b'NUTRITIONUpdate The Lp(a) ConundrumAn excerpt from The Institute for Functional Medicine By Dr. Kara FitzgeraldDespite widespread use of cardio-1.8-2.7 times greater at plasma levelsto oxidized phospholipids (oxPLs) preventive therapies, around 40% ofaround 30 mg/dl.generated by cell membrane stress. NUTRITIONThe 2018 NHLBI working groupLp(a) is the main lipoprotein carrier of deaths are still down to cardiovascular disease. Theres great focus on whattasked with developing Lp(a) recom- these oxPLs, which have been called constitutes this residual risk, andmendations has stated that wellatherosclerosis-relevant antigens lipoprotein(a), AKA Lp(a), may beover 1 billion persons have elevatedfor the strong immune response attributable for much of it. Lp(a) islevels and that 20-30% of humansand altered genetic expression they emerging as an important biomarkerhave Lp(a) levels within the 30-50generate within blood vessels. In fact, for atherosclerosis and coronary heartmg/dl range generally accepted asLp(a)-related risk may follow directly REHAB Councilpotentially atherothrombotic.from its oxPL contents, which are disease, but though it was discovered in 1963and common, about 25% ofAbout one-third of those with familialassociated with small Lp(a) isoforms us have higher levelsits taken moreand predict cardiovascular events. time for researchers to tease out whathypercholesterolemia have Lp(a) levels 50 mg/dl.The Lp(a) Conundrum: Important, yet Lp(a) looks like and what its physiolog- impossible.?ical reason for being might be.Bottomline: These and other hard-Lp(a) is obviously important, so why CHIRO Assist hasnt it had as much share of the lime-Lp(a) has been linked to increasedhitting findings really point the finger risk for all of the following:at Lp(a) as being responsible for a meaningful portion of residual light as other blood constituents? Its Overall cardiovascular disease (CVD),really very simple: its hard to budge cardio risk.especially atherosclerosis Lp(a)s Uniquely Structure: An LDL-ishLp(a) levels, and our understanding of Cardiovascular events like myocardialLp(a) metabolism is still quite limited.protein peppered apo(a) kringlesinfarction and stroke Structurally, Lp(a) consists of oneGender and age have little bearing on Coronary heart disease (CHD),Lp(a) levels, even though associated LDL-like particle with two otherhealth risks may differ by gender, age, including coronary artery diseaseproteins: apolipoprotein B100 (CAD) (apoB100) complexed via disulfideor ancestry at comparable plasma Cerebrovascular stroke bridge to apolipoprotein(a). (NOTE:levels. Most statins and fibrates dont lower Lp(a) levels (some mayTECHNIQUE Council even increase them), though niacin Peripheral vascular events Apolipoprotein(a) is also called apo(a), Endothelial dysfunction and is different from apoA, which isand flaxseed can, and atorvastatin HDL-related.) Apo(a) contains multiple Calcific aortic valve stenosis (CAVS) looping kringles, which are proteinmay mitigate cardiac risk without necessarily altering levels. Lp(a) levels The Studies domains involved in coagulation.typically increase after menopause, An in-depth 2017 review of Lp(a)Think about that a minute: an LDL-ishand hormone replacement therapy lipoprotein plus two apolipoproteins OUR HEALTH with kringles. That constitutes a veryis known to lower them. Insulin has states that it is established as an independent, genetic, and likelybusy molecule having several regionsbeen suggested as a modulator of causal risk factor for CVD.where binding and other biochemicalLp(a) levels, which decreased prior Lp(a) level is also recognized as ato diabetes onset in a 2017 study; changes can take place. See figure 1this may reflect transitions in insulin possible independent risk factorbelow for the far-reaching pathogenic for CAD.mechanisms of Lp(a). Scroll to the endresistance, immune activation, and A landmark 1981 study identifiedof the blog for a rabbit hole discussionredox balance in prediabetes. Lp(a) levels temporarily increase during Lp(a) as an independent risk factoron the structural and genetic details inflammation yet dont change much for myocardial infarction, with a riskof Lp(a) after a fatty meal. However, eating threshold of 30 mg/dl in normolipid- Lp(a)s Fourth Dimension: Oxidationomega-3-enriched pork led to lower emic individuals and a 2.3-fold riskand Other Modifications Lp(a) levels and LDL oxidation in at levels 50 mg/dl.Lp(a) is quite prone to oxidation (moremen, which normal pork increased. A more recent study found aTreatments for lowering Lp(a) levels so than LDL), and can be glycated doubled overall risk for CVD attooand these modifications clearlyare under research, and while a few plasma levels 20 mg/dl. impact vascular health. Lp(a) is inher- meds can impact Lp(a), none yet do so selectively. Even moderate exercise Cerebrovascular stroke risk is aboutently pro-inflammatory, yet its athero-genic potential is increased by bindingdoesnt move Lp(a). 18 I Spring 2020 www.anjc.info'