December 15, 2025 • 35 mins
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In this episode of Your Checkup, we break down lipoprotein(a) — a largely inherited form of cholesterol that can significantly increase the risk of heart disease and stroke, even when standard cholesterol numbers look normal. We talk about what Lp(a) is, why it matters, who should be tested, and how it helps explain “unexpected” heart events in otherwise healthy people. While Lp(a) can’t currently be lowered with diet or exercise, knowing your level allows you and your care team to be more intentional about prevention by aggressively managing other risk factors like LDL cholesterol, blood pressure, and diabetes. We also discuss what the numbers mean, why most people only need to be tested once, and the promising treatments currently being studied that may change care in the future.
References (for Show Notes)
- Nordestgaard BG, Langsted A. Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024;404(10459):1255-1264.
- Reyes-Soffer G, et al. AHA Scientific Statement on Lipoprotein(a). Arterioscler Thromb Vasc Biol. 2022;42(1):e48-e60.
- Di Fusco SA, et al. Lipoprotein(a): Risk Factor and Emerging Target. Heart. 2022;109(1):18-25.
- Nasrallah N, et al. Lp(a) in Clinical Practice. Eur J Clin Invest. 2025:e70127.
- Greco A, et al. Lipoprotein(a) as a Pharmacological Target. Circulation. 2025;151(6):400-415.
- Bess C, Mehta A, Joshi PH. All We Need to Know About Lipoprotein(a). Prog Cardiovasc Dis. 2024;84:27-33.
Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
Vantage Design Works (Vanessa Jones)
Website: https://www.vantagedesignworks.com/
Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qr
Original Artwork Concept: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:07):
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
And I'm Cole Ruffel.
I'm a nurse.
And we are so excited you wereable to join us here again
(00:28):
today.
Um, so we let's see, tis theholiday season.
Oh my gosh.
And whoop-dee-doo.
SPEAKER_02 (00:39):
And dickory does.
Christmas.
We had cookie day.
SPEAKER_01 (00:44):
Yes, lovely tradition.
I'm glad that is continuing,making an abundance of 500
cookies.
All different varieties andtypes.
The um, you know, the the cookiemachine, the cookie gun.
SPEAKER_03 (00:59):
Cookie gun.
SPEAKER_01 (00:59):
The cookie gun was driving me a little crazy.
SPEAKER_03 (01:03):
Um yeah, yeah.
We used to have an older onetoo.
And then it started acting up,so then we got this like new
one.
I avoid the cookie gun.
We don't get along.
SPEAKER_01 (01:18):
Um, yeah, that was great.
Uh, a roast pork sandwich.
I've never liked pork more thanyou know, do as I say, not as I
do.
Um, but you know, especiallywith the cardiovascular episode
coming your way.
Um, I've never liked it morethan when MGA makes it.
SPEAKER_03 (01:38):
Uh yeah, it is really good.
Like I and it was like just likewaiting for us when we got
there.
Always loved that.
SPEAKER_01 (01:51):
Not to take a total 180.
Um, so you know, the last thatpeople heard was last week when
me and Mike were heading to thebasketball game.
And oh yeah.
SPEAKER_03 (01:59):
Do you want to tell us about that?
SPEAKER_01 (02:01):
Yeah, that was an incredible experience.
SPEAKER_03 (02:03):
The pictures you sent were really cool.
SPEAKER_01 (02:04):
Yeah, so this phone like can zoom really cool.
But like I I had chills.
I felt like a little kidwatching a game, and we had
awesome seats, and we were ableto see him.
And when he came out, like whois him?
LeBron.
LeBron James.
SPEAKER_02 (02:19):
LeBron James.
SPEAKER_01 (02:21):
Have you ever heard of him?
Possibly the most famousAmerican.
We'll we'll talk about that act.
That's a good thing to talkabout here.
Um, we yeah, it was it was socool.
Got to see him hug Joelle, andit was a great game to boot.
And you know, me and Mike wentbecause it was like, you know,
the LeBron game.
Um probably the last time we'llsee him live, I would assume.
And lucky to have even donethat.
(02:43):
I it was it's been a very longtime ago.
Um, the man's been playingbasketball for 23 years.
So I think I've seen him oneother time as maybe as a
Cleveland Cavalier, butaltogether, amazing experience.
Um, we did see these three guyswho seemed to have bought two
seats, and there were threeguys, and I'm not sure how they
(03:05):
made it into the section, butthey kept trying to connive
their way into sitting with eachother.
Yeah.
And there was there were twoguys, and for the first half,
the other friend who was likesent off because all the seats
filled up in the section.
So only two of them could sit ina spot, and the third guy is
standing on the stairs, like,what do we do?
(03:26):
Like the guy, he's like, I canread his lips.
He's like, the guy said we canlet them know they aren't sold
out, they can get us otherseats.
Like we can all sit together.
And the one guy, seemingly theringleader, looks back from his
seat and just shrugs hisshoulders.
So now this other guy goes andsits alone.
SPEAKER_02 (03:45):
Oh my god.
SPEAKER_01 (03:46):
And then they switch halfway through, and one of them
stays in the spot altogether.
And this other guy comes up, andof course, there was an empty
seat sitting next to me, andgreat seats, but he came and sat
immediately next to me.
And yeah, I was eavesdropping onhis phone, and they were like
(04:07):
going back and forth about howmad they were.
And I was like, you're it was aLakers fan, of course, and I was
like, You're literally here atthis game, like relax.
Also, now we're stuck in herelike sardines, like you couldn't
have just sat with your buddiesin a slightly different
location.
Oh my god.
Yeah, no, I like that was youdon't do that.
(04:30):
You sit with the people who cameyou came with.
SPEAKER_03 (04:32):
Also, why didn't you just get why didn't you just buy
three tickets?
SPEAKER_01 (04:36):
Yeah, that's that was my question.
Um, so that was the thought thatI had.
Yeah.
Great experience though.
Loved it.
And like he iced the game at theend, like he it was all him at
the end.
The young guys were trying totake care of it, but they knew
they just gave it to him.
(04:57):
He is him, anyway.
He is him, he is him.
Um should we move on to the nextthing before we go to Nikki's
corner?
SPEAKER_03 (05:05):
Sure.
SPEAKER_01 (05:06):
So we ask you, the audience, because uh, you know,
people in my my circles havebeen asking.
This is not a question that hasthe right answer, by the way.
Who is the most famous American?
SPEAKER_03 (05:19):
It's a big question.
SPEAKER_01 (05:20):
It's a big question.
We would love to hear from youif you have a response.
SPEAKER_03 (05:26):
Wait, have you ever told me your answer?
SPEAKER_01 (05:28):
Who I think the most famous American is.
Yeah, I don't think you have.
Um I don't think I have.
You know, I think George is aneasy one.
George Washington, that is.
SPEAKER_03 (05:42):
That's what I was thinking.
SPEAKER_01 (05:43):
Yeah.
Um, I think a lot about like fomost famous American like ever
of all time.
SPEAKER_03 (05:56):
That's a lot of people.
SPEAKER_01 (05:57):
It's a lot of people.
SPEAKER_03 (05:58):
Um so I feel like we gotta go like back to the
beginning, you know?
Like, is it your most famousbecause of the time you were
famous?
Most famous because most peoplelike because you're on a dollar
bill and everyone knows who youare.
Are you the most famous Americanbecause other people in the
world know who you are, youknow?
SPEAKER_01 (06:17):
Right.
I mean, chop and down a cherrytree.
SPEAKER_03 (06:21):
Yeah, I was going George.
Eddie was telling people in someof our other friend circles some
not so savory answers that I wassaying.
I was telling little fibs.
SPEAKER_01 (06:33):
But you are not saying that.
Careful what you speak.
I can edit this in any way I'dlike.
Um no, it was just for the bit.
But the the best part was thatsomeone took it and ran with it
and you know, proclaimed it outto a group of people who we kind
of recently met at a dinnerparty at a cookie exchange.
(06:56):
I know she like took itseriously, and then some people
were like, he's messing withyou, you know that, right?
And she like was taking it upwith you.
She's like, how could that havebeen your answer?
Yeah, that doesn't make anysense at all.
He's not even American.
So I that was good.
I was really happy with that.
I think it's George.
This is the tough one.
(07:17):
I also think of Abe, you know,like ending slavery is a big
deal.
That's a big deal.
Yeah, that was a big one.
