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Your Checkup: Health Education Podcast
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Education Podcast
89: Why Your Cholesterol Can Look Normal — and Still Be Risky
Send us a message with this link, we would love to hear from you. Standard message rates may apply.
In this episode of Your Checkup, we break down lipoprotein(a) — a largely inherited form of cholesterol that can significantly increase the risk of heart disease and stroke, even when standard cholesterol numbers look normal. We talk about what Lp(a) is, why it matters, who should be tested, and how it helps explain “unexpected” heart events in otherwise healthy people. While Lp(a) can’t currently be lowered with diet or exercise, knowing your level allows you and your care team to be more intentional about prevention by aggressively managing other risk factors like LDL cholesterol, blood pressure, and diabetes. We also discuss what the numbers mean, why most people only need to be tested once, and the promising treatments currently being studied that may change care in the future.
References (for Show Notes)
- Nordestgaard BG, Langsted A. Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024;404(10459):1255-1264.
- Reyes-Soffer G, et al. AHA Scientific Statement on Lipoprotein(a). Arterioscler Thromb Vasc Biol. 2022;42(1):e48-e60.
- Di Fusco SA, et al. Lipoprotein(a): Risk Factor and Emerging Target. Heart. 2022;109(1):18-25.
- Nasrallah N, et al. Lp(a) in Clinical Practice. Eur J Clin Invest. 2025:e70127.
- Greco A, et al. Lipoprotein(a) as a Pharmacological Target. Circulation. 2025;151(6):400-415.
- Bess C, Mehta A, Joshi PH. All We Need to Know About Lipoprotein(a). Prog Cardiovasc Dis. 2024;84:27-33.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area. And I'm Cole Ruffel. I'm a nurse. And we are so excited you were able to join us here again today. Um, so we let's see, tis the holiday season. Oh my gosh. And whoop-dee-doo.
SPEAKER_02:And dickory does. Christmas. We had cookie day.
SPEAKER_01:Yes, lovely tradition. I'm glad that is continuing, making an abundance of 500 cookies. All different varieties and types. The um, you know, the the cookie machine, the cookie gun.
SPEAKER_03:Cookie gun.
SPEAKER_01:The cookie gun was driving me a little crazy.
SPEAKER_03:Um yeah, yeah. We used to have an older one too. And then it started acting up, so then we got this like new one. I avoid the cookie gun. We don't get along.
SPEAKER_01:Um, yeah, that was great. Uh, a roast pork sandwich. I've never liked pork more than you know, do as I say, not as I do. Um, but you know, especially with the cardiovascular episode coming your way. Um, I've never liked it more than when MGA makes it.
SPEAKER_03:Uh yeah, it is really good. Like I and it was like just like waiting for us when we got there. Always loved that.
SPEAKER_01:Not to take a total 180. Um, so you know, the last that people heard was last week when me and Mike were heading to the basketball game. And oh yeah.
SPEAKER_03:Do you want to tell us about that?
SPEAKER_01:Yeah, that was an incredible experience.
SPEAKER_03:The pictures you sent were really cool.
SPEAKER_01:Yeah, so this phone like can zoom really cool. But like I I had chills. I felt like a little kid watching a game, and we had awesome seats, and we were able to see him. And when he came out, like who is him? LeBron. LeBron James.
SPEAKER_02:LeBron James.
SPEAKER_01:Have you ever heard of him? Possibly the most famous American. We'll we'll talk about that act. That's a good thing to talk about here. Um, we yeah, it was it was so cool. Got to see him hug Joelle, and it was a great game to boot. And you know, me and Mike went because it was like, you know, the LeBron game. Um probably the last time we'll see him live, I would assume. And lucky to have even done that. I it was it's been a very long time ago. Um, the man's been playing basketball for 23 years. So I think I've seen him one other time as maybe as a Cleveland Cavalier, but altogether, amazing experience. Um, we did see these three guys who seemed to have bought two seats, and there were three guys, and I'm not sure how they made it into the section, but they kept trying to connive their way into sitting with each other. Yeah. And there was there were two guys, and for the first half, the other friend who was like sent off because all the seats filled up in the section. So only two of them could sit in a spot, and the third guy is standing on the stairs, like, what do we do? Like the guy, he's like, I can read his lips. He's like, the guy said we can let them know they aren't sold out, they can get us other seats. Like we can all sit together. And the one guy, seemingly the ringleader, looks back from his seat and just shrugs his shoulders. So now this other guy goes and sits alone.
