Darren Ali recalls experiencing upper back pain as the sole warning sign before suffering a major heart attack known as a “widowmaker” at the age of 45, despite being in good health. The sensation he described as a tightening elastic band in his chest preceded the cardiac event by three months. Ali, now 52 and residing in Maple Ridge, B.C., believes that had he undergone a basic blood test earlier, he may have discovered high levels of Lipoprotein(a) (Lp(a)), a genetically inherited cholesterol-carrying particle in his bloodstream that increases the risk of heart attacks, potentially allowing for preventive measures.
Recent research highlights that approximately one in five Canadians, around eight million individuals, have elevated levels of Lp(a), predisposing them to a higher risk of heart attacks or strokes. However, many are unaware of this risk due to the absence of routine Lp(a) screening and the lack of associated symptoms. Addressing this gap, an updated set of recommendations developed by the Canadian Lp(a) Working Group and recently published in the Canadian Journal of Cardiology aims to raise awareness among family physicians less familiar with Lp(a) to enhance early detection and prevention efforts.
Describing the risks and treatment options, the updated guidance aligns with previous suggestions advocating for a one-time screening of all Canadian adults to identify those with elevated Lp(a), mirroring similar recommendations put forth by the American College of Cardiology. Dr. Sonia Anand, a professor of medicine and epidemiology at McMaster University and one of the authors of the updated guidance, emphasized the significance of Lp(a) testing in preventing cardiovascular events, a leading cause of mortality in Canada.
Lipoprotein(a) is a composite of protein and fat present in the bloodstream of all individuals, with higher levels posing a heightened risk due to its adhesive nature, facilitating the accumulation of plaque in blood vessels. This buildup can impede blood flow to vital organs like the heart and brain, potentially leading to heart attacks or strokes. Individuals with elevated Lp(a) levels, equal to or exceeding 100 nanomoles per litre, face an increased risk, with those surpassing 190 nanomoles per litre at even greater risk.
Since Lp(a) levels are predominantly genetically determined and relatively stable over a lifetime, lifestyle modifications like diet and exercise do not significantly impact them. Exceptions include instances such as pregnancy or post-menopausal stages where levels may fluctuate. Individuals with a family history of high Lp(a) levels should consider testing, along with those exhibiting certain health conditions like heart disease, stroke, or obesity. Research indicates that individuals of African, Caribbean, or South Asian descent are more prone to elevated Lp(a) levels.
Routine cholesterol tests typically exclude Lp(a) screening, necessitating a specific blood test covered by all Canadian provinces for this purpose. Specialists like Dr. Jodi Heshka from the Ottawa Heart Institute advocate for the inclusion of Lp(a) testing in routine screenings to enhance early detection and intervention. While there is currently no specific medication to lower Lp(a), statins are commonly prescribed to manage associated risks by targeting low-density lipoprotein (LDL), compensating for the increased Lp(a) levels.
In conclusion, despite limited treatment options, healthcare professionals stress the importance of early detection through testing for Lp(a) as a preventive measure against heart attacks and strokes. Empowered by knowledge, individuals can proactively manage their cardiovascular health, potentially averting life-threatening events. Ali, currently participating in a drug trial, remains optimistic about new treatment possibilities and emphasizes the importance of Lp(a) testing for all Canadians, including his own family, as a crucial step in safeguarding against cardiovascular risks.
