Lipoprotein(a): to test or not to test?

SOMETIMES you just want answers, even when those answers don’t allow any tangible opportunity for change or improvement. 

When you encounter one of those frustrating anomalies that occur in medicine – a patient who is young, fit and active, with no obvious risk factors, who is suddenly struck down by a myocardial infarction – the quest for a reason may be even more consuming.

In that sort of scenario, lipids specialists will sometimes suggest testing levels of lipoprotein(a) [Lp(a)], a type of low-density lipoprotein with a plasminogen-like protein attached. 

A 2009 meta-analysis of 36 cohort and case-control studies, with data from 126,334 patients, concluded that Lp(a) was continuously, independently and modestly associated with risk of coronary heart disease (CHD) and stroke. 

The review found a 13% greater risk of CHD per 3.5-fold higher than usual Lp(a) concentrations, after adjusting for other risk