Explain Lipoprotein (Lp(a) Excess ?
While cholesterol and triglycerides are important lipid risk factors, another lipoprotein factor called Lipoprotein (a) is thought to play a significant role especially in genetic predisposition to coronary artery disease. Lp (a) is a sub fraction of LDL but ten times more atherogenic, and its serum level is genetically determined. Being a dual pathogen influencing both atherosclerotic and thrombotic process, it is considered as a powerful independent risk factor for premature and extensive coronary disease. It is widely believed to be a biological marker for familial CAD, having the same significance as that of a history of premature CAD in the family.
The inherited serum levels of Lp(a) are not influenced by gender, diet, smoking, or other risk factors. The pathological effects of Lp (a) begin at a level of 20-30 mg/dl and are magnified in the presence of high LDL, low HDL or a high TCHDLc ratio, again highlighting the significance of lipid fraction interrelationship. There is a ethnic and genetic variability in the level of Lp(a). Indians have a higher level than other groups or races like Chinese or Japanese.
However there are no data showing that the decrease in Lp(a) levels is associated with a decrease in the incidence of Cardio-vascular or cerebro-vascular disease. The value of the routine screening for, and/or treating Lp(a) excess, is therefore still debatable. Even then Lp(a) levels should probably be taken into account impatient with CAD without established risk factors. The other factors should be rigorously modified or eliminated because, as has been seen, in hypercholesterolemia patients with increased Lp(a) levels, the decrease in LDL cholesterol levels is followed by neutralisation of the atherogenic potential of Lp(a).