March 24 was Lipoprotein(a) Awareness Day and a timely reminder for Australians to understand their inherited heart attack and stroke risk and ask their GP whether testing is appropriate.

Last week NSW Health Pathology’s Chem­i­cal Pathol­o­gy Depart­ment at Roy­al Prince Alfred Hos­pi­tal (RPAH) sup­port­ed an event focused on improv­ing under­stand­ing of Lipoprotein(a), often abbre­vi­at­ed as Lp(a).

Lp(a) is a type of “bad” cho­les­terol which has puz­zled health experts for over 30 years. Unlike oth­er forms of cho­les­terol, Lp(a) lev­els are large­ly deter­mined by genet­ics and do not respond to stan­dard diet and med­ica­tion advice.

Senior Staff Spe­cial­ist in Chem­i­cal Pathol­o­gy at our RPAH lab­o­ra­to­ry, A/Prof David Sul­li­van says fam­i­ly his­to­ry plays a sig­nif­i­cant role in deter­min­ing lev­els of Lp(a) in the blood.

“One in five peo­ple has ele­vat­ed lipoprotein(a), or Lp(a) but it often goes unde­tect­ed in stan­dard checks,” Asso­ciate Pro­fes­sor Sul­li­van explains.

“An Lp(a) test is a sim­ple, once-in-a-life­time blood test.”

In Aus­tralia, selec­tive test­ing is rec­om­mend­ed for peo­ple with a fam­i­ly his­to­ry of pre­ma­ture heart dis­ease or those at inter­me­di­ate to high car­dio­vas­cu­lar risk. How­ev­er, Asso­ciate Pro­fes­sor Sul­li­van says there is a strong case for broad­er access.

“We need guide­lines to change to sup­port bet­ter access to test­ing, par­tic­u­lar­ly for patients who have already expe­ri­enced a car­dio­vas­cu­lar event.”

What does Lipoprotein (a) do?

While the pre­cise bio­log­i­cal role of Lp(a) remains unclear, its health impact is well established.

“We don’t know its exact func­tion, but we know that it is a harm­ful inde­pen­dent risk fac­tor for heart attack, stroke, artery and valve disease.”

What can we do about lipoprotein (a)?

“The first step is mea­sur­ing it. More recent­ly we have learned how to treat it with the aim of pre­vent­ing heart attack and stroke.

“It will be impor­tant to mea­sure lev­els in peo­ple who may need nov­el treat­ment, such as those who have had an unex­plained heart attack or stroke.

“Roy­al Prince Alfred Hos­pi­tal and NSW Health Pathol­o­gy have been lead­ing these devel­op­ments for over 30 years.”

Advice on mea­sur­ing and man­ag­ing Lipopro­tein (a) is also a fea­ture of the recent­ly pub­lished update to the Amer­i­can Heart Asso­ci­a­tion (AHA) Guidelines.

A patient advocate’s experience

Also attend­ing this week’s aware­ness day event at RPA was patient advo­cate, Chris Daws, who shared her per­son­al expe­ri­ence with Lp(a).

In 2022, Ms Daws was admit­ted to hos­pi­tal with pneu­mo­nia. Dur­ing her admis­sion, doc­tors unex­pect­ed­ly dis­cov­ered wide­spread coro­nary artery dis­ease, despite her hav­ing few tra­di­tion­al car­dio­vas­cu­lar risk factors.

Fur­ther test­ing uncov­ered very high lipoprotein(a) lev­els, explain­ing both the sever­i­ty and ear­ly onset of her heart disease.

Learn­ing that her con­di­tion was hered­i­tary proved life-chang­ing. Ms Daws is now a pas­sion­ate advo­cate for increased aware­ness of Lp(a) test­ing and pre­ven­tion, work­ing to edu­cate her own her fam­i­ly and the wider com­mu­ni­ty about inher­it­ed car­dio­vas­cu­lar risk.

Topics