The Heart's Quiet Killer: Book and Article Review

Medicine has greatly improved on treating the crisis situations of cardiovascular disease such as heart attacks and strokes, but there has been very little advancement in preventing these events in the first place.

Joel K. Kahn, MD has looked into the prevention side as well as emerging evidence of lipoprotein (a) aka Lp(a) as "the heart's quiet killer". Lp(a) is a form of cholesterol that is capable of clogging arteries and heart valves, known as the "sticky cholesterol". The presence of Lp(a) is genetic and has the evolutionary benefit of accelerated wound healing by helping with clotting. This is not so advantageous when the clotting occurs within our blood vessels. The amount of Lp(a) generally plateaus at the age of 2 and then remains relatively the same.

In a study conducted in Denmark in 2009 people with the highest levels of Lp(a) were at 3 times the risk of heart attacks compared to those with the lowest levels. Another study in Germany in 2014 found that those with elevated Lp(a) levels were 1.4 times as likely to have a stroke. Despite these findings, tradition tends to win out and physicians do not test Lp(a) levels to assess risk.

In general levels greater than 30mg/dl is abnormal and 50mg/dl are high risk. Particle size greater than 75nmol/L is abnormal and 125nmol/L is high risk.

The American Heart Association provides this list as risk factors for high Lp(a) levels.

Family history of high Lp(a) or early development of heart disease.
Familial hypercholesterolemia (FH), about a third of people with the condition also have high Lp(a) numbers.
Personal history of heart attack, stroke, or coronary artery disease before age 55 in men or age 65 in women.
Poor circulation in your legs because of peripheral arterial disease.
Diagnosis of aortic stenosis, a narrowing of the valve between the heart’s lower left chamber and the aorta artery.

There are some medications and lifestyle modifications that can lower general cholesterol and may have a slight effect on Lp(a) levels as well, overall reducing the risk of cardiovascular disease.

Unfortunately the most common therapy for high cholesterol is the drug class Statins and these have been found to raise Lp(a) levels by about 11%. However, statins are still found to reduce overall cardiovascular events in people with and without elevated Lp(a) levels. These studies are still limited and more longterm studies are needed.
Fibrates are also used to reduce general cholesterol levels and have been seen to lower Lp(a) levels slightly.
Niacine (vitamin B6) has mixed results in lowering Lp(a) levels, some reports say that combining niacin with omega-3 fatty acid supplements did lower Lp(a) by 23%. This is promising, but still needs more in depth studying.
Coffee and Coenzyme Q10 are hopeful for lowering Lp(a) levels, but limited in the research.
Vitamin C has not found an effect on Lp(a), but it does assist in collagen formation and encouraging the health of arteries in general.
Diet changes have been found to have good effect on lowering Lp(a) levels, specifically the plant-based diet with significant reductions (as much as 32 nmol/L). Flax seed intake alone is associated with an average 14% decrease in Lp(a). Higher fiber diets are also associated with lower levels.

These diet and lifestyle changes still need more research on their effects on Lp(a), but they have been proven to help reduce other risk factors of CVD such as lower overall cholesterol, decrease weight, improved blood sugar control, etc..

Dr. Joel K. Kahn's book Lipoprotein(a): The Heart's Quiet Killer has more information on lipoprotein(a) as well as 50 plant based recipes packed with plant proteins and fiber to help reduce risk of cardiovascular disease rather than just treat after a crisis event such as heart attack or stroke.