EP142: Lipoprotein (a) With Dr. Karam Kostner

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick, a practicing cardiologist and passionate health educator, hosts this episode featuring Dr. Karam Kostner, a lipids management expert from Queensland. The episode focuses on lipoprotein(a) — also written as Lp(a) — a genetic risk factor for heart disease and stroke that functions as "bad cholesterol with extra nasty bits on it," combining an LDL particle with additional protein that increases both clotting risk and arterial buildup. Key Takeaways: Lipoproteins are proteins that carry fats (cholesterol, triglycerides, phospholipids) through the bloodstream to various tissues, functioning similarly to how cream disperses in milk. Lipoprotein(a) is structurally similar to LDL ("bad cholesterol") but has an additional small protein (apolipoprotein(a)) attached, making it unique and more problematic. Lp(a) is probably the most significant genetic risk marker for heart disease and stroke, demonstrated through epidemiological studies, Mendelian randomization studies, and human clinical observations. Elevated Lp(a) levels are commonly found in families with early-onset coronary disease and are associated with increased aortic valve calcification in young people. Current treatment options include aggressively lowering LDL cholesterol, nicotinic acid (30-40% reduction), PCSK9 inhibitors, and apheresis (blood filtration), though newer antisense therapies show promise in clinical trials. Testing for Lp(a) is recommended for people with early family history of cardiovascular disease, those with unexplained heart attack or stroke at a young age, and individuals with genetic lipid disorders. While vitamin D and vitamin K show interesting preliminary associations with Lp(a) and calcium buildup, conclusive evidence is currently lacking. Managing other cardiovascular risk factors (smoking, diabetes, hypertension) aggressively is essential for people with elevated Lp(a), as is achieving very low LDL cholesterol levels.