Civil war.
Um uh, let's see.
And then there's like the modernanswers, but I think it's unfair
because social media exists.
MLK, the big one.
Um Marco Polo.
SPEAKER_03 (07:40):
No.
SPEAKER_01 (07:41):
I know that was that was a joke.
He was not an American.
SPEAKER_03 (07:44):
Wasn't even American.
SPEAKER_01 (07:45):
Was he a Spaniard or Italian?
SPEAKER_03 (07:47):
Uh, I forget.
SPEAKER_01 (07:50):
It was a fun pool game.
Um, I always get a littleworried about hitting the side,
you know, like chipping a toothor something, like you're whilst
in the middle of Marco Polo andyou hear polo in the distance,
and then bang, chip tooth.
Never happened to me, but likealways a lingering concern.
Don't play a lot of Marco Polo.
(08:10):
Um, who else?
You can reach out to us um ifyou are a loyal listener who's
in close contact to us, or youcan send us an email about who
you think the most famousAmerican is.
We're gonna settle on GeorgeWashington, I think.
Um, but you know, Marie Curry.
Um my god.
(08:32):
All right, no.
So why don't we transition?
Why don't we go to Nikki'sCorner?
SPEAKER_03 (08:36):
Okay, this one's gonna be a fun one today.
SPEAKER_01 (08:39):
All right, this is definitely gonna get me.
SPEAKER_03 (08:40):
It'll be an interactive Nikki's corner,
actually.
So since we're like, you know,near the end of the year and you
know, like Spotify has theirwrapped and you know, all the
things.
Did you know that you can askchat um like, what did you learn
(09:01):
from me this year?
Or like based on everything youknow about me, what did you
learn from me this year?
And then it'll give you Yeah, soI want you to do it.
SPEAKER_01 (09:08):
Oh, okay.
SPEAKER_03 (09:09):
And then it'll so I did it the other day, and then
it tells you like things that itlearned about you, and then you
can and then separately you canask it what is the most unhinged
question I've asked you thisyear.
SPEAKER_01 (09:23):
All right, let's do it.
So what am I based on everythingyou know about me?
SPEAKER_03 (09:26):
Yeah, or I just said, what did you learn about
me this year?
SPEAKER_01 (09:29):
Based on everything you know about me, what did you
learn about me this year?
Oh my god, this is kind ofterrifying.
We're doing this live.
Oh, this is this is funny.
Um, did it come in paragraphform?
SPEAKER_03 (09:49):
It did.
You can just like it.
Should we read them?
We can just like read thehighlights.
We don't have to read all theparagraphs.
SPEAKER_01 (09:55):
No, I'll I'll read it all.
It's kind of flattering.
SPEAKER_03 (09:59):
Um You don't have to read it all.
You don't want to put the peopleto sleep.
SPEAKER_01 (10:03):
All right.
Well, you know, I use chat for avery specific set of things.
So it says you're becoming veryintentional about impact.
Early on, you were doing a lotof good things.
This year you started asking,where does my effort actually
move the needle?
That shows up in how you thinkabout your checkup, not just as
a podcast, but as a scalablepatient education tool in how
(10:26):
you approach faculty life.
Oh, patient education tool inhow you approach faculty life,
and even in how you think aboutQI projects and systems change.
You're less interested in beingbusy and more interested in
being useful.
Can you share a paragraph?
SPEAKER_03 (10:46):
Are yours done?
SPEAKER_01 (10:47):
No, there's more.
You're growing into youridentity as an educator, not
just a clinician.
You've always taught well, butthis year you learned, you
learned, you leaned into it.
Your podcast episodes becamemore structured, warmer, and
more patient-centered.
Your feedback on medicalstudents got sharper and more
thoughtful.
No, it's good.
Um, wow, this is a you have aplayful side that you protect on
(11:09):
purpose.
The skits, fake graphics, insidejokes, confident nonsense
trivia.
That's not fluff.
It's how you decompress and stayhuman in a serious profession.
SPEAKER_03 (11:19):
Yeah, we do do a lot of trivia from your chat.
SPEAKER_01 (11:21):
We do.
You seem to understand now thathumor isn't a distraction from
good medicine, it's part of whatkeeps you good at it.
That's nice.
Yeah.
But it's a function of how I usethe tool.
SPEAKER_03 (11:35):
Yeah.
SPEAKER_01 (11:36):
Um, what did your chat say?
SPEAKER_03 (11:39):
Um, mine said, well, the first one obviously was
about Ollie.
Kind of.
It said you care deeply aboutthe people and pets that you
love.
I'm not going to read the wholeparagraphs.
You value meaningfulrelationships, not performative
ones.
You're thoughtful with yourwords, you are emotionally
(11:59):
perceptive and reflective.
You have a strong sense ofself-respect.
You appreciate creativity andthe little joys.
You show up for others.
Overall, you come across aswarm, discerning, loyal, and
quietly strong.
Thanks, chat.
Wow.
And then you can ask it the mostunhinged question you've asked
(12:21):
it.
SPEAKER_01 (12:22):
Yeah, I've I did type that one in while this was
happening.
SPEAKER_03 (12:26):
Um we what mine is, um, I'm not gonna say here, but
I'll tell you.
SPEAKER_01 (12:33):
Okay.
Yeah.
No, I can I can say mine.
This is pretty good.
Um, it says honestly, you don'task reckless unhinged questions.
You ask high-functioningunhinged questions, the kind
that make perfect sense once youremember you're tired, creative,
and medically trained.
But if I had to pick the mostunhinged, I'm gonna send this to
her.
Asking me to create aconfidently incorrect trivia
(12:53):
question and answers about yourfriends.
Oh my god.
In her entire life in history topresent sincerely at her 30th
birthday party.
Yeah, that's a good one.
That's true.
Um, let's see.
Oh, requesting NBA style playergraphic intros for friends.
SPEAKER_02 (13:11):
Oh, yeah.
SPEAKER_01 (13:12):
Yep, that's a good one.
Yeah, that's good.
And you yours is so unhingedthat you can't say it live on
air.
Yeah.
This was fun.
SPEAKER_03 (13:21):
Well, one of them was so it gives you the most
unhinged and then closerunner-ups.
And um one of the closerunner-ups was requesting a
medieval royal portrait of yourcorgi.
SPEAKER_01 (13:33):
Oh, yeah.
Yep.
SPEAKER_03 (13:35):
Um, that was funny because my friend Lauren at work
was like showing me pictures ofshe was looking at mansions to
get like design inspo for herhouse, and she sent me this one.
It was like the inside wascrazy.
It was like all medieval, andshe's like, I keep picturing
Ollie like running around thishouse with like a cape and like
a crown on.
So then I took a picture of oneof the rooms and asked Jack to
(13:58):
put like Ollie in it.
Um, and then another one was Isaw um this, it was like a
patient's PCP's last name, andit looked like a dinosaur.
So then I put it the name intochat, and I said, if this was a
dinosaur, what would it looklike?
So my other friend at work and Iwere talking about it.
(14:19):
And I was like, doesn't thissound like a dinosaur?
That's awesome.
SPEAKER_00 (14:24):
Sweetie.
SPEAKER_03 (14:25):
So that's that.
SPEAKER_00 (14:27):
Wow.
This is great.
What a great exercise.
That was creative of you.
SPEAKER_03 (14:31):
Fun, right?
SPEAKER_00 (14:32):
Did you come up with that?
SPEAKER_03 (14:33):
Uh no, I like saw it online somewhere that you could
do that.
So I thought it would be fun.
SPEAKER_01 (14:37):
Wow, great.
Thank you for Nikki's corner.
SPEAKER_03 (14:40):
You're welcome.
SPEAKER_01 (14:41):
Is that what you had for today?
Okay, great.
Should we get started so that wecan go cuddle?
SPEAKER_03 (14:47):
Yeah.
SPEAKER_01 (14:48):
Okay, great.
SPEAKER_03 (14:49):
What are we talking about today?
SPEAKER_01 (14:52):
I don't know if I like that still.
What are we gonna talk abouttoday, Nick?
SPEAKER_03 (14:56):
Oh, today we're talking about your favorite
thing ever.
Some LP little A.
SPEAKER_01 (15:02):
It's a new thing.
I think I said this last yeararound like when the I
specifically remember doing theepisode when the NFC
championship game was on,because like we in short order
left.
