Besides LDL, Lp(a) can also increase risk for heart disease

Jan 20 2010

LDL isn't the only "bad boy" when it comes to cholesterol. According to a new study, a lipoprotein in the bloodstream called Lp(a) — pronounced "LP little A" — can be labeled "bad cholesterol." The landmark study Genetic Variants Associated with Lp(a) Lipoprotein Level and Coronary Disease recently published in the New England Journal Of Medicine provides the strongest evidence to date that Lp(a) can cause heart disease.

Michael Cobble, M.D., is chief medical officer of Atherotech Inc., developer of the VAP (Vertical Auto Profile) Cholesterol Test that includes Lp(a) as part of its standard panel at no additional cost. Cobble said that while LDL, non-HDL and apoB remain the most dangerous and reliable indicators of heart disease risk, Lp(a) is now a strong additive predictor of risk. All four tests are provided at no extra cost in the VAP lipid panel.

"This study will lead to changes in how physicians approach cholesterol testing and treatment because it demonstrates a growing need for expanded lipid profiling," said Cobble. "This was a well-designed study built on a foundation of several other studies showing a strong association between Lp(a) and heart disease. It gives us conclusive evidence that there is a link between increasing levels of Lp(a) and increasing risk of coronary artery disease, and it indicates that we can identify this added risk."

Cobble said the findings also help to partially explain why the standard cholesterol test fails to detect up to half the people at risk for coronary disease, and why many people with "normal cholesterol levels" still end up having heart attacks.

Standard cholesterol tests check for levels of LDL (bad cholesterol), HDL (good cholesterol), triglycerides and total cholesterol. Comprehensive lipid testing provided by the VAP Cholesterol Test reports Lp(a) along with other important cholesterol subclasses, non-HDL, emerging heart disease risk factors such as the apoB/apoAI ratio, low-density lipoprotein remnants and small dense LDL as well as triglyceride-rich remnant lipoproteins. The VAP Test also doesn't require fasting and provides a direct measurement of LDL. The VAP Test results may also significantly improve medical treatment for controlling cholesterol levels long before they affect the heart.

Cobble added that in patients with a family history of high cholesterol or early heart attacks, a detailed lipid profile such as the VAP Test may be particularly helpful in diagnosing early problems, including the lack of enough HDL2, HDL3 or too much Lp(a).

The only currently available drug for lowering Lp(a) is niacin, although other drugs are currently in development.

The VAP Test reports 22 separate components of cholesterol, including Lp(a), and is covered by Medicare and most private insurance carriers. Unlike other lipid profiles, the VAP Test includes Lp(a) at no additional charge, and it directly measures all three lipoprotein parameters — LDL, non-HDL and apoB — considered necessary by the expert consensus guidelines issued by the American Diabetes Association and American College of Cardiology. The VAP Test identifies a far greater number of people at risk for heart disease than standard cholesterol tests and is the only single cholesterol test that routinely reports apoAI, apoB and the apoB/apoAI ratio.

People with a family history or an existing condition of diabetes, high blood pressure or heart disease — or who are already taking cholesterol-lowering medication — are candidates for the VAP Test.