Deep Dive: Lp(a) — what every doctor, and the 10-20% of the population at risk, needs to know

**Peter Attia** (0:04)
Hey, everyone, welcome to The Peter Attia Drive. I'm your host, Peter Attia.
The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top-performing individuals in the world. And this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peterattiamd.com.
For this podcast, I'm gonna be discussing LP little A. Little while ago, we put up a little questionnaire on Twitter that said, if I'm gonna do a solo podcast interviewed by Bob, what topic would you wanna hear? And we put up two options. The first was LP little A, the second was hormone replacement therapy for postmenopausal women.
Survey ran for about a day, and the results were unambiguous. 80% of you wanted to hear about LP little A, though many of you did wanna hear about HRT, and we will absolutely get to that.
So on this podcast, we structured it as an interview. Originally, I thought I would just do it as a quote unquote lecture, but I realized that would just be way too boring, and it would be more fun to play patty cakes with Bob and have him interview me. So that's what we did. So Bob put together an interview, and he just asked me a bunch of questions about LP little A. We're gonna talk about what the heck it is, why you should care, why it's problematic lipoprotein, what some of the potential treatment options are, and what's on the horizon. Now, I gotta admit, this is a bit of a technical podcast, but I also know that this is kind of a technical loving audience. So don't be discouraged. I also think this is one of the podcasts where you really have to be able to look at the show notes. I find some of this stuff really complicated myself, and I find a picture is sometimes worth a thousand words. So, especially when I get into stuff like kringle repeats and kringle four subsection two zone five, like that kind of stuff, you've just got to be looking at a picture to understand it. So if you can't be able to look at something while you're listening to it, that's fine, but maybe go back after the fact and look at it, or look first and then listen, something like that. But the show notes here will be very helpful, and hopefully this answers a lot of the questions that people have been asking me over the past year about LP little A. And again, if this format is helpful, let us know because we're really happy to kind of do one of these every couple of months where we just put up a general topic and Bob grills me on it. So without further delay, here's the discussion with Bob Kaplan on LP little A.

**Bob Kaplan** (2:49)
Peter.

**Peter Attia** (2:50)
How are you?

**Bob Kaplan** (2:51)
I'm doing well.

**Peter Attia** (2:52)
I noticed you have a coffee there.

**Bob Kaplan** (2:54)
Of course.

**Peter Attia** (2:55)
What number is that today?

**Bob Kaplan** (2:56)
Seven.

**Peter Attia** (2:57)
At least. I've watched four.

**Bob Kaplan** (3:01)
Well, seven doubles, probably seven double espressos.

**Peter Attia** (3:04)
That's true.

**Bob Kaplan** (3:04)
Make it 14

**Peter Attia** (3:05)
Yeah, that's impressive.

**Bob Kaplan** (3:06)
It's a low day.

**Peter Attia** (3:08)
So this is the first of what I suspect and assume we might do more of where we threw a question out to people and said, pick one, have a vote. I don't know, we gave them a day or so. And the choice was, do you want to know about LP little A? Or do you want to know about hormone replacement therapy in post-menopausal women? Which by the way, has a more politically correct name now that I can't remember.
Endocrine modulating therapies for women in menopause or something, I don't know.

**Bob Kaplan** (3:42)
I was gonna go with golden years or something to that effect.

**Peter Attia** (3:45)
The point is HRT versus this. And it was about 80-20 in favor of LP little A, which kind of bums me out because I actually really wanted to talk about HRT. But next time we throw HRT in, we're gonna put it up against something like bocce ball. And hopefully HRT comes out ahead and we can talk about it.
I think you have been accumulating a bunch of questions that people have also started sending in about LP little A. And I think that's what we're gonna talk about.