Everyone Is Talking About Lp(a): What It Means for Your Heart and What to Do If Yours Is High with Dr. Michael Twyman

Dhru Purohit (0:00)

Dr. Michael Twyman, welcome to the podcast. You're my personal cardiologist. I've been seeing you for years. Today, we have you on the podcast to unpack everything about LP little a, including what it means, who should get tested, and most importantly, what we should do if that number comes back elevated or super high. We'll also get into my own results when it comes to LP little a on this podcast. Let's jump in. So, start us off from the basics, Dr. Twyman.

What is LP little a and why is it making the headlines right now?

Michael Twyman (0:35)

So, lipoprotein a is a lipoprotein. It's a lipid protein carrier, and it's not on your traditional cholesterol panel. Everybody has lipoprotein a, but approximately 20% of the population has high serum levels of lipoprotein little a.

And the recent cardiovascular guidelines started to recommend that everybody over the age of 18 has this checked at least one time. And as you had mentioned in your intro, that only about 1% of the population knows do they have high serum levels. From previous mineralization trials and other cardiovascular trials, it's been shown that high levels of lipoprotein a are associated with increased coronary artery disease, risk of stroke, but also increased risk of something called erudyctinosis, which is a valve disease, and is probably most correlated with erudyctinosis. So people who have high lipoprotein a may have an early family history of cardiovascular disease. So if you have parents or grandparents that had heart disease in the 40s and 50s, or you have everybody in your family had some type of heart attack or stroke, high lipoprotein a is often the main reason why there's a cluster of vascular disease in families.

Dhru Purohit (1:42)

Let's talk about why it's in the headlines. People have probably seen there's news articles or some of their favorite influencers or people on Twitter or X are talking about it. Why are people talking about it right now more than previously?

Michael Twyman (1:55)

Because up until recently, there has no effective drug therapy that lowers lipoprotein in the leg.

The PCSK9 inhibitors may be lowered 20, 30 percent. Some supplements may be 10, 20 percent, but nothing is effectively really lowered other than aphoresis, which is a very inconvenient procedure where you have to go to the hospital, they take your blood out, they spin it through a machine and put your blood back in, and it's not something that's permanent. You have to keep going back every couple of weeks to have this treatment done, so it's not very popular to sign up for. So approximately two weeks ago, we're in September 2026, the first drug, the lower lipotenase, was completed their phase three trials. And right now we only have a press release. The final report of what happened during this trial will not be released fully until November at the American Heart Association's trials. But the press release came out stating that the drug Pellicarsin failed at reducing major adverse cardiovascular endpoints, or MACE. So the drug lowered lipoprotein in the LA, and they don't yet release the data. But in their phase two trials, it looked like it was lowering LPLA about 72 percent, which is more than anything to date that has been released.

But it had shown that lowering LPLA in these trials, the patients did not have decreased heart attacks, strokes, need for revascularization.

Dhru Purohit (3:19)

Yeah. Thanks for that breakdown. Why I think this is important and why we have you back on the podcast, I think this is probably your fourth appearance on the podcast, is because when it comes to the world of cardiology, let's say there's mainstream traditional cardiology, that's on one side and largely mainstream traditional cardiology. We'll say the most important things are lowering your cholesterol, especially your LDL, and yes, APOB is important, but get aggressive as possible at lowering your LDL, and especially that means for a lot of people bringing in prescription drugs like statins, and now the recommendations coming in started earlier, especially if somebody has cardiovascular risk or history in their family, but even if they don't, sometimes still aggressively lowering the LDL. Then let's say on the other side of the spectrum, all the way on the opposite side of the spectrum, you have a lot, I don't even know what to call this category, but there are people who don't believe that LDL is the end-all be-all, or APO-B is the end-all be-all, and they think that all the advice about lowering your cholesterol is missing the point. Cholesterol is an important hormone that plays a role in all different parts of the body and different things that it does, and we're misguided and really it's about metabolic health, staying fit, staying active, and keeping your nitric oxide levels in good standing. Maybe so there's some more details that are inside of there, but largely that side of the spectrum feels like we're missing the boat when it comes to all this focus on cholesterol.