SPEAKER_02:Oh my god.
SPEAKER_01:And then they switch halfway through, and one of them stays in the spot altogether. And this other guy comes up, and of course, there was an empty seat sitting next to me, and great seats, but he came and sat immediately next to me. And yeah, I was eavesdropping on his phone, and they were like going back and forth about how mad they were. And I was like, you're it was a Lakers fan, of course, and I was like, You're literally here at this game, like relax. Also, now we're stuck in here like sardines, like you couldn't have just sat with your buddies in a slightly different location. Oh my god. Yeah, no, I like that was you don't do that. You sit with the people who came you came with.
SPEAKER_03:Also, why didn't you just get why didn't you just buy three tickets?
SPEAKER_01:Yeah, that's that was my question. Um, so that was the thought that I had. Yeah. Great experience though. Loved it. And like he iced the game at the end, like he it was all him at the end. The young guys were trying to take care of it, but they knew they just gave it to him. He is him, anyway. He is him, he is him. Um should we move on to the next thing before we go to Nikki's corner?
SPEAKER_03:Sure.
SPEAKER_01:So we ask you, the audience, because uh, you know, people in my my circles have been asking. This is not a question that has the right answer, by the way. Who is the most famous American?
SPEAKER_03:It's a big question.
SPEAKER_01:It's a big question. We would love to hear from you if you have a response.
SPEAKER_03:Wait, have you ever told me your answer?
SPEAKER_01:Who I think the most famous American is. Yeah, I don't think you have. Um I don't think I have. You know, I think George is an easy one. George Washington, that is.
SPEAKER_03:That's what I was thinking.
SPEAKER_01:Yeah. Um, I think a lot about like fo most famous American like ever of all time.
SPEAKER_03:That's a lot of people.
SPEAKER_01:It's a lot of people.
SPEAKER_03:Um so I feel like we gotta go like back to the beginning, you know? Like, is it your most famous because of the time you were famous? Most famous because most people like because you're on a dollar bill and everyone knows who you are. Are you the most famous American because other people in the world know who you are, you know?
SPEAKER_01:Right. I mean, chop and down a cherry tree.
SPEAKER_03:Yeah, I was going George. Eddie was telling people in some of our other friend circles some not so savory answers that I was saying. I was telling little fibs.
SPEAKER_01:But you are not saying that. Careful what you speak. I can edit this in any way I'd like. Um no, it was just for the bit. But the the best part was that someone took it and ran with it and you know, proclaimed it out to a group of people who we kind of recently met at a dinner party at a cookie exchange. I know she like took it seriously, and then some people were like, he's messing with you, you know that, right? And she like was taking it up with you. She's like, how could that have been your answer? Yeah, that doesn't make any sense at all. He's not even American. So I that was good. I was really happy with that. I think it's George. This is the tough one. I also think of Abe, you know, like ending slavery is a big deal. That's a big deal. Yeah, that was a big one. Civil war. Um uh, let's see. And then there's like the modern answers, but I think it's unfair because social media exists. MLK, the big one. Um Marco Polo.
SPEAKER_03:No.
SPEAKER_01:I know that was that was a joke. He was not an American.
SPEAKER_03:Wasn't even American.
SPEAKER_01:Was he a Spaniard or Italian?
SPEAKER_03:Uh, I forget.
SPEAKER_01:It was a fun pool game. Um, I always get a little worried about hitting the side, you know, like chipping a tooth or something, like you're whilst in the middle of Marco Polo and you hear polo in the distance, and then bang, chip tooth. Never happened to me, but like always a lingering concern. Don't play a lot of Marco Polo. Um, who else? You can reach out to us um if you are a loyal listener who's in close contact to us, or you can send us an email about who you think the most famous American is. We're gonna settle on George Washington, I think. Um, but you know, Marie Curry. Um my god. All right, no. So why don't we transition? Why don't we go to Nikki's Corner?