And I was like, oh yeah, thereare these extra cardiovascular
risk things that I don't knowenough about to tell you right
now.
SPEAKER_03 (15:19):
Yeah, but now you know.
SPEAKER_01 (15:20):
Now I know enough.
So lipoprotein A or LP little Ahas become very important to me,
and I think raising awareness ofits existence at least is
important.
And that's what I'm trying to doin this episode today.
And it is relevant for probablyalmost everyone, I think.
(15:40):
Would you agree?
Yeah.
SPEAKER_00 (15:41):
Yeah.
SPEAKER_01 (15:41):
From my because we from what you've told me.
Yeah.
Well, we spend a lot of timetalking at home about it.
Um, I find myself going back andreading about it, talking to
people at parties about it.
Um here we go.
So the easiest way to thinkabout it is an LP little A, like
literally it's like LP, and thenparentheses around the lowercase
(16:03):
A is a cholesterol particle inyour blood that looks a lot like
LDL.
And we've discussed previously Lfor Lard.
LDL is the bad cholesterol.
But there's an extra proteinattached to it.
And the key difference, and thispart really matters, is that the
LP little A is almost entirelygenetic.
(16:27):
So it is a blood test.
It is a blood test that is agenetic marker of cardiovascular
risk.
Not in total, but it couldincrease risk.
So being that it's 90%inherited, diet doesn't
(16:47):
meaningfully change it, exercisedoesn't meaningfully change it,
weight loss doesn't meaningfullychange it.
So if you have a high LP littleA, it's not something that you
cost, it's something that youwere born with, and for a lot of
patients that thing can bereassuring in and of itself.
(17:10):
So this comes up with like, whythe heck is this guy talking
about this?
Why do we care about thisnumber?
Right.
Um, so LP little A is a direct,independent risk factor for
heart disease and stroke, evenwhen everything else looks good.
And when I say independent, Imean on its own, in a separate
(17:34):
bucket.
So what we know from largestudies is that uh probably
about 20 to 25 percent of peoplehave an elevated LP Little A.
Once levels are above 50milligrams per deciliter,
cardiovascular risk starts torise.
For every 50 nanomoles per literor 20 to 26 milligrams per
(17:59):
deciliter, the risk of heartattack goes up by roughly 10 to
15 percent.
That's for every 20 to 26milligrams per deciliter on that
number.
And the people in the highest 5%of LPA levels can have 1.7 to
three times the risk of heartattack or aortic valve disease
(18:22):
compared to people with lowlevels.
Well, I'll try to paint thispicture for you because this is
an incredibly big deal, butsometimes it can maybe feel a
little bit more real in a storybecause many of these people who
have this look low risk onpaper.
I'll put I'll give you twoscenarios.
A 21-year-old coming in for asports physical, who we just I
(18:46):
learned about this, so I starteddoing cholesterol screening.
It's reasonable to do ascreening for familial
hypercholesterolemia, which isI'm gonna say that out loud
because it's important to knowthat those people have very high
cardiovascular risk, on average,having their first heart attack
by the age 45.
That's crazy.
(19:06):
So we look at labs to make surethat people don't have that.
So after learning this, Iscreened this guy, 21-year-old,
like I would anyone else.
His LP little A came back over200.
Yikes.
Right.
So I messaged my friendlycardiologist in the
neighborhood, and I was like, Ihave another one.
(19:28):
Am I really gonna think aboutdoing something with this guy?
And he's like, Yeah, there's alot to do for him that you need
to this needs to get startedright now.
Or, and he had no familyhistory, which is terrifying.
But then there was a 38 year oldwoman came in, she did have a
(19:49):
family history and of like maybeearly cardiovascular disease,
and we'll talk about what thatexactly means.
She also had one over 200.
That was the first time I sawthat.
This and I was ordering this,and I was like, Oh my God, I
didn't actually expect this tohappen.
So I messaged that cardiologist.
This was the first time, and hewas like, Yep, let's get this
(20:10):
patient locked and loaded andstart doing a lot of things for
them.
I was like, wow.
And then I came home and toldyou about it.
Did you?
I mean, we'll get back to thescript and all, but um, had you
heard about it before I cameback and told you about this?
SPEAKER_03 (20:24):
No, I haven't.
And now I'm really curious aboutwhat mine is.
SPEAKER_01 (20:28):
Yeah, it's something.
So, you know, these people, mindyou, this person had like an
incredible, both of them hadincredible cholesterol profiles,
like low LDL, high HDL.
And then we found this elevatedLP little A.
And people at the top risk,people with the highest LP
(20:49):
little A's, have similarcardiovascular risk to people
with familialhypercholesterolemia, is what
I've been reading.
That's intense.
So some of this might be helpfulto understand like what LPA
actually does.
So when I explain it, I usuallydescribe LPA as a very sticky
cholesterol, and it can causeproblems in two ways.
(21:10):
It builds plaque in the arterywalls, much like we understand
LDL does, and it interferes withthe body's natural clot
dissolving system.
So in that way, it bothincreases plaque buildup and
clot risk, which is why it's soclosely related to heart
attacks, strokes, and aorticvalve disease.
(21:31):
All right, Nikki.
I have been talking a lot.
SPEAKER_03 (21:34):
All right, Eddie.
Tell us who should be tested forthis level.
SPEAKER_01 (21:38):
Well, a lot of medical organizations, like
specifically the American HeartAssociation, is now recommending
that everyone get an LP little Aat least once in their lifetime.
And the good thing is, is LPlittle A stays stable throughout
the lifetime.
So it quite literally is aone-time thing.
And like we talked about,nothing you can do can change
(22:01):
that specific number, but youcan do a bunch of other stuff,
and we're gonna talk about that.
SPEAKER_03 (22:06):
So like you can't make it better if it's high.
SPEAKER_01 (22:09):
Correct.
SPEAKER_03 (22:09):
You can't make it worse if it's low.
SPEAKER_01 (22:11):
Correct.
Exactly.
It just is what it is.
So some people would then say,like, and I was a part of
discussions like this as aresident, of like, well, why
would you check if you can't doanything with it?
Well, you can.
You can do other things.
Like you can become obsessedabout your cardiovascular health
in every other way.
SPEAKER_03 (22:31):
Which you like should be anyway, you know.
SPEAKER_01 (22:33):
Which you should be anyway, right?
And we're gonna reiterate all ofthe like wonderful things you
can do to reduce those risks,but like you focus on those
things.
Um, you don't need to be fastingwhen you take it, which is nice.
Um, it's a simple blood test.
I click a button and it'sordered.
It takes a little bit longerthan the other labs to come
(22:54):
back, but I click a button andthen the person goes and gets
blood drawn, and we knowvaluable information.
It's incredible science.
Um, and like I said, you onlyneed to check it once.
But this, these are the groupsof people who should really be
thinking about asking theirdoctor, like, should I do this?
If they have a family history ofearly heart disease, I want to
(23:17):
define this for people because Iknow that this is something I've
been talking about a lot more.
Um some people think like, oh,I've got grandfathers, I've got
uncles with heart disease.
This is a pretty specificdefinition.
First degree relative, mom, dad,sister, brother, biological,
having heart attack or stroke,men age 55 and younger, and
(23:39):
women 65 and younger, that isearly cardiovascular disease.
If you were listening to thisand you think that you fall in
that category, because thisprobably too often doesn't get
asked to people at the doctor'soffice.
Did you get if you ever went,did they ask you specifically
(23:59):
about my family history ofcardiovascular disease?
Oh, they did.
Good, good.
SPEAKER_03 (24:03):
Yeah, great.
You know, like family, da-da-da,mom and dad, are they healthy?
Yada yada yada.
SPEAKER_01 (24:10):
Gotcha.
Good.
SPEAKER_03 (24:11):
Which I've had to do multiple times because every PCP
I've ever had just moves away.
SPEAKER_01 (24:16):
Yeah, it's a big problem.
SPEAKER_03 (24:17):
Now I'm in the market for a new one.
SPEAKER_01 (24:19):
Hi.
Um if you've had a heart attack,so the second group, if you've
had a heart attack or a strokeat a young age, probably
worthwhile to get this checked.
If someone has heart diseasethat isn't fully explained by
other risk factors, great personto get this checked on.
(24:41):
This, this was huge.
Family members with a known highLPA.
You heard from earlier in ourepisode that 90% of it is
inheritable and it has anautosomal codominant pattern of
inheritance by everything I wasreading recently.
