“When your doctor asks you to do tests to find out the condition of your sugar, liver, kidneys and red blood cells, he should tell you Aren’t I asking for lipoprotein A?“Suggests Pablo Corral, former president of the Argentine Lipid Society (SAL) and lead researcher on a study that showed this A third of Argentines have high Lp(a) levels.This increases the risk of heart attacks and strokes, among other cardiovascular diseases.
In the framework of the first multicenter study that evaluated the prevalence of lipoprotein A in Argentina and its clinical outcomes were evaluated About 3,000 adults From six regions of the country who attended their routine clinical or cardiology consultations, in both the public and private sectors.
They weren’t necessarily people with high cholesterol: Their doctors simply ordered a blood test to measure Lp(a), among other variables. 31.4% were highwhich is higher than the estimated global prevalence rate. The work has just been published in arteriosclerosisone of the most important medical journals in the region.
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“Large studies conducted in different parts of the world, but mainly in Europe and North America, have shown that one in four or one in five has an elevated lipoprotein(a) level (between 20% and 25% of the population). We did not have local data and In Latin America there was no precedent either From a study like the one we conducted,” he commented Clarion Coral, who has been researching the topic for more than a decade, is today considered a reference at the local and international levels.
He began his studies in Mar del Plata, where he resides, and from there he built a network of… 70 researchers Which makes up the Argentine group Estudio Lp(a) -GAELp(a). “We created a tool that evaluates 50 variables (parental, clinical, laboratory, imaging and therapeutic data) and we measured the prevalence, that is, the percentage of the Argentine population that has an elevated lipoprotein (a) level and whether it is associated with heart attacks and strokes, among other modifications,” he explained.
They found that elevated Lp(a) levels independently predicted major cardiovascular events (MACE), “reinforcing its role in the treatment of cardiovascular disease.” Residual sign of danger to the heart and blood vessels“.
“Lipoprotein A has gone from being an unknown lipoprotein to becoming a lipoprotein Central determinant of residual cardiovascular risk“Wrote Tariq Harb, Gary Gerstenblith, and Thorsten M. Locker, of the Department of Cardiology at Johns Hopkins University School of Medicine, in Baltimore, US, who analyzed the Argentine work in an editorial commentary published in arteriosclerosis.
Remaining, keyword. What does that mean? That risk is still high Even when the classic factors are under control Which contribute to its increase, such as harmful cholesterol, high blood pressure, smoking, diabetes, obesity, and a sedentary lifestyle, which helps explain why some people develop cardiovascular diseases despite controlling the rest of their indicators.
The presence of high lipoprotein(a) (defined as values ≥50 mg/dL or ≥125 nmol/L) was associated with a population studied in Argentina with 53% more likely to have a heart attack, stroke, or other complications higher, compared to participants with lower values.
The paper’s authors wrote that the registry results underscore the need “Early detection” “Routine Lp(a) testing in the prevention of atherosclerosis-related cardiovascular disease,” especially among those with more risk factors.
In this sense, at the beginning of the year, the experts gathered in the International Working Group Lp(a) signed the Brussels Declaration, a call to “Lp(a) testing is routine and universally accessible.”.
Currently, “despite the strength of scientific evidence, Less than 2% of the world’s population is tested This has left the vast majority unaware of their risks and without access to potentially life-saving preventative care, the statement’s authors warned.
“truly It will be a before and after “When we also have tools to manage high values,” said Corral, who traveled to Belgium to represent Latin America.
The “mysterious sister” of LDL cholesterol
Lp(a) has been known for six decades, but in recent years research has accelerated. Austrian researcher Florian Kronenberg, one of the world’s leading experts, described it as “mysterious” because although its study has flourished (also driven by the development of treatments to lower its levels), there are still many unresolved questions about Lp(a).
There is a growing consensus among those who have studied it for years: Without measuring it, there is a deficiency A key piece of the puzzle Of cardiovascular risks.
Cholesterol is transported through the blood by lipoproteins, which are measured in laboratory tests. We are accustomed to reading in the results the values of total cholesterol, LDL (popularly known as the “bad”, although experts insist that we stop calling it that) and HDL (popularly known as the “good”). But it is not common for Lp(a) to be requested.
What is Lp(a)?
“It is a subtype of atheroma cholesterol that is genetically inherited. It is like the color of eyes, it cannot be changed. You are born with a value which cannot be modified today because although it is under development, there are still no drugs to lower it,Or it is acquired by bad habits, and does not improve by good habits. “It’s like a genetic stamp that we have that is associated with cardiovascular disease,” Corral explained.
“A person can have too much total cholesterol, but part of that cholesterol is provided by lipoprotein A. If you don’t measure it, you’re not seeing the whole picture.. He added that the elements evade you.
– What’s the point of measuring it if nothing can currently be done to modify it?
— Many patients, and even colleagues, ask this question. When you have high Lp(a), Your heart risk goes up a little. What does this mean? If you have low heart risk, but you measure your Lp(a) and it is high, you are no longer low risk, you are average risk. If you have medium risk, you go to high risk.
That is, a higher Lp(a) means that all other variables must be adjusted: You have to lower your cholesterol more, and you have to control your blood pressure better. And all other risk factors.
Since it is a hereditary disease, if a family member suffers from high Lp(a), You have to measure it in the restwhich helps discover family members most at risk. Among the patients we measured in Argentina, the Lp(a) value was higher on average in the familial hypercholesterolemia group.
—Is measuring Lp(a) expensive? Is there little reference due to cost issues or lack of knowledge among the medical community?
—I think it’s 95% ignorance, because Lp(a) is a detector like any other.It costs much less than measuring vitamin D The same as the TSH assessment, which is the value one asks for when looking for thyroid disorders. It’s an available determination, it’s not complicated — it’s measured through a blood test — and it’s not expensive. All international guidelines state that every person should, at least once in their life, know their lipoprotein A value.
The Lp(a) value is genetically determined. Shutterstock illustration.Treatments are on the way
In editorial commentary, Johns Hopkins researchers welcomed the generation of local data and noted that “with several Lp(a)-lowering targeted therapies currently in late-stage clinical outcomes trials, the importance of understanding specific population distributions and relationships to risk is important.” He has never been greater“.
– How close are they to approval and how do they work?
There are five medicines in the world that are in the third stage, which is the last stage before these medicines are marketed. It’s very likely that we have two of them Results in 2026. They change the protein that generates Lp(a) and prevent it from being produced by the liver. Applied subcutaneously, usually once a month, they reduce lipoprotein by up to 90%, Corral concluded.
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