SPEAKER_03:Okay, this one's gonna be a fun one today.
SPEAKER_01:All right, this is definitely gonna get me.
SPEAKER_03:It'll be an interactive Nikki's corner, actually. So since we're like, you know, near the end of the year and you know, like Spotify has their wrapped and you know, all the things. Did you know that you can ask chat um like, what did you learn from me this year? Or like based on everything you know about me, what did you learn from me this year? And then it'll give you Yeah, so I want you to do it.
SPEAKER_01:Oh, okay.
SPEAKER_03:And then it'll so I did it the other day, and then it tells you like things that it learned about you, and then you can and then separately you can ask it what is the most unhinged question I've asked you this year.
SPEAKER_01:All right, let's do it. So what am I based on everything you know about me?
SPEAKER_03:Yeah, or I just said, what did you learn about me this year?
SPEAKER_01:Based on everything you know about me, what did you learn about me this year? Oh my god, this is kind of terrifying. We're doing this live. Oh, this is this is funny. Um, did it come in paragraph form?
SPEAKER_03:It did. You can just like it. Should we read them? We can just like read the highlights. We don't have to read all the paragraphs.
SPEAKER_01:No, I'll I'll read it all. It's kind of flattering.
SPEAKER_03:Um You don't have to read it all. You don't want to put the people to sleep.
SPEAKER_01:All right. Well, you know, I use chat for a very specific set of things. So it says you're becoming very intentional about impact. Early on, you were doing a lot of good things. This year you started asking, where does my effort actually move the needle? That shows up in how you think about your checkup, not just as a podcast, but as a scalable patient education tool in how you approach faculty life. Oh, patient education tool in how you approach faculty life, and even in how you think about QI projects and systems change. You're less interested in being busy and more interested in being useful. Can you share a paragraph?
SPEAKER_03:Are yours done?
SPEAKER_01:No, there's more. You're growing into your identity as an educator, not just a clinician. You've always taught well, but this year you learned, you learned, you leaned into it. Your podcast episodes became more structured, warmer, and more patient-centered. Your feedback on medical students got sharper and more thoughtful. No, it's good. Um, wow, this is a you have a playful side that you protect on purpose. The skits, fake graphics, inside jokes, confident nonsense trivia. That's not fluff. It's how you decompress and stay human in a serious profession.
SPEAKER_03:Yeah, we do do a lot of trivia from your chat.
SPEAKER_01:We do. You seem to understand now that humor isn't a distraction from good medicine, it's part of what keeps you good at it. That's nice. Yeah. But it's a function of how I use the tool.
SPEAKER_03:Yeah.
SPEAKER_01:Um, what did your chat say?
SPEAKER_03:Um, mine said, well, the first one obviously was about Ollie. Kind of. It said you care deeply about the people and pets that you love. I'm not going to read the whole paragraphs. You value meaningful relationships, not performative ones. You're thoughtful with your words, you are emotionally perceptive and reflective. You have a strong sense of self-respect. You appreciate creativity and the little joys. You show up for others. Overall, you come across as warm, discerning, loyal, and quietly strong. Thanks, chat. Wow. And then you can ask it the most unhinged question you've asked it.
SPEAKER_01:Yeah, I've I did type that one in while this was happening.
SPEAKER_03:Um we what mine is, um, I'm not gonna say here, but I'll tell you.
SPEAKER_01:Okay. Yeah. No, I can I can say mine. This is pretty good. Um, it says honestly, you don't ask reckless unhinged questions. You ask high-functioning unhinged questions, the kind that make perfect sense once you remember you're tired, creative, and medically trained. But if I had to pick the most unhinged, I'm gonna send this to her. Asking me to create a confidently incorrect trivia question and answers about your friends. Oh my god. In her entire life in history to present sincerely at her 30th birthday party. Yeah, that's a good one. That's true. Um, let's see. Oh, requesting NBA style player graphic intros for friends.
SPEAKER_02:Oh, yeah.
SPEAKER_01:Yep, that's a good one. Yeah, that's good. And you yours is so unhinged that you can't say it live on air. Yeah. This was fun.