And so this mean this it runsstrong in families, is
(25:01):
essentially the easiest way toexplain it.
And it runs strong, and the thegene itself expresses easily
between family members.
So if you have it or someone youknow in your family has it, a
good idea to go get it checked.
Yeah.
This is like, I mean, this is alot.
(25:22):
This is groundbreaking.
And this is not new.
This has been around for awhile, but awareness has been
low, as far as I can tell.
So, my next thing that I want totry to explain is what do the
numbers mean?
And a lot of this conversationis between you and your doctor,
but I wanted to try to go overit in some way.
So the LPA can be reported intwo different units, which can
(25:42):
be confusing, but here's thesimple takeaway.
Anything above 50 milligrams perdeciliter is high risk, or
increased risk rather.
Or the equivalent of that isroughly to 100 to 125 nanomoles
per liter.
That's more of the chemistrymindset of describing the
concentration of something.
(26:02):
These thresholds are generallyconsidered elevated and they
increase cardiovascular risk,and you and your doctor will
decide what to do with thosenumbers when they come back.
Okay.
So we kept teasing that we'regonna talk about all of the
things you can do.
Um, we're gonna add this to ourcollection of cardiovascular
(26:24):
risk episodes that we alreadyhave three others of, but this
is the part that can commonly befrustrated or misunderstood.
We've said a lot, right?
That like you can't make the LPAlower.
So right now, there are noapproved medications
specifically designed to lowerLPA.
This is actually a huge reason Isend some of these people, the
(26:47):
two I've met, who like havethese numbers that are so high
to cardiologists to be able tolike keep up with this, right?
And like look at the clinicaltrials when things come out.
Fair?
SPEAKER_02 (26:58):
Yeah.
SPEAKER_01 (26:59):
So then the idea though is that you can look at
every other thing.
So this means that you can lowerLDL cholesterol targets.
Say, like, you're whimsicallyrunning around there, and like
for an average low-risk person,an LDL less than 130 is probably
fine.
But then let's say you get thisLPA back and it's 200.
(27:22):
I had the cardiologist tell methat the LDL number needs to be
less than 55.
SPEAKER_03 (27:27):
Oh wow.
SPEAKER_01 (27:28):
And he's like, you need to push and you need to
like do a lot to get it there.
So I'll put it to you this wayeven in the youngest patient, he
was saying this person should dointense diet and exercise
changes.
And if possible, like theyshould consider starting the
(27:48):
lowest dose of a statin everyother day.
And this is like not made up,this is real, this is important.
I was shocked.
I was timid.
I was like, Am I really thinkingabout starting a statin on this
21-year-old?
And he reaffirmed my belief.
Isn't that crazy?
SPEAKER_03 (28:05):
Yeah.
But it's also like, I don'tknow, it's crazier to have a
heart attack when you're 40 thantake a statin every other day
when you're 21.
Right.
SPEAKER_01 (28:16):
No, I think like these are the people that are
walking around.
The people who are at thehighest risk, like I was talking
about, like that's why I madethe I liken this to familial
hypercholesterolemia, because Ithink it's a little bit more
well known that some people walkaround with LDL cholesterols in
the 190s at high risk of heartattacks in their 40s and 50s,
and every year beyond that.
(28:38):
And this was just mysteriouslylurking in you.
And now I'm like cycling throughlike how many people out there
are there who like this couldhappen to when you hear about
the like random 29-year-oldheart attack, 40-year-old heart
attack.
Oh, you met me when I was 50.
I had a heart attack eight yearsago.
(29:00):
Like, this is so important.
And it's so primary care.
Like, this is oh, all right.
So you can lower the LDLcholesterol goal.
SPEAKER_03 (29:16):
What's that?
Said I want to know what mine isnow.
Yeah.
I'm curious.
Well, because you got yours andyours is like non-existent.
So happy for you.
Me too.
Me too.
It's all part of my making anylive forever plan.
Freeze me.
SPEAKER_01 (29:32):
Just keep the temperature in the house lower
so it's like a refrigerator inhere.
Um, so lowering those goals, andyou know, if you're gonna do it
diet-wise, like saturated fatsare the most correlated to LDL
cholesterol.
So take a look at your diet,take an inventory of how much
saturated fat is in there, andmaybe you can afford to turn the
dial down if you have that muchsaturated fat.
(29:55):
The other is earlier or strongercholesterol-lowering
medications.
The conversations really startheavily around age 40 for
cardiovascular risk for peoplewho have certain risk enhancers.
There's a lot of wiggle roombetween 20 and 39.
But I mean, here's an argumentto have those conversations way
earlier in people.
(30:16):
So, food for thought.
Um, very tight blood pressurecontrol, like probably to the
point where it's a very movingtarget, but people usually start
thinking about taking medicinearound 140 or 90.
And I mean, are you reallytrying to push these people down
into the one teens over 70s?
Maybe exquisite control ofdiabetes is extremely important
(30:40):
in these situations.
These people also cannot smoke,simply cannot smoke.
Smoking is the worst thing to dofor cardiovascular health,
moment to moment, day in, dayout.
And people who have this as wellcannot.
It's just not an option anymore.
SPEAKER_03 (30:56):
Yeah.
Also, like, why are we stillsmoking?
SPEAKER_01 (30:59):
Because addiction.
SPEAKER_03 (31:00):
It's it's almost 2026, it's like not cool
anymore, you know?
SPEAKER_01 (31:04):
Because of addiction.
That's why.
And we haven't done thatactually.
We haven't done a whole likesmoking episode.
We need to get um I wonder whatChloe's doing.
She was big into that.
SPEAKER_03 (31:17):
Into smoking?
SPEAKER_01 (31:18):
No, no, like the station.
Yeah.
Oh, she worked the ball, shelike worked at the lung center
in Temple.
SPEAKER_03 (31:25):
She was big into smoking.
I'm like, I've literally neverseen her smoke.
SPEAKER_01 (31:28):
No, no cigarettes there.
No, she no, she like did this.
SPEAKER_03 (31:32):
She was big into that.
SPEAKER_01 (31:33):
No, she did that for like that was her job.
That was a huge part of her job.
She would be like, she was cool.
She would be like in people'schests and then go counsel them
about why they should stop sothat they don't get there.
It's pretty cool.
Staying physically active issuper important.
The short answer is 30 minutes,five times a week of moderate
intensity cardiovascularexercise and two days of
(31:54):
strength training.
That lowers your risk ofcardiovascular disease.
More is better, but not to thepoint of injury.
And eating a heart-healthy diet,we have the Mediterranean diet
episode that you can refer backto to help more ideas there.
And the take-home that there isthat when LPA is elevated,
controlling these modifiablerisk factors matters even more.
(32:17):
So the point of this is to raiseawareness and work with your
doctor.
If you have a high LP little A,your doctor may treat
cholesterol more aggressively,start medications earlier, or
they may recommend additionaltesting.
They may go for a coronarycalcium score, they may go for
a, they may go for a coronaryartery angiogram, because not
all plaque is the same as Ilearned this weekend.
(32:38):
There is calcified plaque,there's uncalcified plaque.
It's a fascinating world incardiology, especially from the
viewpoint of family medicine.
And this also is not aboutpanic.
This is about a personalizedprevention plan specific to you
in the most proactive way.
If you do end up finding thatyou have a high LP little A,
please tell your family.
(32:59):
Because LPA little A isinherited, your close family
members may have it too.
And it's a good idea to get themchecked.
Parents, siblings, children.
Encouraging them to get testingdone can be incredibly valuable
to the health of your family.
And there's hope.
Out on the horizon, there areclinical trials.
There are new medications inadvanced clinical trials that
(33:21):
can lower LP little A levels by80 to 98% by targeting the gene
in the liver that produces it.
Science is cool.
So we just learned about this.
Now hopefully we can actuallyturn it down and help these
people.
These studies are looking atwhether lowering LP little A
level actually reduces heartattacks, strokes, and valve
disease.
(33:41):
And these results of thesetrials will shape care for years
to come.
So the bottom line (33:46):
a high LP little A is an important piece
of your cardiovascular risk.
It's not the whole picture.
It is extra information that canhelp you, it can help your
doctor understand your risk moreclearly.
It can help you be moreintentional with prevention and
make smarter long-termdecisions.
(34:07):
So some questions to ask yourdoctor.
