some of the current and future treatment options, and further research avenues that we have available.
0:37
I'm going to start off with a case, and this is someone that I'd typically might see in my clinic. This is Mrs. K. She's a 57-year-old lady and she's got a background history of some fibromyalgia, and she had a PCI to her LAD in 2022. Her medicines are as much as you would expect in someone who's had a PCI, and she's on atorvastatin 20 milligrams once a day for cholesterol. There is a noise in her family history. Her father had an MI at 59 and her brother had a PCI at 62. Her blood pressure is pretty reasonable; it could be slightly more tightly controlled, her BMI is 24 and she's a non-smoker. Looking at her lab tests, we can see that her CRP is normal; her eGFR is normal. She doesn't have diabetes, and her lipids are not ideal; her LDL cholesterol probably could be a bit more tightly controlled.
1:31
That's the standard lipid profile we would get. However, in someone like her who has not really had any other obvious risk factors other than that family history, in our clinic we would have tested lipoprotein(a). In this lady, her Lp(a) came back at 355 nanomoles per liter. To put this into context, when we look at the EAS, elevated Lp(a) thresholds, you talk about 125 which equates to the 83rd percentile of Lp(a) concentration, her levels are exceptionally high. These are between the 95th and the 99th percentile. These really help to explain why this lady may have had premature cardiovascular disease.

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