A new kid on the cholesterol block

Article published 2 June 2023

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A new kid on the cholesterol block

Cholesterol is a major factor in heart disease. It now appears that even a strict diet won't help if genetics are stacked against you.

IN October last year, we published a post on good and bad cholesterol, which described how good cholesterol was just cholesterol that wasn’t bad. Unlike doctors believed for a long time, good cholesterol does nothing to lessen the effects of bad cholesterol.

Now there is another type of cholesterol, and you guessed it, it’s also not good. In fact, it’s not just bad but very bad, because there’s not much you can do about it.

Another cholesterol baddie

The name of the culprit is Lipoprotein (a). There are two reasons why it is worse than the other two types.

First, it travels towards the heart, unlike High Density Lipoprotein (HDL, not bad), which takes it away from the heart. Low Density Lipoprotein (LDL, bad) also travels towards the heart, but you can do something about it by avoiding foods rich in LDL.

This brings us to the second reason why Lipoprotein (a) is worse than the other types: there’s nothing you can do about it. Whether you have it or not depends on genetics only. You can be even more fanatical about avoiding food rich in LDL to minimise cholesterol travelling towards the heart, but that’s about it.

The risk associated with cholesterol travelling towards the heart rather than elsewhere is obvious. If too much cholesterol accumulates in the heart, a heart attack is sure to follow.

Why we should test

Even though Lipoprotein (a) roams free at the moment without any way known to corral it, cardiologists are keen to screen people with a simple and relatively cheap test, which is currently not (yet) on the PBS list.

GPs don’t prescribe the test because it isn’t free and also because there’s nothing that will specifically combat the effects of high levels of Lipoprotein (a).

But cardiologists disagree.

As Professor Jason Kovacic, executive director of the Victor Chang Cardiac Research Institute, told The Australian, “It is very worrying that there could be tens of thousands of Australians who are at increased risk of developing heart disease but are completely oblivious to it. We could find these people with a one-off blood test”.

Treatment is in the future

“There are currently no specific drugs to treat high levels of Lipoprotein (a)”, concedes Professor Kovacic. “But having a test to check levels does identify people who are at additional risk of coronary heart disease and enables us to double down on conventional risk factors like blood pressure, cholesterol, smoking and diet, and to put a really focused effort on making sure all those other factors are optimally controlled.”

Professor Kovacic said that in the coming years, there are likely to be effective pharmaceuticals available that specifically target Lipoprotein(a) and save lives.

The Australian reports that such drugs are in the advanced stages of clinical trials and looking promising.

Some doctors perform apheresis – a type of blood filtering to remove the Liptoprotein (a) particles – for extremely high-risk individuals, but this is rare.

Statin medications do not have an effect on Lipoprotein(a).


For more information please email our media contact at media@cpsa.org.au

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