What is my LPA level and whatdoes it mean for me?
Should my family members betested?
What other risk factors shouldwe prioritize?
Would advanced imaging behelpful?
And are there clinical trials Ishould know about?
We included our references inthe show notes, and we wanted to
(34:28):
thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
You can check out our website.
You can send this episode toliterally anyone you know
because it's relevant to them.
You can send it to your mom, youcan send it to your brother, you
can send it to a friend.
(34:49):
But hopefully you learnsomething today.
Most importantly, stay healthy,my friends.
Until next time, I'm Ed Delesky.
SPEAKER_03 (34:56):
I'm Nicole Rufo.
SPEAKER_01 (34:57):
Thank you and goodbye.
SPEAKER_03 (34:58):
Bye.
SPEAKER_01 (35:01):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(35:23):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
And I'm Cole Ruffel.
I'm a nurse.
And we are so excited you wereable to join us here again
(00:28):
today.
Um, so we let's see, tis theholiday season.
Oh my gosh.
And whoop-dee-doo.
SPEAKER_02 (00:39):
And dickory does.
Christmas.
We had cookie day.
SPEAKER_01 (00:44):
Yes, lovely tradition.
I'm glad that is continuing,making an abundance of 500
cookies.
All different varieties andtypes.
The um, you know, the the cookiemachine, the cookie gun.
SPEAKER_03 (00:59):
Cookie gun.
SPEAKER_01 (00:59):
The cookie gun was driving me a little crazy.
SPEAKER_03 (01:03):
Um yeah, yeah.
We used to have an older onetoo.
And then it started acting up,so then we got this like new
one.
I avoid the cookie gun.
We don't get along.
SPEAKER_01 (01:18):
Um, yeah, that was great.
Uh, a roast pork sandwich.
I've never liked pork more thanyou know, do as I say, not as I
do.
Um, but you know, especiallywith the cardiovascular episode
coming your way.
Um, I've never liked it morethan when MGA makes it.
SPEAKER_03 (01:38):
Uh yeah, it is really good.
Like I and it was like just likewaiting for us when we got
there.
Always loved that.
SPEAKER_01 (01:51):
Not to take a total 180.
Um, so you know, the last thatpeople heard was last week when
me and Mike were heading to thebasketball game.
And oh yeah.
SPEAKER_03 (01:59):
Do you want to tell us about that?
SPEAKER_01 (02:01):
Yeah, that was an incredible experience.
SPEAKER_03 (02:03):
The pictures you sent were really cool.
SPEAKER_01 (02:04):
Yeah, so this phone like can zoom really cool.
But like I I had chills.
I felt like a little kidwatching a game, and we had
awesome seats, and we were ableto see him.
And when he came out, like whois him?
LeBron.
LeBron James.
SPEAKER_02 (02:19):
LeBron James.
SPEAKER_01 (02:21):
Have you ever heard of him?
Possibly the most famousAmerican.
We'll we'll talk about that act.
That's a good thing to talkabout here.
Um, we yeah, it was it was socool.
Got to see him hug Joelle, andit was a great game to boot.
And you know, me and Mike wentbecause it was like, you know,
the LeBron game.
Um probably the last time we'llsee him live, I would assume.
And lucky to have even donethat.
(02:43):
I it was it's been a very longtime ago.
Um, the man's been playingbasketball for 23 years.
So I think I've seen him oneother time as maybe as a
Cleveland Cavalier, butaltogether, amazing experience.
Um, we did see these three guyswho seemed to have bought two
seats, and there were threeguys, and I'm not sure how they
(03:05):
made it into the section, butthey kept trying to connive
their way into sitting with eachother.
Yeah.
And there was there were twoguys, and for the first half,
the other friend who was likesent off because all the seats
filled up in the section.
So only two of them could sit ina spot, and the third guy is
standing on the stairs, like,what do we do?
(03:26):
Like the guy, he's like, I canread his lips.
He's like, the guy said we canlet them know they aren't sold
out, they can get us otherseats.
Like we can all sit together.
And the one guy, seemingly theringleader, looks back from his
seat and just shrugs hisshoulders.
So now this other guy goes andsits alone.
SPEAKER_02 (03:45):
Oh my god.
SPEAKER_01 (03:46):
And then they switch halfway through, and one of them
stays in the spot altogether.
And this other guy comes up, andof course, there was an empty
seat sitting next to me, andgreat seats, but he came and sat
immediately next to me.
And yeah, I was eavesdropping onhis phone, and they were like
(04:07):
going back and forth about howmad they were.
And I was like, you're it was aLakers fan, of course, and I was
like, You're literally here atthis game, like relax.
Also, now we're stuck in herelike sardines, like you couldn't
have just sat with your buddiesin a slightly different
location.
Oh my god.
Yeah, no, I like that was youdon't do that.
(04:30):
You sit with the people who cameyou came with.
SPEAKER_03 (04:32):
Also, why didn't you just get why didn't you just buy
three tickets?
SPEAKER_01 (04:36):
Yeah, that's that was my question.
Um, so that was the thought thatI had.
Yeah.
Great experience though.
Loved it.
And like he iced the game at theend, like he it was all him at
the end.
The young guys were trying totake care of it, but they knew
they just gave it to him.
(04:57):
He is him, anyway.
He is him, he is him.
Um should we move on to the nextthing before we go to Nikki's
corner?
SPEAKER_03 (05:05):
Sure.
SPEAKER_01 (05:06):
So we ask you, the audience, because uh, you know,
people in my my circles havebeen asking.
This is not a question that hasthe right answer, by the way.
Who is the most famous American?
SPEAKER_03 (05:19):
It's a big question.
SPEAKER_01 (05:20):
It's a big question.
We would love to hear from youif you have a response.
SPEAKER_03 (05:26):
Wait, have you ever told me your answer?
SPEAKER_01 (05:28):
Who I think the most famous American is.
Yeah, I don't think you have.
Um I don't think I have.
You know, I think George is aneasy one.
George Washington, that is.
SPEAKER_03 (05:42):
That's what I was thinking.
SPEAKER_01 (05:43):
Yeah.
Um, I think a lot about like fomost famous American like ever
of all time.
SPEAKER_03 (05:56):
That's a lot of people.
SPEAKER_01 (05:57):
It's a lot of people.
SPEAKER_03 (05:58):
Um so I feel like we gotta go like back to the
beginning, you know?
Like, is it your most famousbecause of the time you were
famous?
Most famous because most peoplelike because you're on a dollar
bill and everyone knows who youare.
Are you the most famous Americanbecause other people in the
world know who you are, youknow?
SPEAKER_01 (06:17):
Right.
I mean, chop and down a cherrytree.
SPEAKER_03 (06:21):
Yeah, I was going George.
Eddie was telling people in someof our other friend circles some
not so savory answers that I wassaying.
I was telling little fibs.
SPEAKER_01 (06:33):
But you are not saying that.
Careful what you speak.
I can edit this in any way I'dlike.
Um no, it was just for the bit.
But the the best part was thatsomeone took it and ran with it
and you know, proclaimed it outto a group of people who we kind
of recently met at a dinnerparty at a cookie exchange.
(06:56):
I know she like took itseriously, and then some people
were like, he's messing withyou, you know that, right?
And she like was taking it upwith you.
She's like, how could that havebeen your answer?
Yeah, that doesn't make anysense at all.
He's not even American.
So I that was good.
I was really happy with that.
I think it's George.
This is the tough one.
(07:17):
I also think of Abe, you know,like ending slavery is a big
deal.
That's a big deal.
Yeah, that was a big one.
Civil war.
Um uh, let's see.
And then there's like the modernanswers, but I think it's unfair
because social media exists.
MLK, the big one.
Um Marco Polo.
SPEAKER_03 (07:40):
No.
SPEAKER_01 (07:41):
I know that was that was a joke.
He was not an American.
SPEAKER_03 (07:44):
Wasn't even American.
SPEAKER_01 (07:45):
Was he a Spaniard or Italian?
SPEAKER_03 (07:47):
Uh, I forget.
SPEAKER_01 (07:50):
It was a fun pool game.
Um, I always get a littleworried about hitting the side,
you know, like chipping a toothor something, like you're whilst
in the middle of Marco Polo andyou hear polo in the distance,
and then bang, chip tooth.
Never happened to me, but likealways a lingering concern.
Don't play a lot of Marco Polo.