SPEAKER_03:Well, one of them was so it gives you the most unhinged and then close runner-ups. And um one of the close runner-ups was requesting a medieval royal portrait of your corgi.
SPEAKER_01:Oh, yeah. Yep.
SPEAKER_03:Um, that was funny because my friend Lauren at work was like showing me pictures of she was looking at mansions to get like design inspo for her house, and she sent me this one. It was like the inside was crazy. It was like all medieval, and she's like, I keep picturing Ollie like running around this house with like a cape and like a crown on. So then I took a picture of one of the rooms and asked Jack to put like Ollie in it. Um, and then another one was I saw um this, it was like a patient's PCP's last name, and it looked like a dinosaur. So then I put it the name into chat, and I said, if this was a dinosaur, what would it look like? So my other friend at work and I were talking about it. And I was like, doesn't this sound like a dinosaur? That's awesome.
SPEAKER_00:Sweetie.
SPEAKER_03:So that's that.
SPEAKER_00:Wow. This is great. What a great exercise. That was creative of you.
SPEAKER_03:Fun, right?
SPEAKER_00:Did you come up with that?
SPEAKER_03:Uh no, I like saw it online somewhere that you could do that. So I thought it would be fun.
SPEAKER_01:Wow, great. Thank you for Nikki's corner.
SPEAKER_03:You're welcome.
SPEAKER_01:Is that what you had for today? Okay, great. Should we get started so that we can go cuddle?
SPEAKER_03:Yeah.
SPEAKER_01:Okay, great.
SPEAKER_03:What are we talking about today?
SPEAKER_01:I don't know if I like that still. What are we gonna talk about today, Nick?
SPEAKER_03:Oh, today we're talking about your favorite thing ever. Some LP little A.
SPEAKER_01:It's a new thing. I think I said this last year around like when the I specifically remember doing the episode when the NFC championship game was on, because like we in short order left. And I was like, oh yeah, there are these extra cardiovascular risk things that I don't know enough about to tell you right now.
SPEAKER_03:Yeah, but now you know.
SPEAKER_01:Now I know enough. So lipoprotein A or LP little A has become very important to me, and I think raising awareness of its existence at least is important. And that's what I'm trying to do in this episode today. And it is relevant for probably almost everyone, I think. Would you agree? Yeah.
SPEAKER_00:Yeah.
SPEAKER_01:From my because we from what you've told me. Yeah. Well, we spend a lot of time talking at home about it. Um, I find myself going back and reading about it, talking to people at parties about it. Um here we go. So the easiest way to think about it is an LP little A, like literally it's like LP, and then parentheses around the lowercase A is a cholesterol particle in your blood that looks a lot like LDL. And we've discussed previously L for Lard. LDL is the bad cholesterol. But there's an extra protein attached to it. And the key difference, and this part really matters, is that the LP little A is almost entirely genetic. So it is a blood test. It is a blood test that is a genetic marker of cardiovascular risk. Not in total, but it could increase risk. So being that it's 90% inherited, diet doesn't meaningfully change it, exercise doesn't meaningfully change it, weight loss doesn't meaningfully change it. So if you have a high LP little A, it's not something that you cost, it's something that you were born with, and for a lot of patients that thing can be reassuring in and of itself. So this comes up with like, why the heck is this guy talking about this? Why do we care about this number? Right. Um, so LP little A is a direct, independent risk factor for heart disease and stroke, even when everything else looks good. And when I say independent, I mean on its own, in a separate bucket. So what we know from large studies is that uh probably about 20 to 25 percent of people have an elevated LP Little A. Once levels are above 50 milligrams per deciliter, cardiovascular risk starts to rise. For every 50 nanomoles per liter or 20 to 26 milligrams per deciliter, the risk of heart attack goes up by roughly 10 to 15 percent. That's for every 20 to 26 milligrams per deciliter on that number. And the people in the highest 5% of LPA levels can have 1.7 to three times the risk of heart attack or aortic valve disease compared to people with low levels. Well, I'll try to paint this picture for you because this is an incredibly big deal, but sometimes it can maybe feel a little bit more real in a story because many of these people who have this look low risk on paper. I'll put I'll give you two scenarios. A 21-year-old coming in for a sports physical, who we just I learned about this, so I started doing cholesterol screening. It's reasonable to do a screening for familial hypercholesterolemia, which is I'm gonna say that out loud because it's important to know that those people have very high cardiovascular risk, on average, having their first heart attack by the age 45. That's crazy. So we look at labs to make sure that people don't have that. So after learning this, I screened this guy, 21-year-old, like I would anyone else. His LP little A came back over 200. Yikes. Right. So I messaged my friendly cardiologist in the neighborhood, and I was like, I have another one. Am I really gonna think about doing something with this guy? And he's like, Yeah, there's a lot to do for him that you need to this needs to get started right now. Or, and he had no family history, which is terrifying. But then there was a 38 year old woman came in, she did have a family history and of like maybe early cardiovascular disease, and we'll talk about what that exactly means. She also had one over 200. That was the first time I saw that. This and I was ordering this, and I was like, Oh my God, I didn't actually expect this to happen. So I messaged that cardiologist. This was the first time, and he was like, Yep, let's get this patient locked and loaded and start doing a lot of things for them. I was like, wow. And then I came home and told you about it. Did you? I mean, we'll get back to the script and all, but um, had you heard about it before I came back and told you about this?
