Quietly, but with dramatic significance, the American College of Cardiology has published a new recommendation: Every adult should undergo an Lp(a) test at least once in their lifetime.
This is a simple blood test, which is not part of routine testing in Israel despite its wide availability, and it can reveal hidden genetic risk for cardiovascular disease even in completely healthy individuals.
The equally important news: The test is available in Israel at no cost through a family physician in the health funds.
The story that illustrates the problem
Guy, a 47-year-old high-tech worker, had taken care of his health over the years. He did not smoke, maintained a reasonable diet, and underwent periodic tests. After his father died at a young age from a heart attack, he was also careful to perform lipid tests.The results were encouraging: The cholesterol was normal, everything seemed fine.
Two years later, shortly before the age of 50, Guy arrived at the hospital with chest pain. An urgent catheterization revealed a completely blocked artery.
Only after the event was it discovered that his Lp(a) levels were very high.
What is Lp(a)
Lp(a) is a fatty particle similar to bad cholesterol, but with an added unique protein that makes it particularly dangerous. It operates through several mechanisms simultaneously:
• Accelerates the formation of atherosclerotic plaque in the arteries• Encourages inflammatory processes• Affects blood clotting
This combination makes it a significant risk factor for heart disease and stroke, sometimes at a young age.
Unlike regular cholesterol, Lp(a) levels are almost not affected by lifestyle. Neither diet, nor exercise, nor weight loss significantly change it. The main factor is genetic.
About 15 to 20 percent of the population carry high levels, and many of them are not aware of it at all. This is exactly why the test is important: It is impossible to guess this risk without testing.
The new recommendation that changes the rules
For years, the recommendation to perform the test was mainly for people with a family history or risk factors.
Now, with the new recommendation in the United States, the approach is changing: One test for every adult, at least once in a lifetime. The reason is simple: Lp(a) levels hardly change over the course of life, so a one-time test is sufficient in most cases to assess risk.
Values above 30 milligrams per deciliter are considered elevated, and above 50 are already defined as higher risk. In some laboratories, the test is measured in other units, so it is important to consult a physician regarding interpretation of the result.
You had the test and the result is high – what do you do?
This is where medical complexity comes in. Unlike regular cholesterol, there is currently no simple and direct treatment that significantly lowers Lp(a).
However, there are several important steps:• More aggressive control of LDL cholesterol• Treatment of additional risk factors• Closer cardiology follow-up
New drugs are in advanced development and are expected to change the field in the coming years, with the ability to significantly reduce the levels of the particle.
High levels of Lp(a) are not a verdict, but a warning sign. They allow:• Early identification of risk• Personalization of treatment• Prevention of future cardiac events
In other words, this is a test that can save lives, דווקא among those who appear completely healthy.
If there is one thing to take from this article, it is this: Even if your blood tests are normal, even if you maintain a healthy lifestyle and even if there are no symptoms, you may have a genetic risk factor that has not been tested.
The Lp(a) test is simple, available and free of charge. Contact your family physician in the health fund to which you are affiliated, and request it. Sometimes, what is not seen in routine tests is exactly what is important to discover in time.
The author is a specialist in internal medicine, chair of the Israeli Society for LGBT Medicine in the Israeli Medical Association, and a partner physician at the LGBTQ clinic in Gan Meir
Source:
www.jpost.com