(08:10):
Um, who else?
You can reach out to us um ifyou are a loyal listener who's
in close contact to us, or youcan send us an email about who
you think the most famousAmerican is.
We're gonna settle on GeorgeWashington, I think.
Um, but you know, Marie Curry.
Um my god.
(08:32):
All right, no.
So why don't we transition?
Why don't we go to Nikki'sCorner?
SPEAKER_03 (08:36):
Okay, this one's gonna be a fun one today.
SPEAKER_01 (08:39):
All right, this is definitely gonna get me.
SPEAKER_03 (08:40):
It'll be an interactive Nikki's corner,
actually.
So since we're like, you know,near the end of the year and you
know, like Spotify has theirwrapped and you know, all the
things.
Did you know that you can askchat um like, what did you learn
(09:01):
from me this year?
Or like based on everything youknow about me, what did you
learn from me this year?
And then it'll give you Yeah, soI want you to do it.
SPEAKER_01 (09:08):
Oh, okay.
SPEAKER_03 (09:09):
And then it'll so I did it the other day, and then
it tells you like things that itlearned about you, and then you
can and then separately you canask it what is the most unhinged
question I've asked you thisyear.
SPEAKER_01 (09:23):
All right, let's do it.
So what am I based on everythingyou know about me?
SPEAKER_03 (09:26):
Yeah, or I just said, what did you learn about
me this year?
SPEAKER_01 (09:29):
Based on everything you know about me, what did you
learn about me this year?
Oh my god, this is kind ofterrifying.
We're doing this live.
Oh, this is this is funny.
Um, did it come in paragraphform?
SPEAKER_03 (09:49):
It did.
You can just like it.
Should we read them?
We can just like read thehighlights.
We don't have to read all theparagraphs.
SPEAKER_01 (09:55):
No, I'll I'll read it all.
It's kind of flattering.
SPEAKER_03 (09:59):
Um You don't have to read it all.
You don't want to put the peopleto sleep.
SPEAKER_01 (10:03):
All right.
Well, you know, I use chat for avery specific set of things.
So it says you're becoming veryintentional about impact.
Early on, you were doing a lotof good things.
This year you started asking,where does my effort actually
move the needle?
That shows up in how you thinkabout your checkup, not just as
a podcast, but as a scalablepatient education tool in how
(10:26):
you approach faculty life.
Oh, patient education tool inhow you approach faculty life,
and even in how you think aboutQI projects and systems change.
You're less interested in beingbusy and more interested in
being useful.
Can you share a paragraph?
SPEAKER_03 (10:46):
Are yours done?
SPEAKER_01 (10:47):
No, there's more.
You're growing into youridentity as an educator, not
just a clinician.
You've always taught well, butthis year you learned, you
learned, you leaned into it.
Your podcast episodes becamemore structured, warmer, and
more patient-centered.
Your feedback on medicalstudents got sharper and more
thoughtful.
No, it's good.
Um, wow, this is a you have aplayful side that you protect on
(11:09):
purpose.
The skits, fake graphics, insidejokes, confident nonsense
trivia.
That's not fluff.
It's how you decompress and stayhuman in a serious profession.
SPEAKER_03 (11:19):
Yeah, we do do a lot of trivia from your chat.
SPEAKER_01 (11:21):
We do.
You seem to understand now thathumor isn't a distraction from
good medicine, it's part of whatkeeps you good at it.
That's nice.
Yeah.
But it's a function of how I usethe tool.
SPEAKER_03 (11:35):
Yeah.
SPEAKER_01 (11:36):
Um, what did your chat say?
SPEAKER_03 (11:39):
Um, mine said, well, the first one obviously was
about Ollie.
Kind of.
It said you care deeply aboutthe people and pets that you
love.
I'm not going to read the wholeparagraphs.
You value meaningfulrelationships, not performative
ones.
You're thoughtful with yourwords, you are emotionally
(11:59):
perceptive and reflective.
You have a strong sense ofself-respect.
You appreciate creativity andthe little joys.
You show up for others.
Overall, you come across aswarm, discerning, loyal, and
quietly strong.
Thanks, chat.
Wow.
And then you can ask it the mostunhinged question you've asked
(12:21):
it.
SPEAKER_01 (12:22):
Yeah, I've I did type that one in while this was
happening.
SPEAKER_03 (12:26):
Um we what mine is, um, I'm not gonna say here, but
I'll tell you.
SPEAKER_01 (12:33):
Okay.
Yeah.
No, I can I can say mine.
This is pretty good.
Um, it says honestly, you don'task reckless unhinged questions.
You ask high-functioningunhinged questions, the kind
that make perfect sense once youremember you're tired, creative,
and medically trained.
But if I had to pick the mostunhinged, I'm gonna send this to
her.
Asking me to create aconfidently incorrect trivia
(12:53):
question and answers about yourfriends.
Oh my god.
In her entire life in history topresent sincerely at her 30th
birthday party.
Yeah, that's a good one.
That's true.
Um, let's see.
Oh, requesting NBA style playergraphic intros for friends.
SPEAKER_02 (13:11):
Oh, yeah.
SPEAKER_01 (13:12):
Yep, that's a good one.
Yeah, that's good.
And you yours is so unhingedthat you can't say it live on
air.
Yeah.
This was fun.
SPEAKER_03 (13:21):
Well, one of them was so it gives you the most
unhinged and then closerunner-ups.
And um one of the closerunner-ups was requesting a
medieval royal portrait of yourcorgi.
SPEAKER_01 (13:33):
Oh, yeah.
Yep.
SPEAKER_03 (13:35):
Um, that was funny because my friend Lauren at work
was like showing me pictures ofshe was looking at mansions to
get like design inspo for herhouse, and she sent me this one.
It was like the inside wascrazy.
It was like all medieval, andshe's like, I keep picturing
Ollie like running around thishouse with like a cape and like
a crown on.
So then I took a picture of oneof the rooms and asked Jack to
(13:58):
put like Ollie in it.
Um, and then another one was Isaw um this, it was like a
patient's PCP's last name, andit looked like a dinosaur.
So then I put it the name intochat, and I said, if this was a
dinosaur, what would it looklike?
So my other friend at work and Iwere talking about it.
(14:19):
And I was like, doesn't thissound like a dinosaur?
That's awesome.
SPEAKER_00 (14:24):
Sweetie.
SPEAKER_03 (14:25):
So that's that.
SPEAKER_00 (14:27):
Wow.
This is great.
What a great exercise.
That was creative of you.
SPEAKER_03 (14:31):
Fun, right?
SPEAKER_00 (14:32):
Did you come up with that?
SPEAKER_03 (14:33):
Uh no, I like saw it online somewhere that you could
do that.
So I thought it would be fun.
SPEAKER_01 (14:37):
Wow, great.
Thank you for Nikki's corner.
SPEAKER_03 (14:40):
You're welcome.
SPEAKER_01 (14:41):
Is that what you had for today?
Okay, great.
Should we get started so that wecan go cuddle?
SPEAKER_03 (14:47):
Yeah.
SPEAKER_01 (14:48):
Okay, great.
SPEAKER_03 (14:49):
What are we talking about today?
SPEAKER_01 (14:52):
I don't know if I like that still.
What are we gonna talk abouttoday, Nick?
SPEAKER_03 (14:56):
Oh, today we're talking about your favorite
thing ever.
Some LP little A.
SPEAKER_01 (15:02):
It's a new thing.
I think I said this last yeararound like when the I
specifically remember doing theepisode when the NFC
championship game was on,because like we in short order
left.
And I was like, oh yeah, thereare these extra cardiovascular
risk things that I don't knowenough about to tell you right
now.
SPEAKER_03 (15:19):
Yeah, but now you know.
SPEAKER_01 (15:20):
Now I know enough.
So lipoprotein A or LP little Ahas become very important to me,
and I think raising awareness ofits existence at least is
important.
And that's what I'm trying to doin this episode today.
And it is relevant for probablyalmost everyone, I think.
(15:40):
Would you agree?
Yeah.
SPEAKER_00 (15:41):
Yeah.
SPEAKER_01 (15:41):
From my because we from what you've told me.
Yeah.
Well, we spend a lot of timetalking at home about it.
Um, I find myself going back andreading about it, talking to
people at parties about it.
Um here we go.
