Judging by every outward sign, my father was in excellent cardiovascular health. At age 73, he still routinely impressed his grandchildren with his ability to do lengthy handstands, and he swam and played tennis almost every day. But one hidden factor that put him at risk for heart disease was lurking under the surface: Lipoprotein(a), or Lp(a).
He had already been somewhat aware that he was at risk for heart disease after two older brothers had died of heart attacks, one in his 40s. And his twin brother had heart bypass surgery several years earlier. Given his likely genetic disposition toward heart disease, he had done everything possible to protect himself: He exercised vigorously every day. He followed a plant-based diet. He was thin. He never smoked. He saw a cardiologist regularly, had great blood pressure and low cholesterol. And he was already taking both a statin and aspirin to lower his heart attack risk.
But one day, as he was running around the tennis courts, he began to have chest pain. Despite all of his preventive efforts, his coronary arteries (blood vessels that provide oxygen to the heart) had been slowly and silently accumulating plaque. His genetics — and specifically his elevated Lp(a) — had led to almost completely blocked coronary arteries. He now needed a major intervention: coronary artery bypass surgery, or open-heart surgery.
As a primary care provider, I routinely talk with patients about how to lower heart disease risk. Yet my father’s story stood out — and not just because he is my father and we share this genetic risk. But because, even with the healthiest lifestyles and preventive measures, almost 1 in 4 people have high Lp(a) levels and are at a much higher risk of heart disease or stroke. High Lp(a) is the story of many families — yet most people may not even know it.
Sometimes, no matter how hard you fight it, genetics will win.
What Is Lipoprotein(a)?
Lp(a) is a type of low-density lipoprotein (LDL) that carries cholesterol through the blood. But Lp(a) is a little different from other types of cholesterol in that it increases plaque formation and blood-clotting risk.
There may be some good evolutionary reasons for having high Lp(a) levels. Lp(a) may provide some survival advantages, such as with healing wounds or limiting bleeding during childbirth. Lp(a) levels are determined by your genes, and stay the same throughout your life, regardless of your lifestyle habits like diet and exercise.
But high Lp(a) levels have been shown to triple your risk of a heart attack or stroke. It’s still not known exactly why or how, but it’s likely related to increasing plaque formation and cholesterol deposits leading to inflammation and calcification (calcium build up and hardening) in the arteries.
What if I Have a High Lipoprotein(a)?
It’s not unusual to have a high Lp(a) level. In fact, over 20% of the U.S. population does. It needs to be evaluated with other risk factors for heart disease so that your overall risk can be reduced.
We are still learning a lot about Lp(a) and what to do about it, but we do know that standard treatments for high cholesterol, such as dietary changes and statins, don’t significantly lower Lp(a) levels. There are new medications currently being tested to lower Lp(a) and heart disease risk.
If you have a high level, it’s important to discuss your overall heart disease risk with your health care provider. While it may be hard to lower Lp(a) levels, you can take other steps to lower your heart disease risk.
Am I at Risk for Heart Disease?
It’s important to know your own heart disease risk. There are risk calculators that can help you determine your risk of a heart attack or stroke. These will take into account age, gender, race, blood pressure, cholesterol levels and other risk factors of smoking or diabetes.
Importantly, not all risk calculators take into account family history or risk factors like Lp(a). If you have a strong family history of heart disease, it’s a good idea to talk with your health care provider about additional heart health testing. While heart disease may not cause symptoms and can be hard to “see” with routine blood testing, there are tests that can look for evidence of heart disease, such as a coronary CT scan.
What Symptoms Should I Look Out For?
Heart disease is so dangerous because it often develops without causing any symptoms. In fact, 20% of heart attacks are silent. Heart disease can’t easily be seen, and so most of the time we have to assess it with other markers like blood pressure and cholesterol.
As heart disease progresses, it can present in different ways. In some cases, it can start slowly and cause symptoms such as chest pain or shortness of breath with exercise. In other cases, the first symptom may be a heart attack. It’s always a good idea to discuss any new symptoms with a health care provider.
Signs and symptoms that can be a sign of heart disease or a heart attack include:
— Chest pain.
— Shortness of breath.
— Neck or arm pain.
— Stomach pain or nausea.
Symptoms can present differently in women and may be more likely to have shortness of breath, nausea or jaw pain.
If you’re having any symptoms of a heart attack, it’s important to call 911 or seek emergency medical attention.
What Should I Ask My Doctor?
You can make an appointment with your doctor to focus on your heart health, or you may discuss it at a regular check up.
Here are some questions to make sure you ask:
— What does my family history tell me about my own heart risks?
— What is my 10-year risk of a heart attack?
— What can I do to lower my heart disease risk?
— What additional tests should I have to evaluate my heart health?
What Can I Do if I Have a High Heart Disease Risk?
If you have an increased risk of heart disease, there are steps you can take to lower your risk. This includes:
— Follow a heart-healthy diet high in whole foods, fiber and healthy fats. Avoid foods like processed meats, fried foods, trans fats and sugary foods.
— Do regular physical activity.
— Avoid smoking.
— Avoid excessive alcohol.
— Sleep well (try to get at least 7 hours).
Depending on your personal risk level, you and your doctor can decide if other medications or tests may be helpful to help lower your risk.
What if Prevention Isn’t Enough?
Even if you take every preventive step possible, you may still need more aggressive interventions like surgery. Facing something like open-heart surgery is scary and overwhelming. It’s important to know how to advocate for yourself, to ask questions and to understand your options.
This may include:
— Know your options and the ratings for hospitals and doctors.
— Build your health care team, which will include many people in addition to your cardiologist and surgeon.
— Educate yourself on your health condition.
— Be your own health advocate to get the care that you need.
— Don’t be afraid to ask your health care provider all of your questions.
— Communicate with those around you to get the help and support you need.
— Have the confidence to make the right choices for you.
— Plan for your recovery period, which in many ways is the most important part of open-heart surgery.
Heart disease is the leading cause of death in the U.S. It’s important to know your risk, including hidden markers like Lp(a). With more knowledge, and with modern medical interventions, your family history may be able to be rewritten.
Like my father, you may face open-heart surgery and — once you’ve recovered — feel healthier than ever. My dad is even back to impressing his grandchildren with his handstands. He even decided to write a book, “Open Heart,” about his experience, to help others going through the same thing.
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How a Hidden Genetic Factor Could Play a Role in Your Heart Disease Risk originally appeared on usnews.com