Lipoprotein(a) May Be a Strong Genetic Marker to Heart Disease
Jason came to the office because of chest pain. At 34 years old, he works as manager of a local non-fast food restaurant, but indulges in lots of the odds and ends.
Among his indulgences: Diet Coke®. He told me of his peculiar experience: every time he'd have a Diet Coke®, he'd have pain in his chest. No Diet Coke®-no chest pain. If Jason drank coffee, no chest pain. Other foods, no chest pain. Anyway, just eliminating the Diet Coke® seemed to do the trick. (Aspartame?)
Anyway, that's not why I tell you Jason's story. In the midst of the evaluation of chest pain, an echocardiogram showed a mildly enlarged aorta (4.0 cm in diameter), the major artery of the body that is the first to emerge from the heart and an unusual and concerning finding, particularly at age 34. So we looked for a cause since, if allowed to progress, this young man could end up with an aneurysm or stroke by his mid-40s. Jason's evaluation uncovered a pattern called lipoprotein(a), or Lp(a) for short. We talked about how to correct this pattern. Among the strategies we discussed was niacin (vitamin B3), a moderately effective method of treatment.
But what bothered me about Jason's story was that neither of his parents had a diagnosis of heart disease. Not only could Lp(a) account for Jason's enlarged aorta, it also posed greater risk for heart disease and heart attack, sometimes as early as 40s in males, 50s in females. Lp(a) is among the highest risk markers for heart disease known, present in approximately 15% of the population. Since the gene is passed from one or the other parent, Jason had to have gotten Lp(a) from either his mother or father. You cannot acquire Lp(a). So one of Jason's parents was likely sitting on a genetic time bomb of unrecognized Lp(a) and hidden heart disease.
I urged Jason to advise his parents to have their Lp(a) measured, along with a CT heart scan to measure any hidden coronary plaque. Because Jason's paternal grandfather had a heart attack at age 62, only Jason's Dad had the heart scan (though I urged both parents to get one). Score: 1483. (Heart scan scores >1000 carry a risk of death or heart attack of as much as 25% per year if no preventive action is taken.) Next, of course, we had to persuade Jason's Dad that a program of prevention-intensive prevention-was in order, including a measure of Lp(a).
So that's the curious story of how Diet Coke® probably saved Jason's Dad's life. The lesson is that if you or someone you know has Lp(a), think about their children as well as their parents, each of whom carry a 50% chance of having the pattern.