So the easiest way to thinkabout it is an LP little A, like
literally it's like LP, and thenparentheses around the lowercase
(16:03):
A is a cholesterol particle inyour blood that looks a lot like
LDL.
And we've discussed previously Lfor Lard.
LDL is the bad cholesterol.
But there's an extra proteinattached to it.
And the key difference, and thispart really matters, is that the
LP little A is almost entirelygenetic.
(16:27):
So it is a blood test.
It is a blood test that is agenetic marker of cardiovascular
risk.
Not in total, but it couldincrease risk.
So being that it's 90%inherited, diet doesn't
(16:47):
meaningfully change it, exercisedoesn't meaningfully change it,
weight loss doesn't meaningfullychange it.
So if you have a high LP littleA, it's not something that you
cost, it's something that youwere born with, and for a lot of
patients that thing can bereassuring in and of itself.
(17:10):
So this comes up with like, whythe heck is this guy talking
about this?
Why do we care about thisnumber?
Right.
Um, so LP little A is a direct,independent risk factor for
heart disease and stroke, evenwhen everything else looks good.
And when I say independent, Imean on its own, in a separate
(17:34):
bucket.
So what we know from largestudies is that uh probably
about 20 to 25 percent of peoplehave an elevated LP Little A.
Once levels are above 50milligrams per deciliter,
cardiovascular risk starts torise.
For every 50 nanomoles per literor 20 to 26 milligrams per
(17:59):
deciliter, the risk of heartattack goes up by roughly 10 to
15 percent.
That's for every 20 to 26milligrams per deciliter on that
number.
And the people in the highest 5%of LPA levels can have 1.7 to
three times the risk of heartattack or aortic valve disease
(18:22):
compared to people with lowlevels.
Well, I'll try to paint thispicture for you because this is
an incredibly big deal, butsometimes it can maybe feel a
little bit more real in a storybecause many of these people who
have this look low risk onpaper.
I'll put I'll give you twoscenarios.
A 21-year-old coming in for asports physical, who we just I
(18:46):
learned about this, so I starteddoing cholesterol screening.
It's reasonable to do ascreening for familial
hypercholesterolemia, which isI'm gonna say that out loud
because it's important to knowthat those people have very high
cardiovascular risk, on average,having their first heart attack
by the age 45.
That's crazy.
(19:06):
So we look at labs to make surethat people don't have that.
So after learning this, Iscreened this guy, 21-year-old,
like I would anyone else.
His LP little A came back over200.
Yikes.
Right.
So I messaged my friendlycardiologist in the
neighborhood, and I was like, Ihave another one.
(19:28):
Am I really gonna think aboutdoing something with this guy?
And he's like, Yeah, there's alot to do for him that you need
to this needs to get startedright now.
Or, and he had no familyhistory, which is terrifying.
But then there was a 38 year oldwoman came in, she did have a
(19:49):
family history and of like maybeearly cardiovascular disease,
and we'll talk about what thatexactly means.
She also had one over 200.
That was the first time I sawthat.
This and I was ordering this,and I was like, Oh my God, I
didn't actually expect this tohappen.
So I messaged that cardiologist.
This was the first time, and hewas like, Yep, let's get this
(20:10):
patient locked and loaded andstart doing a lot of things for
them.
I was like, wow.
And then I came home and toldyou about it.
Did you?
I mean, we'll get back to thescript and all, but um, had you
heard about it before I cameback and told you about this?
SPEAKER_03 (20:24):
No, I haven't.
And now I'm really curious aboutwhat mine is.
SPEAKER_01 (20:28):
Yeah, it's something.
So, you know, these people, mindyou, this person had like an
incredible, both of them hadincredible cholesterol profiles,
like low LDL, high HDL.
And then we found this elevatedLP little A.
And people at the top risk,people with the highest LP
(20:49):
little A's, have similarcardiovascular risk to people
with familialhypercholesterolemia, is what
I've been reading.
That's intense.
So some of this might be helpfulto understand like what LPA
actually does.
So when I explain it, I usuallydescribe LPA as a very sticky
cholesterol, and it can causeproblems in two ways.
(21:10):
It builds plaque in the arterywalls, much like we understand
LDL does, and it interferes withthe body's natural clot
dissolving system.
So in that way, it bothincreases plaque buildup and
clot risk, which is why it's soclosely related to heart
attacks, strokes, and aorticvalve disease.
(21:31):
All right, Nikki.
I have been talking a lot.
SPEAKER_03 (21:34):
All right, Eddie.
Tell us who should be tested forthis level.
SPEAKER_01 (21:38):
Well, a lot of medical organizations, like
specifically the American HeartAssociation, is now recommending
that everyone get an LP little Aat least once in their lifetime.
And the good thing is, is LPlittle A stays stable throughout
the lifetime.
So it quite literally is aone-time thing.
And like we talked about,nothing you can do can change
(22:01):
that specific number, but youcan do a bunch of other stuff,
and we're gonna talk about that.
SPEAKER_03 (22:06):
So like you can't make it better if it's high.
SPEAKER_01 (22:09):
Correct.
SPEAKER_03 (22:09):
You can't make it worse if it's low.
SPEAKER_01 (22:11):
Correct.
Exactly.
It just is what it is.
So some people would then say,like, and I was a part of
discussions like this as aresident, of like, well, why
would you check if you can't doanything with it?
Well, you can.
You can do other things.
Like you can become obsessedabout your cardiovascular health
in every other way.
SPEAKER_03 (22:31):
Which you like should be anyway, you know.
SPEAKER_01 (22:33):
Which you should be anyway, right?
And we're gonna reiterate all ofthe like wonderful things you
can do to reduce those risks,but like you focus on those
things.
Um, you don't need to be fastingwhen you take it, which is nice.
Um, it's a simple blood test.
I click a button and it'sordered.
It takes a little bit longerthan the other labs to come
(22:54):
back, but I click a button andthen the person goes and gets
blood drawn, and we knowvaluable information.
It's incredible science.
Um, and like I said, you onlyneed to check it once.
But this, these are the groupsof people who should really be
thinking about asking theirdoctor, like, should I do this?
If they have a family history ofearly heart disease, I want to
(23:17):
define this for people because Iknow that this is something I've
been talking about a lot more.
Um some people think like, oh,I've got grandfathers, I've got
uncles with heart disease.
This is a pretty specificdefinition.
First degree relative, mom, dad,sister, brother, biological,
having heart attack or stroke,men age 55 and younger, and
(23:39):
women 65 and younger, that isearly cardiovascular disease.
If you were listening to thisand you think that you fall in
that category, because thisprobably too often doesn't get
asked to people at the doctor'soffice.
Did you get if you ever went,did they ask you specifically
(23:59):
about my family history ofcardiovascular disease?
Oh, they did.
Good, good.
SPEAKER_03 (24:03):
Yeah, great.
You know, like family, da-da-da,mom and dad, are they healthy?
Yada yada yada.
SPEAKER_01 (24:10):
Gotcha.
Good.
SPEAKER_03 (24:11):
Which I've had to do multiple times because every PCP
I've ever had just moves away.
SPEAKER_01 (24:16):
Yeah, it's a big problem.
SPEAKER_03 (24:17):
Now I'm in the market for a new one.
SPEAKER_01 (24:19):
Hi.
Um if you've had a heart attack,so the second group, if you've
had a heart attack or a strokeat a young age, probably
worthwhile to get this checked.
If someone has heart diseasethat isn't fully explained by
other risk factors, great personto get this checked on.
(24:41):
This, this was huge.
Family members with a known highLPA.
You heard from earlier in ourepisode that 90% of it is
inheritable and it has anautosomal codominant pattern of
inheritance by everything I wasreading recently.
And so this mean this it runsstrong in families, is
(25:01):
essentially the easiest way toexplain it.
And it runs strong, and the thegene itself expresses easily
between family members.
So if you have it or someone youknow in your family has it, a
good idea to go get it checked.
Yeah.
This is like, I mean, this is alot.
(25:22):
This is groundbreaking.
And this is not new.
This has been around for awhile, but awareness has been
low, as far as I can tell.
So, my next thing that I want totry to explain is what do the
numbers mean?
And a lot of this conversationis between you and your doctor,
but I wanted to try to go overit in some way.
So the LPA can be reported intwo different units, which can
(25:42):
be confusing, but here's thesimple takeaway.
Anything above 50 milligrams perdeciliter is high risk, or
increased risk rather.