SPEAKER_03:No, I haven't. And now I'm really curious about what mine is.
SPEAKER_01:Yeah, it's something. So, you know, these people, mind you, this person had like an incredible, both of them had incredible cholesterol profiles, like low LDL, high HDL. And then we found this elevated LP little A. And people at the top risk, people with the highest LP little A's, have similar cardiovascular risk to people with familial hypercholesterolemia, is what I've been reading. That's intense. So some of this might be helpful to understand like what LPA actually does. So when I explain it, I usually describe LPA as a very sticky cholesterol, and it can cause problems in two ways. It builds plaque in the artery walls, much like we understand LDL does, and it interferes with the body's natural clot dissolving system. So in that way, it both increases plaque buildup and clot risk, which is why it's so closely related to heart attacks, strokes, and aortic valve disease. All right, Nikki. I have been talking a lot.
SPEAKER_03:All right, Eddie. Tell us who should be tested for this level.
SPEAKER_01:Well, a lot of medical organizations, like specifically the American Heart Association, is now recommending that everyone get an LP little A at least once in their lifetime. And the good thing is, is LP little A stays stable throughout the lifetime. So it quite literally is a one-time thing. And like we talked about, nothing you can do can change that specific number, but you can do a bunch of other stuff, and we're gonna talk about that.
SPEAKER_03:So like you can't make it better if it's high.
SPEAKER_01:Correct.
SPEAKER_03:You can't make it worse if it's low.
SPEAKER_01:Correct. Exactly. It just is what it is. So some people would then say, like, and I was a part of discussions like this as a resident, of like, well, why would you check if you can't do anything with it? Well, you can. You can do other things. Like you can become obsessed about your cardiovascular health in every other way.
SPEAKER_03:Which you like should be anyway, you know.
SPEAKER_01:Which you should be anyway, right? And we're gonna reiterate all of the like wonderful things you can do to reduce those risks, but like you focus on those things. Um, you don't need to be fasting when you take it, which is nice. Um, it's a simple blood test. I click a button and it's ordered. It takes a little bit longer than the other labs to come back, but I click a button and then the person goes and gets blood drawn, and we know valuable information. It's incredible science. Um, and like I said, you only need to check it once. But this, these are the groups of people who should really be thinking about asking their doctor, like, should I do this? If they have a family history of early heart disease, I want to define this for people because I know that this is something I've been talking about a lot more. Um some people think like, oh, I've got grandfathers, I've got uncles with heart disease. This is a pretty specific definition. First degree relative, mom, dad, sister, brother, biological, having heart attack or stroke, men age 55 and younger, and women 65 and younger, that is early cardiovascular disease. If you were listening to this and you think that you fall in that category, because this probably too often doesn't get asked to people at the doctor's office. Did you get if you ever went, did they ask you specifically about my family history of cardiovascular disease? Oh, they did. Good, good.
SPEAKER_03:Yeah, great. You know, like family, da-da-da, mom and dad, are they healthy? Yada yada yada.
