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Understanding heart diseases, particularly the risk of heart attack, strokes, valvular diseases requiring stents or cardiac surgery, is a dynamic field. Heart diseases, particularly coronary heart disease (CHD), remain the #1 risk of disability and death in western countries in both men and women. The traditional risk factors for early CHD are smoking, diabetes mellitus, hypertension, elevated cholesterol, and a family history of early CHD. The standard lipid profile has served as a mainstay of CHD risk assessment for decades.

Lipoprotein(a) (Lp[a]) is a type of cholesterol particle that is not measured on standard lab panels. Measure Lp(a) can help refine strategies of CHD risk assessment. Lp(a) has huge importance as it is estimated to be elevated in approximately 20% of the world’s population and is genetically determined. It is a complex structure that has a low-density lipoprotein (LDL) particle with an added apolipoprotein(a) via a totally different hepatic pathway than LDL cholesterol. If inherited, the level of Lp(a) in the blood is elevated and has the potential to do harm by 1–2 years of age! Ongoing strategies to lower Lp(a) in patients at risk or with proven CHD are a recent focus of pharmaceutical companies but none are approved for use at this time. This case study indicates that “natural” approaches using diet and supplements may have a profound impact on the level of Lp(a). …


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Everyone has heard about LDL cholesterol, elevated blood pressure, diabetes mellitus and smoking in terms of heart disease risk. Unfortunately, most have not heard of Lipoprotein(a), also known as Lp(a) or the “sticky” cholesterol. Lp(a) is a low-density lipoprotein (LDL) cholesterol particle with an added tail called apolipoprotein(a) that makes it a unique and potentially dangerous for future heart attack, stroke, and valvular disease. An individual’s Lp(a) level is 80–90% genetically determined in an autosomal codominant inheritance pattern with full expression by 1–2 years of age and adult-like levels achieved by approximately 5 years of age. …


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In medical school nearly 40 years ago I was taught that heart disease is mainly due to smoking, hypertension, diabetes, cholesterol disorders, and a family history of early heart events (Framingham risk factors). Most patients are still evaluated by obtaining information regarding these 5 factors. …

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