Pescatarian is troubled by level

Dear Dr. Roach: I’m a 56-year-old-female with very high lipoprotein(a) and am wondering if I should be as concerned about it as I am. I became aware of it in 2018. After almost two years of looking for a doctor to take my concern seriously, I was tested again. I also had a carotid ultrasound and a stress test (treadmill); both were apparently OK.

I’m now taking blood pressure medication. I started at 5 mg ramipril and am now at 10 mg. I also take 20 mg of rosuvastatin, which contributed to my LDL going from 137 to 69 in about two months, and I take an 81-mg extended-release daily aspirin. I also have four glasses of red wine each week and take cod liver oil. My doctor told me that changing my already pretty good diet wouldn’t help, and he encouraged me to keep exercising.

I’m very active, not overweight and a pescatarian for the past 28 years. My mother, father and brother died of heart attacks. How concerned I should be? — M.L.

Lp(a) — lipoprotein A, called “L P little A” — is a risk factor for heart disease and stroke. Several mechanisms are known that link Lp(a) with increased blockages in blood vessels as well as blood clots, both of which are instrumental for heart attacks and stroke. Unfortunately, there are no known treatments that reduce Lp(a) that have also been proven to reduce the risk of heart attack and stroke.

Testing is recommended for people with heart disease or a very strong family history.

Your pescatarian diet and the fact that you exercise are likely to reduce your risk, but neither the red wine nor the cod liver oil are proven to reduce heart disease risk.

In my opinion, a cardiologist with expertise in managing cholesterol abnormalities would be a useful consultant.