Not all so-called bad cholesterol would be equally scary. The danger to the arteries is called ‘ new bad cholesterol ‘, or Lipoprotein (a). Known by the acronym Lp (a), it is a significant genetic risk factor, neglected for too long, for cardiovascular diseases, which represent the leading cause of death globally, with an estimated 17 million deaths per year.
It was discovered more than 50 years ago and is structurally similar to Low-Density Lipoproteins (Ldl, the bad cholesterol ‘ traditional ‘) and synthesized by the liver. The low-density Lipoprotein (Ldl, in fact) is associated with an apolipoprotein (a), and for this reason, responsible for the transport of cholesterol in the blood.
Like Ldl, Lp (a), if the new cholesterol has high levels (> 30 mg / dL), it helps to increase a person’s overall risk of developing atherosclerotic diseases such as coronary artery disease and stroke. Lp (a) promotes Ldl accumulation on the blood vessel wall, thus favouring the formation of atherosclerotic plaques. Plaques can lead to narrowing blood vessels and consequent blockage of blood flow, increasing the likelihood of many problems, including heart attack and stroke. Studies have shown that high Lp (a) levels are associated with an increased risk of coronary heart disease and aortic valve stenosis. Moreover, people with familial hypercholesterolemia (Fh) have increased plasma levels of Lp (a) compared to those who do not suffer from familial hypercholesterolemia. Conversely, genetically determined low levels of Lp (a) [<30 mg / L – (<75 nmol / L)] are associated with reduced cardiovascular risk.
No cure now
However, Lp (a) does not respond to standard Ldl lowering therapy, such as a varied and healthy diet, exercise, or statin intake. There are currently no drugs approved to specifically reduce plasma Lp (a) levels, but emerging evidence is rekindling interest in the lipoprotein particle.
Knowing for each individual the future risk of heart attack, and more generally of cardiovascular diseases linked to atherosclerosis, appears fundamental in personalized prevention. For this reason, as the guidelines of the European Society of Cardiology (Esc) and EAS have recommended for some years, the measurement of Lp (a) is indicated only in patients at high risk for the development of cardiovascular diseases or with a medical history positive family member for the juvenile onset of cardiovascular diseases. It is essential to undergo the Lp (a) test even after a heart attack or stroke if you have hypercholesterolemia or slightly increased Ldl cholesterol levels. The measurement of Lp (a) takes place through a straightforward blood sampling. In general, the exam does not require any preparation.