Active pescatarian is troubled by high lipoprotein(a) level, risk for disease

DEAR DR. ROACH »

I’m a 56-year-oldfemale with very high lipoprotein(a) and am wondering if I should be concerned about it. 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, although my blood pressure isn’t normally high. 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’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, and should people be tested? — M.L.

ANSWER » 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.

As such, people with high levels of Lp(a) are recommended for other therapies that reduce heart disease risk.

Statins, although they tend to increase Lp(a), nonetheless seem to reduce heart disease and stroke risk anyway, so I agree with the rosuvastatin (Crestor) you take. Your LDL level is below 70, so most experts would probably hold off on additional therapies for you at this time.

Those other therapies to be considered for people with elevated Lp(a) and who have not had such a good response to the statin include: aspirin, which you’re on; ezetimibe (Zetia); and evolocumab (Repatha).

A new therapy, called antisense oligonucleotides, has been shown to reduce Lp(a) levels by up to 80%. It’s not yet clear whether this will translate to fewer heart attacks.

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