SPEAKER_01:Gotcha. Good.
SPEAKER_03:Which I've had to do multiple times because every PCP I've ever had just moves away.
SPEAKER_01:Yeah, it's a big problem.
SPEAKER_03:Now I'm in the market for a new one.
SPEAKER_01:Hi. Um if you've had a heart attack, so the second group, if you've had a heart attack or a stroke at a young age, probably worthwhile to get this checked. If someone has heart disease that isn't fully explained by other risk factors, great person to get this checked on. This, this was huge. Family members with a known high LPA. You heard from earlier in our episode that 90% of it is inheritable and it has an autosomal codominant pattern of inheritance by everything I was reading recently. And so this mean this it runs strong in families, is essentially the easiest way to explain it. And it runs strong, and the the gene itself expresses easily between family members. So if you have it or someone you know in your family has it, a good idea to go get it checked. Yeah. This is like, I mean, this is a lot. This is groundbreaking. And this is not new. This has been around for a while, but awareness has been low, as far as I can tell. So, my next thing that I want to try to explain is what do the numbers mean? And a lot of this conversation is between you and your doctor, but I wanted to try to go over it in some way. So the LPA can be reported in two different units, which can be confusing, but here's the simple takeaway. Anything above 50 milligrams per deciliter is high risk, or increased risk rather. Or the equivalent of that is roughly to 100 to 125 nanomoles per liter. That's more of the chemistry mindset of describing the concentration of something. These thresholds are generally considered elevated and they increase cardiovascular risk, and you and your doctor will decide what to do with those numbers when they come back. Okay. So we kept teasing that we're gonna talk about all of the things you can do. Um, we're gonna add this to our collection of cardiovascular risk episodes that we already have three others of, but this is the part that can commonly be frustrated or misunderstood. We've said a lot, right? That like you can't make the LPA lower. So right now, there are no approved medications specifically designed to lower LPA. This is actually a huge reason I send some of these people, the two I've met, who like have these numbers that are so high to cardiologists to be able to like keep up with this, right? And like look at the clinical trials when things come out. Fair?
SPEAKER_02:Yeah.
SPEAKER_01:So then the idea though is that you can look at every other thing. So this means that you can lower LDL cholesterol targets. Say, like, you're whimsically running around there, and like for an average low-risk person, an LDL less than 130 is probably fine. But then let's say you get this LPA back and it's 200. I had the cardiologist tell me that the LDL number needs to be less than 55.
SPEAKER_03:Oh wow.
SPEAKER_01:And he's like, you need to push and you need to like do a lot to get it there. So I'll put it to you this way even in the youngest patient, he was saying this person should do intense diet and exercise changes. And if possible, like they should consider starting the lowest dose of a statin every other day. And this is like not made up, this is real, this is important. I was shocked. I was timid. I was like, Am I really thinking about starting a statin on this 21-year-old? And he reaffirmed my belief. Isn't that crazy?
SPEAKER_03:Yeah. But it's also like, I don't know, it's crazier to have a heart attack when you're 40 than take a statin every other day when you're 21. Right.
SPEAKER_01:No, I think like these are the people that are walking around. The people who are at the highest risk, like I was talking about, like that's why I made the I liken this to familial hypercholesterolemia, because I think it's a little bit more well known that some people walk around with LDL cholesterols in the 190s at high risk of heart attacks in their 40s and 50s, and every year beyond that. And this was just mysteriously lurking in you. And now I'm like cycling through like how many people out there are there who like this could happen to when you hear about the like random 29-year-old heart attack, 40-year-old heart attack. Oh, you met me when I was 50. I had a heart attack eight years ago. Like, this is so important. And it's so primary care. Like, this is oh, all right. So you can lower the LDL cholesterol goal.
SPEAKER_03:What's that? Said I want to know what mine is now. Yeah. I'm curious. Well, because you got yours and yours is like non-existent. So happy for you. Me too. Me too. It's all part of my making any live forever plan. Freeze me.
