Epidemiological Manichaeism has wanted the story about cholesterol to be divided into good (HDL) and bad (LDL). But there is a "third party in discord" – which actually plays for the second – whose origin is genetic and has been little studied in routine consultations.
This lack of knowledge is due, in large part, to the fact that their eventual high levels in the body do not respond to environmental, dietary or lifestyle factors. And there is still no drug to combat it. That is, there is not much that medicine can do today to stop it. But that would be on the way to beginning to change.
There are already phase 2 and 3 clinical trials of drugs that promise to change the course of this story. Some of the tests are being carried out in Argentina, but the information is handled with great secrecy both by the laboratories involved and by the researchers who carry them out.
The therapeutic target targets lipoprotein (a) (Lp(a)). It is estimated that 20 percent of the population (1 in 5 people) inherits high values of this type of cholesterol and, as scientifically proven, it is a factor that increases both the risk of myocardial infarction and stroke.
However, it is not often ordered at routine checkups with blood tests, so the vast majority of people who have this associated risk factor ignore it. The probability of having it increases if the parents also suffered from it, but the chain of ignorance is reproduced over time.
Lipoprotein (a) is a genetic factor associated with bad cholesterol (LDL), which enhances risks.
Gustavo Giunta, coordinator of the Lipids and Atherosclerosis section of the Favaloro Foundation, explained that "Lp(a) is a lipoprotein very similar to bad cholesterol and is associated with cardiovascular risk. In the world, some guidelines propose that we measure it to all adults."
Giunta considered that "it is a measurement of a risk factor with a slightly particular philosophy. As there is no way to treat high Lp(a), when we measure it we do not have a specific treatment for now, but we have to ask patients to take maximum care of the rest of their risk factors."
The expert warned that "above the cut-off level that is proposed as a reference there may be 20 percent of the adult population. But the worrying values are the extremely high ones." And he pointed out that "the issue is now having a resurgence because probably in a few years specific treatments will appear."
In search of the antidote
Argentina is currently participating in some of the global trials that seek to reach a solution for people who have this type of genetic predisposition. Several of them are held at the Belgrano Adventist Clinic.
Marcelo Casas is co-director of Research of the clinic and co-founder of Arsema, a research company that is currently conducting local trials of the -he excused- can not give details due to the confidentiality clauses that laboratories require them to sign.
In the case of lipoprotein (a) the quality of life does not influence because its cause is genetic. Photo: Shutterstock,
Casas explained some of the reasons why Lp(a) is not often requested today in routine studies: "On the one hand, it is an issue that is not in the heads of doctors and on the other, not all laboratories have the reagents that are needed to measure it. Then, the value that is obtained is for informational purposes because it cannot be modified with diet or losing weight. "
In any case, he said that "knowing the data could help raise awareness among the rebellious patient." As for the drugs that are in development, he said that "they must demonstrate not only if they manage to lower the level of Lp (a), but also if they manage to lower the number of heart attacks and mortality, since there could be a more complex cause that exceeds lowering that value."
Giunta added that "for now they are experimental medications that have already been quite well demonstrated in safety." With the conclusions of phase 3 it will be possible to determine their efficacy and if they can, then, be incorporated as a preventive treatment.
According to experts, Lp(a) tends to have greater variability in its levels compared to other lipids such as LDL cholesterol. That is, while some people may have very high levels of Lp(a), others may have lower or even undetectable levels.
In routine blood tests today the value of liproprocontained (a) is not usually requested. Photo Shutterstock.
While Lp(a) is similar to low-density lipoprotein (LDL) in its structure and composition, it has an additional protein called apolipoprotein(a). It is a protein synthesized in the liver and is thought to play a role in blood clotting and clot formation.
According to the U.S. Centers for Disease Control and Prevention, like LDL, Lp(a) can build up in the walls of blood vessels. And the higher your level, the more likely that is to happen.
These cholesterol deposits, called plaques, can decrease blood flow to the heart, brain, kidneys, lungs, legs, and other parts of the body. Plaques can grow over time or rupture suddenly, blocking blood vessels and leading to heart attacks or strokes.
Giunta clarified that the units of measurement are important: "It is considered a high value of lipoprotein (a) when it is greater than 50 mg / dl and very high when it exceeds 180 mg / dl." And he considered that "possibly when there is a treatment it is proposed for people with more than 90/100 mg / dl. But this is still theoretical."