Or the equivalent of that isroughly to 100 to 125 nanomoles
per liter.
That's more of the chemistrymindset of describing the
concentration of something.
(26:02):
These thresholds are generallyconsidered elevated and they
increase cardiovascular risk,and you and your doctor will
decide what to do with thosenumbers when they come back.
Okay.
So we kept teasing that we'regonna talk about all of the
things you can do.
Um, we're gonna add this to ourcollection of cardiovascular
(26:24):
risk episodes that we alreadyhave three others of, but this
is the part that can commonly befrustrated or misunderstood.
We've said a lot, right?
That like you can't make the LPAlower.
So right now, there are noapproved medications
specifically designed to lowerLPA.
This is actually a huge reason Isend some of these people, the
(26:47):
two I've met, who like havethese numbers that are so high
to cardiologists to be able tolike keep up with this, right?
And like look at the clinicaltrials when things come out.
Fair?
SPEAKER_02 (26:58):
Yeah.
SPEAKER_01 (26:59):
So then the idea though is that you can look at
every other thing.
So this means that you can lowerLDL cholesterol targets.
Say, like, you're whimsicallyrunning around there, and like
for an average low-risk person,an LDL less than 130 is probably
fine.
But then let's say you get thisLPA back and it's 200.
(27:22):
I had the cardiologist tell methat the LDL number needs to be
less than 55.
SPEAKER_03 (27:27):
Oh wow.
SPEAKER_01 (27:28):
And he's like, you need to push and you need to
like do a lot to get it there.
So I'll put it to you this wayeven in the youngest patient, he
was saying this person should dointense diet and exercise
changes.
And if possible, like theyshould consider starting the
(27:48):
lowest dose of a statin everyother day.
And this is like not made up,this is real, this is important.
I was shocked.
I was timid.
I was like, Am I really thinkingabout starting a statin on this
21-year-old?
And he reaffirmed my belief.
Isn't that crazy?
SPEAKER_03 (28:05):
Yeah.
But it's also like, I don'tknow, it's crazier to have a
heart attack when you're 40 thantake a statin every other day
when you're 21.
Right.
SPEAKER_01 (28:16):
No, I think like these are the people that are
walking around.
The people who are at thehighest risk, like I was talking
about, like that's why I madethe I liken this to familial
hypercholesterolemia, because Ithink it's a little bit more
well known that some people walkaround with LDL cholesterols in
the 190s at high risk of heartattacks in their 40s and 50s,
and every year beyond that.
(28:38):
And this was just mysteriouslylurking in you.
And now I'm like cycling throughlike how many people out there
are there who like this couldhappen to when you hear about
the like random 29-year-oldheart attack, 40-year-old heart
attack.
Oh, you met me when I was 50.
I had a heart attack eight yearsago.
(29:00):
Like, this is so important.
And it's so primary care.
Like, this is oh, all right.
So you can lower the LDLcholesterol goal.
SPEAKER_03 (29:16):
What's that?
Said I want to know what mine isnow.
Yeah.
I'm curious.
Well, because you got yours andyours is like non-existent.
So happy for you.
Me too.
Me too.
It's all part of my making anylive forever plan.
Freeze me.
SPEAKER_01 (29:32):
Just keep the temperature in the house lower
so it's like a refrigerator inhere.
Um, so lowering those goals, andyou know, if you're gonna do it
diet-wise, like saturated fatsare the most correlated to LDL
cholesterol.
So take a look at your diet,take an inventory of how much
saturated fat is in there, andmaybe you can afford to turn the
dial down if you have that muchsaturated fat.
(29:55):
The other is earlier or strongercholesterol-lowering
medications.
The conversations really startheavily around age 40 for
cardiovascular risk for peoplewho have certain risk enhancers.
There's a lot of wiggle roombetween 20 and 39.
But I mean, here's an argumentto have those conversations way
earlier in people.
(30:16):
So, food for thought.
Um, very tight blood pressurecontrol, like probably to the
point where it's a very movingtarget, but people usually start
thinking about taking medicinearound 140 or 90.
And I mean, are you reallytrying to push these people down
into the one teens over 70s?
Maybe exquisite control ofdiabetes is extremely important
(30:40):
in these situations.
These people also cannot smoke,simply cannot smoke.
Smoking is the worst thing to dofor cardiovascular health,
moment to moment, day in, dayout.
And people who have this as wellcannot.
It's just not an option anymore.
SPEAKER_03 (30:56):
Yeah.
Also, like, why are we stillsmoking?
SPEAKER_01 (30:59):
Because addiction.
SPEAKER_03 (31:00):
It's it's almost 2026, it's like not cool
anymore, you know?
SPEAKER_01 (31:04):
Because of addiction.
That's why.
And we haven't done thatactually.
We haven't done a whole likesmoking episode.
We need to get um I wonder whatChloe's doing.
She was big into that.
SPEAKER_03 (31:17):
Into smoking?
SPEAKER_01 (31:18):
No, no, like the station.
Yeah.
Oh, she worked the ball, shelike worked at the lung center
in Temple.
SPEAKER_03 (31:25):
She was big into smoking.
I'm like, I've literally neverseen her smoke.
SPEAKER_01 (31:28):
No, no cigarettes there.
No, she no, she like did this.
SPEAKER_03 (31:32):
She was big into that.
SPEAKER_01 (31:33):
No, she did that for like that was her job.
That was a huge part of her job.
She would be like, she was cool.
She would be like in people'schests and then go counsel them
about why they should stop sothat they don't get there.
It's pretty cool.
Staying physically active issuper important.
The short answer is 30 minutes,five times a week of moderate
intensity cardiovascularexercise and two days of
(31:54):
strength training.
That lowers your risk ofcardiovascular disease.
More is better, but not to thepoint of injury.
And eating a heart-healthy diet,we have the Mediterranean diet
episode that you can refer backto to help more ideas there.
And the take-home that there isthat when LPA is elevated,
controlling these modifiablerisk factors matters even more.
(32:17):
So the point of this is to raiseawareness and work with your
doctor.
If you have a high LP little A,your doctor may treat
cholesterol more aggressively,start medications earlier, or
they may recommend additionaltesting.
They may go for a coronarycalcium score, they may go for
a, they may go for a coronaryartery angiogram, because not
all plaque is the same as Ilearned this weekend.
(32:38):
There is calcified plaque,there's uncalcified plaque.
It's a fascinating world incardiology, especially from the
viewpoint of family medicine.
And this also is not aboutpanic.
This is about a personalizedprevention plan specific to you
in the most proactive way.
If you do end up finding thatyou have a high LP little A,
please tell your family.
(32:59):
Because LPA little A isinherited, your close family
members may have it too.
And it's a good idea to get themchecked.
Parents, siblings, children.
Encouraging them to get testingdone can be incredibly valuable
to the health of your family.
And there's hope.
Out on the horizon, there areclinical trials.
There are new medications inadvanced clinical trials that
(33:21):
can lower LP little A levels by80 to 98% by targeting the gene
in the liver that produces it.
Science is cool.
So we just learned about this.
Now hopefully we can actuallyturn it down and help these
people.
These studies are looking atwhether lowering LP little A
level actually reduces heartattacks, strokes, and valve
disease.
(33:41):
And these results of thesetrials will shape care for years
to come.
So the bottom line (33:46):
a high LP little A is an important piece
of your cardiovascular risk.
It's not the whole picture.
It is extra information that canhelp you, it can help your
doctor understand your risk moreclearly.
It can help you be moreintentional with prevention and
make smarter long-termdecisions.
(34:07):
So some questions to ask yourdoctor.
What is my LPA level and whatdoes it mean for me?
Should my family members betested?
What other risk factors shouldwe prioritize?
Would advanced imaging behelpful?
And are there clinical trials Ishould know about?
We included our references inthe show notes, and we wanted to
(34:28):
thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
You can check out our website.
You can send this episode toliterally anyone you know
because it's relevant to them.
You can send it to your mom, youcan send it to your brother, you
can send it to a friend.
(34:49):
But hopefully you learnsomething today.
Most importantly, stay healthy,my friends.
Until next time, I'm Ed Delesky.
SPEAKER_03 (34:56):
I'm Nicole Rufo.
SPEAKER_01 (34:57):
Thank you and goodbye.
SPEAKER_03 (34:58):
Bye.
SPEAKER_01 (35:01):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(35:23):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
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