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

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 30 July 2018

⏱️ 76 minutes

🔗️ Recording | iTunes | RSS

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Summary

Pronounced, el-pee-little-a, this lipoprotein is simply described as a low density lipoprotein (LDL) that has an apoprotein “a” attached to it...but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.

A quick primer on lipoproteins [7:30];
Intro to Lp(a) [11:00];
Lab tests for Lp(a) and reference ranges [20:00];
The physiologic functions of Lp(a) [31:00];
The problems associated with high Lp(a) [34:15];
Lipid-lowering therapies of Lp(a) [44:45];
Lp(a) modification through lifestyle intervention [1:00:45];
High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
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Transcript

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0:00.0	Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia.
0:10.0	The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking,
0:15.7	along with a few other obsessions along the way. I've spent the last several years working
0:19.6	with some of the most successful top performing individuals in the world, and this podcast
0:23.8	is my attempt to synthesize what I've learned along the way to help you live a higher quality
0:28.3	and more fulfilling life. If you enjoy this podcast, you can find more information on today's
0:32.5	episode and other topics at peteratiamd.com.
0:41.7	In this podcast, I'm going to be discussing LP Little A. Little while ago, we put up a little
0:47.5	question here on Twitter that said, if I'm going to do a solo podcast interviewed by Bob, what
0:53.4	topic would you want to hear? And we put up two options. The first was LP Little A. The
0:57.7	second was hormone replacement therapy for postmenopausal women. Survey ran for about a day, and the
1:04.3	results were unambiguous. 80% of you wanted to hear about LP Little A, though many of you did want
1:09.0	to hear about HRT, and we will absolutely get to that. So on this podcast, we structured it as an
1:15.4	interview. Originally, I thought I would just do it as a quote unquote lecture, but I realized
1:19.6	that would just be way too boring, and it would be more fun to play patty cakes with Bob and have
1:23.7	him interview me. So that's what we did. So Bob put together an interview, and he just asked me a
1:30.2	bunch of questions about LP Little A. We're going to talk about what the heck it is, why you should care,
1:35.8	why it's problematic, like the protein, what some of the potential treatment options are, and what's
1:41.3	on the horizon. Now, I got to admit, this is a bit of a technical podcast, but I also know that
1:46.8	this is kind of a technical loving audience. So don't be discouraged. I also think this is one of
1:52.1	the podcasts where you really have to be able to look at the show notes. I find some of this stuff
1:57.4	really complicated myself, and I find a picture is sometimes worth a thousand words. So, especially
	...

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