Lp(a) has a similar effect to the “bad” LDL cholesterol. While an excessively high LDL cholesterol level can be reduced at least within certain limits through a healthier diet and more exercise and can otherwise also be treated with medication, the situation with Lp(a) is different. The genes largely determine how much Lp(a) is in the blood and there are currently no drugs on the market that can reduce this genetic risk factor.
First drugs are tested
However, the head of the Institute for Genetic Epidemiology at the Medical University of Innsbruck, Florian Kronenberg, sees a silver lining when it comes to drug treatment. There are currently studies worldwide with drugs that can reduce the Lp(a) concentration by 80 to 90 percent. It is expected that this massive reduction will also reduce the risk of heart attack and stroke. The first studies should be completed in 2025, says Kronenberg.
Lp(a)-Spiegel
The Lp(a) level is not considered elevated if it is below 75 nmol/L or below 30 mg/dl.
If the drugs really do reduce heart attack and stroke rates, then these drugs would first be used in patients who have already had a heart attack or stroke. Only further studies would then show whether these drugs are of any benefit at all in people who have had a stroke or heart attack.
There is no need to panic when the Lp(a) level is high
The most important thing for Kronenberg is not to panic if an increased Lp(a) value is detected. If there are no other risk factors such as high blood pressure, high LDL cholesterol levels or diabetes, then an elevated Lp(a) value is easier to bear than if there are many risk factors, says the expert.
A single measurement is sufficient
One should never look at an elevated Lp(a) value in isolation, but relate it to the other risk factors and then develop a plan on how to proceed. That might be a change in lifestyle, but often also a drug treatment of the other risk factors, says Kronenberg. The Lp(a) value can be examined as part of a blood test. According to Kronenberg, a one-off measurement is sufficient because the value is genetically determined and is therefore only subject to minor fluctuations.
Tyrol at the center of Lp(a) research
As far as research on Lp(a) is concerned, Innsbruck has held a leading position for decades. In the 1990s, the former head of the Human Genetics Section, Gerd Utermann, and his team published the most fundamental work on Lp(a) genetics. This is what made it possible to prove Lp(a) as a causal risk factor for heart attacks and strokes, says Kronenberg from the Tyrolean research.
Lp(a) has been examined in large population studies over the past few decades and there is very precise data on the frequency of an Lp(a) increase and on the connection with heart attacks, “we are still very active there,” says Kronenberg.