Summary
In this podcast episode, Peter Atia discusses LP little a, a lipoprotein that is considered the most atherogenic particle after LDL. He explains that LP little a is attached to a subset of LDL particles through a covalent bond and resembles plasminogen in structure, with Kringle domains that determine its mass. LP little a particle number is a better indicator of risk than LP little a mass, as individuals with more particles are at a higher risk. The speaker discusses the lysine binding domains of LP little a and their potential benefits in scavenging oxidized phospholipids. The speaker speculates that LP little a may have provided advantages in clotting and bleeding control in evolutionary environments.
The context also discusses the clearance for LP little-a, which is a particle that can enhance atherosclerosis, aortic stenosis, and venous thrombosis. Elevated LP little-a is associated with a 2-4x increased risk of aortic stenosis and a 3x increased risk of venous thrombosis. Atherosclerosis is the most concerning risk factor, with a 60% increased risk at 200 milligrams per deciliter. Elevated LP little-a is determined through a blood test and is prevalent in 1-5% of the population, with higher rates in some cultures.
The speaker also discusses the treatment options for patients with elevated levels of LP little-a. Apheresis, a treatment where blood is taken out and run through a machine to remove the desired particle, is rarely used due to its frequency and difficulty. Niacin and hormone therapy have also been shown to reduce LP little-a levels by up to 50%. The main treatment option for patients with elevated LP little-a levels is to control a POB with statins, as a lower LDL target is necessary for these patients. Antisense oligonucleotides (ASOs) have been developed as a treatment to directly lower LP little-a. Phase one and two trials have concluded with safety and efficacy, and phase three trials are ongoing.
Overall, the podcast provides a technical but informative discussion about LP little a and its implications for cardiovascular disease risk. The speaker encourages listeners to refer to the show notes and pictures to better understand the topic. It is important for healthcare professionals to understand the implications of elevated LP little-a and screen patients accordingly. While lifestyle changes may not significantly modify LP little-a levels, the speaker suggests that replacing saturated fat with monounsaturated fat can help to lower LDL levels.
