Darren Ali, now 52 years old and residing in Maple Ridge, B.C., shared that the only indication of an impending “widowmaker” heart attack he experienced at age 45 was some discomfort in his upper back.
Just three months later, he suffered a significant heart attack.
“It feels like an elastic band tightening inside your chest,” recalled Ali.
If he had undergone a straightforward blood test earlier in his life, he might have discovered that he had elevated levels of a cholesterol-carrying particle linked to genetics in his bloodstream. This knowledge could have alerted him to an increased risk of a heart attack, potentially allowing him to take preventive measures.
Research suggests that approximately one in five Canadians—around eight million individuals—have high levels of Lipoprotein(a), or Lp(a), which elevates their risk of heart attacks or strokes. Many remain unaware of this risk since there is currently no routine screening for Lp(a), which also does not present any symptoms.
This gap in awareness is something that experts are keen to address.
New recommendations created by a panel of physicians, known as the Canadian Lp(a) Working Group, published this month in the Canadian Journal of Cardiology, aims to enhance understanding among family doctors who may not be fully informed about Lp(a).
Researchers caution that Lipoprotein(a), a key factor in sudden heart attacks among younger and otherwise healthy individuals, is often overlooked in standard cholesterol tests. They now advocate for testing for elevated Lp(a) levels.
The updated recommendations elaborate on risks and treatments while reinforcing previous guidelines, which have strongly recommended a one-time screening for all Canadian adults to better identify those with elevated Lp(a) levels. This aligns with recommendations issued last month by the American College of Cardiology.
“When we evaluate all potential biomarkers, this one is crucial for preventing one of the leading causes of mortality among Canadians,” stated Dr. Sonia Anand, a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, and one of the contributors to the updated guidelines.
What is Lp(a)?
Lipoprotein(a) is a combination of protein and fat that circulates in everyone’s blood.
Elevated levels of Lp(a) can pose risks as it is stickier than other cholesterol types, making it more likely to adhere to blood vessel walls.
Excessive buildup can lead to plaque formation, obstructing blood flow to vital organs like the heart and brain. Should the plaque accumulation become too severe, blood vessels can rupture, resulting in a heart attack or stroke.
Moreover, Lp(a) can heighten the likelihood of clot formation and encourage inflammation, further increasing plaque rupture risk.
“If Lp(a) levels are elevated, an individual may face a two- to four-fold increase in the risk of a cardiovascular event, and there are measures we can take to mitigate that risk,” Anand explained.
Dr. Sonia Anand is among the co-authors of the updated clinical recommendations published this month in the Canadian Journal of Cardiology. (Turgut Yeter/CBC)
According to the revised recommendations, a person is deemed at elevated risk if their Lp(a) levels are 100 nanomoles per liter or higher.
Levels of 190 nanomoles per liter or above indicate an even greater risk.
How to manage Lp(a) levels
Since Lp(a) concentrations are predominantly determined by genetics, they cannot be significantly altered, according to Anand, and are unlikely to change substantially throughout one’s life.
However, there are exceptions. For instance, Lp(a) levels can rise during pregnancy and in post-menopausal women.
Due to the genetic factor, if an immediate family member has elevated levels, it is advisable to get tested as well, advises Dr. Alykhan Abdulla, a family physician in Manotick, Ontario.
There are also several other conditions that could prompt doctors to conduct further testing.
Dr. Alykhan Abdulla is a family doctor in Manotick, Ontario. (Francis Ferland/CBC)
“We are looking for individuals with known heart disease, stroke history, dementia, kidney issues, obesity, fatty liver, and … erectile dysfunction,” explained Abdulla, who did not contribute to the updated guidelines.
People of African or Caribbean heritage, as well as those of South Asian descent, have a higher likelihood of possessing elevated levels, as research from 2022 indicates.
What is the screening test?
Standard cholesterol tests do not assess Lp(a) levels, which, according to Dr. Jodi Heshka, necessitates a specific blood test—one that the Canadian Cardiovascular Society confirms is covered by all provinces in Canada.
Dr. Heshka, a cardiometabolic specialist at the Ottawa Heart Institute, supports incorporating this blood test into routine screenings.
“I strongly encourage patients to inquire about it with their healthcare providers,” she stated.
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What can I do to treat this?
Making lifestyle adjustments, such as improving diet or increasing physical activity, will not actually reduce Lp(a), according to Anand—though these changes are still essential for overall health.
Currently, there is no medication available that specifically lowers Lp(a), although several clinical trials are underway to discover effective drugs.
At this time, individuals diagnosed with elevated Lp(a) levels are typically prescribed statins. While these drugs do not lower Lp(a), they target another harmful cholesterol type, low-density lipoprotein (LDL), which may help balance the effect of increased Lp(a).
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‘Every Canadian really should be tested’
Despite the limited treatment options available, medical professionals like Anand assert that “knowledge is power,” and being informed can aid in preventing a heart attack or at the very least, help recognize early warning signs.
Ali, who is currently involved in a drug trial, expresses hope that new medications can benefit others, including his children.
“My youngest daughter actually has a lipoprotein(a) level higher than I did when I experienced my heart attack,” Ali shared.
“She is currently on statins at only 25 years old. … It requires just a simple blood test. This is a test every Canadian should have.”
