Leading cardiologists are calling for doctors across Australia to start testing for a new marker of 'bad' cholesterol.
Professor Jason Kovacic, Executive Director of the Victor Chang Cardiac Research Institute, says there needs to be far greater awareness of the dangers of Lipoprotein(a), or Lp(a) for short, which can be detected in a simple blood test.
He says that up to 20 per cent of the population might have at least mild elevated levels of Lp(a).
Professor Kovacic says: "It is very worrying that there could be many tens of thousands of Australians who are at increased risk of developing heart disease but are completely oblivious to it. We could find these people with a one-off blood test."
Lp(a) is now known to be a major risk factor for atherosclerosis, which is the hardening and narrowing of the arteries in the heart caused by a build-up of plaque and is the major driver of heart disease.
Lp(a) is strongly associated with a person's genetics, but it is not yet routinely tested for despite recent evidence showing that people with raised Lp(a) levels are 2-4 times more likely to develop atherosclerosis.
Current cholesterol panels (also called a 'lipid panel') typically check for levels of four markers; LDL which is the well-known 'bad' type of cholesterol more associated with lifestyle factors; total cholesterol; HDL which is the 'good' cholesterol, and triglyceride levels.
Professor Kovacic, who is leading research into atherosclerosis at the Institute and is also a cardiologist at St Vincent's Hospital, Sydney, says Lp(a) cannot be overlooked any longer.
While reimbursement for the test has still not been resolved in Australia, Professor Kovacic and other cardiologists are calling for Lp(a) testing to be conducted on males below 55 or women below 60 years with a history of heart attack, stroke, angina, coronary stent or coronary bypass surgery, which is not explained by other risk factors. Or, if there is a family history of these heart diseases in males below 55 or women below 60 without obvious risk factors.
While universal testing isn't appropriate at this time, others could also benefit from testing for Lp(a) levels, like across family members when one or more have already been diagnosed with high Lp(a).
Professor Kovacic adds: "We have long wondered why healthy people with low cholesterol levels and seemingly no other major risk factors like smoking or diabetes can suffer heart attacks. But, we now understand that high levels of Lp(a) could be responsible for many of these events.
"If we were able to diagnose people with high levels of Lp(a) far earlier in their lives, we could not only help prevent them from developing life-threatening complications, we could also test their family members too as this is genetic."
New targeted therapies to lower Lp(a) are in the final phase of clinical studies.
Associate Professor Peter Psaltis, who leads the Heart and Vascular Program at the South Australian Health and Medical Research Institute, agrees it's time to take a proactive approach to test for high Lp(a) in patients with early heart disease and those considered at increased risk.
A/Prof Psaltis, who is also a cardiologist at the Royal Adelaide Hospital, says: "While we're waiting for these new treatments to arrive, there is still a lot we can do to make sure that people with high Lp(a) levels have their other risk factors managed more aggressively. We can also monitor these individuals more closely, but we can only do that if we identify them in the first place."
The call for greater awareness and a rollout of testing has been backed by Sarah Beale, whose partner Ben died of a heart attack aged 47 while jogging.
Ben's death was originally described as a 'one-off catastrophic event' but Professor Kovacic was able to identify that Ben likely had increased levels of Lp(a).
This means that Ben's five children can now be tested for their levels of Lp(a) and be monitored closely.
Sarah says: "It's heartbreaking to think that a simple blood test could potentially have helped save Ben's life. But at least our family now knows his history and what likely contributed to his heart attack. It's also a huge relief that we can now test his children and identify if they are at risk. It's high time that this test becomes mainstream so we can protect other families from losing their loved ones."