SPEAKER_01:Just keep the temperature in the house lower so it's like a refrigerator in here. Um, so lowering those goals, and you know, if you're gonna do it diet-wise, like saturated fats are the most correlated to LDL cholesterol. So take a look at your diet, take an inventory of how much saturated fat is in there, and maybe you can afford to turn the dial down if you have that much saturated fat. The other is earlier or stronger cholesterol-lowering medications. The conversations really start heavily around age 40 for cardiovascular risk for people who have certain risk enhancers. There's a lot of wiggle room between 20 and 39. But I mean, here's an argument to have those conversations way earlier in people. So, food for thought. Um, very tight blood pressure control, like probably to the point where it's a very moving target, but people usually start thinking about taking medicine around 140 or 90. And I mean, are you really trying to push these people down into the one teens over 70s? Maybe exquisite control of diabetes is extremely important in these situations. These people also cannot smoke, simply cannot smoke. Smoking is the worst thing to do for cardiovascular health, moment to moment, day in, day out. And people who have this as well cannot. It's just not an option anymore.
SPEAKER_03:Yeah. Also, like, why are we still smoking?
SPEAKER_01:Because addiction.
SPEAKER_03:It's it's almost 2026, it's like not cool anymore, you know?
SPEAKER_01:Because of addiction. That's why. And we haven't done that actually. We haven't done a whole like smoking episode. We need to get um I wonder what Chloe's doing. She was big into that.
SPEAKER_03:Into smoking?
SPEAKER_01:No, no, like the station. Yeah. Oh, she worked the ball, she like worked at the lung center in Temple.
SPEAKER_03:She was big into smoking. I'm like, I've literally never seen her smoke.
SPEAKER_01:No, no cigarettes there. No, she no, she like did this.
SPEAKER_03:She was big into that.
SPEAKER_01:No, she did that for like that was her job. That was a huge part of her job. She would be like, she was cool. She would be like in people's chests and then go counsel them about why they should stop so that they don't get there. It's pretty cool. Staying physically active is super important. The short answer is 30 minutes, five times a week of moderate intensity cardiovascular exercise and two days of strength training. That lowers your risk of cardiovascular disease. More is better, but not to the point of injury. And eating a heart-healthy diet, we have the Mediterranean diet episode that you can refer back to to help more ideas there. And the take-home that there is that when LPA is elevated, controlling these modifiable risk factors matters even more. So the point of this is to raise awareness and work with your doctor. If you have a high LP little A, your doctor may treat cholesterol more aggressively, start medications earlier, or they may recommend additional testing. They may go for a coronary calcium score, they may go for a, they may go for a coronary artery angiogram, because not all plaque is the same as I learned this weekend. There is calcified plaque, there's uncalcified plaque. It's a fascinating world in cardiology, especially from the viewpoint of family medicine. And this also is not about panic. This is about a personalized prevention plan specific to you in the most proactive way. If you do end up finding that you have a high LP little A, please tell your family. Because LPA little A is inherited, your close family members may have it too. And it's a good idea to get them checked. Parents, siblings, children. Encouraging them to get testing done can be incredibly valuable to the health of your family. And there's hope. Out on the horizon, there are clinical trials. There are new medications in advanced clinical trials that can lower LP little A levels by 80 to 98% by targeting the gene in the liver that produces it. Science is cool. So we just learned about this. Now hopefully we can actually turn it down and help these people. These studies are looking at whether lowering LP little A level actually reduces heart attacks, strokes, and valve disease. And these results of these trials will shape care for years to come. So the bottom line: a high LP little A is an important piece of your cardiovascular risk. It's not the whole picture. It is extra information that can help you, it can help your doctor understand your risk more clearly. It can help you be more intentional with prevention and make smarter long-term decisions. So some questions to ask your doctor. What is my LPA level and what does it mean for me? Should my family members be tested? What other risk factors should we prioritize? Would advanced imaging be helpful? And are there clinical trials I should know about? We included our references in the show notes, and we wanted to thank you for coming back to another episode of Your Checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. You can check out our website. You can send this episode to literally anyone you know because it's relevant to them. You can send it to your mom, you can send it to your brother, you can send it to a friend. But hopefully you learn something today. Most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky.
SPEAKER_03:I'm Nicole Rufo.
SPEAKER_01:Thank you and goodbye.
SPEAKER_03:Bye.
SPEAKER_01:This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.
