Sometimes a heart attack just doesn’t suit the patient. In such cases, it is important to determine an often neglected value: lipoprotein(a). You can read why here.
Too high LDL cholesterolvalues lead to an increased risk of heart attacks and strokes. So far, so well known. However, another risk factor receives significantly less attention among doctors: that Lipoprotein(a) (Lp(a)). A reason for Dr. Christoph Altmann, Chief Physician at the Clinic for Cardiovascular Diseases at MEDIAN Klinik Bad Gottleuba, to dedicate himself to the often neglected plasma protein.
Not treating is not the answer
An elevated Lp(a) level is mostly hereditary and is considered an independent risk factor for the Coronary heart disease and arteriosclerosis – and yet it is rarely recorded in patients with heart attacks. “Lp(a) is only determined in regarding 5 percent of heart attacks,” says Altmann. The reason: Many doctors told him that they would not record the Lp(a) “because we can’t do anything regarding it anyway,” says Altmann in an interview with DocCheck.
Therapy for an elevated Lp(a) level is indeed not uncomplicated. To date, there is no approved drug treatment that provides truly satisfactory results. stays the Lipidapheresea form of hemapheresis in which LDL cholesterol, Lp(a) and triglycerides can be removed from the blood. With a duration of treatment between 1.5 and 3 hours and a one or two week cycle – depending on Level of the initial values - however, it is not necessarily feasible for many patients or is not even covered by health insurance. But why not look in the first place?
Knowledge always helps
Altmann doesn’t understand the attitude of many colleagues. “It is important to inform the patient. In addition, there are always ways to react – even if it’s preventive care.” The chief physician and his team only started examining Lp(a) regularly a few years ago. For regarding 10 years, they have been determining Lp(a) in all heart attack patients under the age of 60 as standard. “Some patients just don’t fit the typical pattern. They are active in sports, relatively young and have few risk factors, do not smoke. There it makes a lot of sense to check the Lp(a),” explains Altmann. A hit rate of 25 percent in these patients proves him right. “But we are often the first to determine Lp(a) in these people at all.” And that, although the recommendation every adult at least once in their life the Lp(a) to be determined, since 2019 in the Guidelines the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). (Class IIa recommendation).
The chief physician does not want to accept the argument of the lack of therapy options. Just because there aren’t many options right now doesn’t mean a patient doesn’t have the right to know if they have an elevated Lp(a). With the knowledge he might take preventive measures and, for example, advise close relatives to also be examined. He can also inform himself and stay up to date with regard to the availability of medicines. “We have recognized how important it is for patients to feel supported and informed.” That’s why Altmann helped some time ago to set up Germany’s first and so far only Lp(a) self-help group for affected patients.
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More visibility, more research, better treatment
First, he consulted regularly with colleagues – and found that they all had positive experiences when they shared their diagnosis and information with patients. So he organized patient meetings where information regarding Lp(a) was given. “Patients are grateful that they are given tips and are informed regarding their options and the current state of research,” says Altmann. Eventually, a few affected people came together to set up the self-help group. On your website Patients – and also doctors – can now find important information and regular training courses from specialists in order to find out regarding the topic of Lp(a). “If doctors shy away from the time it takes to inform their patients regarding Lp(a), they can also order flyers and information material from us to display in the practice,” explains the doctor.
In addition, research is well on the way to the point that more options will soon be available to those affected. “First of all, in patients with elevated Lp(a), the cholesterol levels are suppressed. There are also fascinating new lipid-lowering drugs that can be injected weeks or months apart. Unfortunately, they are not yet approved for the treatment of elevated Lp(a), but individual solutions can also be found there if you expect success.” Altmann regularly supports those affected, writes to doctors or health insurance companies, so patients receive treatment. And some new treatment approaches are already in the pipeline. That’s how it will be Antisense Oligonucleotide Pelacarsen is currently testing a drug that might reduce Lp(a) levels by an average of 80 percent. First clinical studies are promising.
“So it’s not as hopeless as it seems. You should also tell the patient that,” says Altmann. Also the possibility of clinical studies Doctors should inform those affected to participate. For the future, Altmann would like more medical professionals to keep Lp(a) on their radar, especially when a heart attack doesn’t quite suit the patient. This is the only way to create more visibility for the parameter. Altmann would also like more members for the self-help group so that those affected are not left alone with their worries and questions.
Image source: Li Zhang, unsplash
