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I’ve known since I was a young woman that my siblings and I did not win the genetic lottery when it comes to health, particularly regarding heart disease. My grandfathers and my father all died of heart attacks in their 60s. My dad was the youngest, only 61 when he passed. My brother, now 54, had a quadruple bypass when he was just 47.
Only recently did I become aware that a “bad family history” actually had a specific indicator, Lipoprotein (a), or Lp(a). It’s a form of bad cholesterol that is genetically determined and not linked to lifestyle, and it increases your risk for heart attacks and strokes. I was tested recently for it, and my number is bad. Really bad. My brother and sister also have bad Lp(a) numbers. We assume our dad did, too, but back in 2000 when he died, they weren’t testing for that.
Another recent discovery is that breast arterial calcifications (BACs), which can show up on mammograms, is a warning sign of plaque in the arteries. My primary care doctor alerted me in April that BACs were evident in my recent mammogram. I asked for the lab test for the Lp(a), a coronary artery calcium scan (CAC), and a referral to a cardiologist, whom I saw today.
So…my CAC score isn’t good, and neither is my Lp(a) number. Oddly, though, that’s partly “good” news. The gold standard treatment for high Lp(a) is a biweekly injectable called Repatha. My brother’s been on it since February, and his Lp(a) score and LDL-C are both way down. He also takes a statin, and my sister and I both started statins within the last couple of months.
My cardiologist explained to me that my CAC score will qualify me for insurance coverage for Repatha, which can be hard to get. She wants me to start it ASAP; it will not only lower the cholesterol numbers but also stabilize the plaque and even cause to reverse (somewhat).
In a very real sense, I lucked out. I have all the risk factors (including Hashimoto’s thyroiditis) but have not yet had a cardiovascular event or even any symptoms. The cardiologist asked me detailed questions about my exercise regimen, my heart rate during cardio workouts, and how I felt. The real life evidence suggests I’m healthy. The clinical evidence says “not so fast.” Because of the clinical evidence, I get to start taking the best medication available, and I’ll be in line as new ones get approved.
So it’s funny. I think of myself as a “healthy” person. Turns out I’m actually a person with cardiovascular disease. But in a very linear sense, that may well keep me healthy(ier) for longer.
Hello, I am a recently retired primary care doctor. I spent the last 15 years of my career focused on preventive health and health maintenance. My comments and unsolicited advice:
Onward!
Thanks for this. In my case, my high CAC officially makes me a person with cardiovascular disease, and the reason I described myself as “healthy” is that, thankfully, at 66 I’ve not had any adverse cardiac events or even symptoms, and I do pretty robust cardio 4-5 days a week (heart zones 3-4 most days) with no ill effects. My Lp(a) number alone probably wouldn’t have gotten me approved for Repatha in 24 hours. As you note, Lp(a) is a risk factor, not disease itself.
If I could go back 10-15 years, I’d have gotten myself under the care of a cardiologist sooner and probably would have been on a statin years ago, which might have prevented at least some of the calcification. But I felt fine, never had bad “regular” LDL numbers, and didn’t know from Lp(a). So other than being aware of bad family history, I didn’t have enough information as a layperson to be more proactive. So oh, well—onward, as you say!
One in five people are hyper absorbers as opposed to hyper synthesizers. I am one of those 20%. After years of dealing with statins I tried Ezetimibe, which is for hyper absorbers. My LDL/total non HDL/triglycerides/APOb all fell dramatically.I am constantly amazed at the number of folks who don’t ask their docs to at least try this safe,cheap and often successful drug
Wow, I’ve never even heard of that, but pretty much all of this is new to me. I’m thinking that since just 7 weeks on a statin got my LDL and ApoB into the 60s (and probably dropping), I’m in the 80%.