At the Kahn Center, we see many patients that we identify have inherited the ability to make excess Lipoprotein(a) or Lp(a), a genetic cholesterol that ads risk to the standard lipid profile. It is inherited by about 20-25% of people at conception and is elevated in the blood lifelong in those persons. Other patients at the Kahn Center seek consultation because they found out on their lab studies that they inherited Lp(a).
Lp(a) is associated with ischemic stroke, but the strength of association based on demographic differences remains unclear. A new study aimed to investigate the association between Lp(a)>125 nmol/L and stroke by age, sex, and racial/ethnic subgroups.
Using data from the UK Biobank, 353,309 participants with an Lp(a) measurement without a history of atherosclerotic cardiovascular disease (ASCVD) were analyzed.
Stroke was defined as ischemic stroke or hemorrhagic stroke (with subtypes subarachnoid hemorrhage and intracerebral hemorrhage). The risk of stroke based on Lp(a) measurements was determined.
The study population consisted of 56 % women and 94 % White individuals with average age of 56 years. The median Lp(a) level was 21nmol/L and prevalence of Lp(a) >125 nmol/L was 11.1 %.
Over a median follow-up of 14 years, there were 5002 (1.4 %) ischemic strokes and 1462 (0.4 %) hemorrhagic strokes.
Lp(a) > 125 nmol/L was associated with a 12% increased risk for ischemic stroke but not hemorrhagic stroke.
The association between Lp(a)>125 nmol/L and ischemic stroke did not vary by age or race/ethnicity but did vary by sex with an association among men (20% higher) but not among women.
Lp(a) is independently associated with ischemic stroke, with variation by sex but not age or race/ethnicity. Lp(a) was not significantly associated with hemorrhagic stroke.
At the Kahn Center, we recommend aspirin or nattokinase to patients with an elevated level >125 nmol/L unless a contraindication is present.
Lp(a) is a challening risk factor at present as their is no FDA approved therapy for it. At the Kahn Center, we attempt to lower Lp(a) by reducing statin dosing if present and adding in ezetimibe, recommending hormone replacement therapy to suitable women, discussing the pros and cons of niacin (vitamin B3) therapy, and some other natural approaches like the Pauling Theory (C/Lysine/Proline) and amla. Ongoing studies of new agents are very much anticipated.
