The good, the bad and the ugly of heart disease risk factors

All cholesterol is not created equal – HDL is known as the good cholesterol, LDL is the bad and lipoprotein(a), called Lp(a), is the ugly. The reason most people don’t even know they have high Lp(a), the strongest inherited risk factor for heart disease, is because it is not routinely measured. What’s more, there is no approved effective treatment available.

“Lp(a) is known as the stealth risk factor. It is hereditary; 90% of the levels are determined by your genetics. There is no approved therapy that lowers the levels of Lp(a). What we can do is treat other risk factors using statins, a PCSK9 inhibitor or lifestyle changes to lessen the overall cholesterol burden,” said Dr. Christie Ballantyne, professor of medicine and chief of the section of cardiology at Baylor College of Medicine.

LDL, low-density lipoprotein cholesterol, is a type of cholesterol that can cause blockages in the walls of your blood vessels. There are effective measures, whether lifestyle adjustments or medication, that help maintain healthy levels.

Lp(a) is a lipoprotein that travels through the bloodstream, collecting in arteries, leading to gradual narrowing of the artery that can limit blood supply to parts of the body, including the heart and lungs. It can increase the risk of blood clots, heart attack or stroke.

There is a light at the end of the tunnel. Studies that target the production of Lp(a) currently are ongoing, and so far the results are promising. These new therapies target messenger RNA, the genetic material that contains instructions for making proteins. The drug therapies target and block the production of Lp(a) before it can affect cardiovascular health.

“Our studies in patients with clinical heart disease have shown a drop in Lp(a) levels by 80 to 90%, and we are finding that very low dosages have a long lasting effect, with injections needed every 1 to 3 months,” Ballantyne said. “This will help with medication adherence; it is much easier to get a shot once a month or every few months versus daily medications.”

While studies are ongoing, what you can do now is to talk to your doctor about your risk factors. There is a blood test to measure Lp(a) levels as well as genetic testing.

“Until a therapy has been approved, the most important part of knowing this number, along with your other risk factors, is understanding your overall risk.

Your doctor can help you find the right lifestyle modifications or medications to target the other traditional risk factors such as smoking, diabetes, high cholesterol and blood pressure and family history,” Ballantyne said.

Ballantyne also is the director of the Maria and Alando J. Ballantyne Atherosclerosis Clinical Research Laboratory at Baylor, director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center and co-director of the Lipid Metabolism and Atherosclerosis Clinic at Houston Methodist. He also holds the J.S. Abercrombie Chair in Atherosclerosis and Lipoprotein Research at Baylor.

Learn more about heart health here and find more info on a current study looking at ways to reduce Lp(a) here.