MedEvidence! Truth Behind the Data

🎙 Two Docs Talk Lp(a) Part 1 Ep 83

February 27, 2023 Dr. Michael Koren, Dr. Dennis Leahy Episode 83
MedEvidence! Truth Behind the Data
🎙 Two Docs Talk Lp(a) Part 1 Ep 83
Show Notes Transcript Chapter Markers

Join Drs. Michael Koren and Dennis Leahy, cardiovascular specialists, in a 4 part series of MedEvidence exploring Lipoprotein A also know as Lp(a). Dr. Leahy shares his personal experience with LP(a) and the duo delve into cutting-edge strategies for managing this risk factor for cardiovascular disease. So, tune in to learn more about this lesser known condition and possible treatment options.

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Dr. Dennis Leahy is a retired interventional cardiologist living in San Diego. He received his education from Princeton University and Columbia University and his residency at the University of California. In addition to enjoying the opportunity to surf and golf, he has maintained a personal and professional interest in Lipoprotein A research and treatment.

Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.

He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. 

Dr. Koren has served as an Investigator in over 2,000 trials and as the international lead investigator for many multi-centered trials including ALLIANCE, ROLE, TREAT to TARGET, OSLER, and MENDEL studies. He has written and co-authored over 100 peer-reviewed articles and been published in the most prestigious medical journals. Dr. Koren has also designed a research train

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Speaker 1:

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by Encore Research Group and hosted by cardiologist and top medical researcher, Dr Michael Koren.

Speaker 2:

My name is Dr Michael Koren and I'm delighted to moderate another session of MedEvidence. Moderate another session of MedEvidence and we're very fortunate today to have a special guest, dr Dennis Leahy, from San Diego, who's going to talk about lipoprotein little a from both the perspective of a clinical cardiologist, interventional cardiologist and also a patient that has this problem. So it's a fascinating opportunity for us to dig in, and Dennis and I were just joking before I got on air here and stated hey, this is two docs talking LPA, and so we're going to give you the opportunity to basically eavesdrop on our discussion and you can see how two physicians who are really interested in the space, particularly the space of how to deal with this really, really really bad cholesterol that we call LP little a, and ultimately, what somebody that has this problem, that has knowledge, is doing to deal with it. So with that introduction, dennis, just tell the audience a little bit about your background and your passions and practice and when you first found out about your specific problem with lipoprotein little a.

Speaker 1:

Sure, I'm happy to do so. Um, I actually uh went to college, in medical school on the east coast, but then had the good fortune to come out to ucsd, where I uh have have not budged since, uh, since I arrived here in 1973 where'd you grow up. Yeah, it was.

Speaker 2:

It was a good deal so I I'm just curious where'd you grow up?

Speaker 1:

but part of the country I grew up outside chicago and then, uh, as I said, eight years on the East Coast and then came here. So I was trained at UCSD doing my medical internship, residency and cardiology fellowship and then went into practice here and have been in San Diego since, really started my practice or joined practice in 1981 as a general cardiologist who did caths, but as you know, interventional cardiology really kind of came along somewhat after that.

Speaker 1:

So, did some retraining, having done a lot of work in the cath lab already and went into the interventional space as well. So did general cardiology and a lot of interventional work. I actually continued in that practice and just retired about six years ago. But in the interim I encountered my own particular vulnerability to heart disease when I discovered that I had high LP little a. I'm a classic LP little a person in that I had a very strong family history of vascular disease probably came mostly from my mother's side of the family. I won't go into great detail unless you want to hear that, but she had a very strong I actually love to hear that.

Speaker 2:

So just a couple of quick comments. Interesting One is that interventional cardiologists often don't care about cholesterol problems, and so you're you're probably an exception to the rule. I remember when I was doing my cardiology fellowship a few years after you, the chairman of the program was skeptical about cholesterol issues completely and was certainly not one that would push the idea that aggressive lipid control was a really important skill for a cardiologist idea that aggressive lipid control was a really important skill for a cardiologist, which, of course, I found other mentors to follow with regard to my career path. But the fact that you're an interventional cardiologist that thinks that cardiology is more than just fixing lesions is really heartwarming to me as a non-interventional research cardiologist. So I think that's really really neat.

Speaker 2:

But the other part to explore what you said is this family history concept is really really important. So, going back to my cardiology days, one of the things that struck me when I first learned about LPA is the really, really strong family history of people with this problem. So you'll get folks, for example, that have a father and mother who had some complications in their 20s, 30s or 40s, and this is following each generation down the road. So, and to that point, I did my training at New York Hospital and one of the famous LPA patients at New York Hospital was Arthur Ashe, who had this type of family history of having both mother and father have heart disease at a young age, and Arthur Ashe, as a fit professional athlete, had his first cardiac issue at age 29. So it was a very profound introduction to me of this particular problem. So, yes, tell us a little bit more about your family history. When did your mom and dad first develop issues with their heart or vasculature?

Speaker 1:

Yeah, well, the family history thing is as you said. It's a huge component of the LP little a story and people who have high LP, little a, I think the risk has to be taken somewhat in context of their family history. And if you have the family history I have and the LP little I have, level I have. Growing up I was probably about 10 years old and my mother's brother, who I assume was maybe in his mid-50s, then had to have bilateral carotid endarterectomies and I remember hearing that term. It kind of caught my ear because what 10-year-old would have any idea what that meant? And it's actually one of the first times I remember thinking, you know, I kind of maybe would want to be a doctor because I want to know what that means more than anything else. So you didn't have other physicians in the family.

Speaker 1:

Well, my grandfather, who I never met, he was pre-deceased. My arrival With atherosclerosis complications Not sure actually, you know that was a long time ago, but anyway, my mother's brother had it. My mother herself wound up having to have bypass surgery. She was living in Arizona at the time. She was probably in her late 60s. She had complete venous graft failure within six months and had to have a redo cabbage. When I brought her out to San Diego to have that done, and so that generation I think several of her sisters had heart disease as well. The details are a little bit murky and that's when I really decided I better look into my own risk here in depth. And that's when I really started down the you know, pursuing my own risk, and that's an interesting story in itself.

Speaker 2:

So let's jump into that a little bit, because I think that that's actually very, very interesting from a number of perspectives.

Speaker 2:

One I know if you're willing or able to share numbers with people, but one of the questions that comes up is what your numbers are and what they mean, and the fact that LPA issues are fundamentally a little bit different than cholesterol issues. So you know, as we all know, for cholesterol issues there's sort of a Gaussian-shaped curve of distribution of levels, and if you're at the higher end of the Gaussian curve then you tend to have problems, but pretty much anybody within the curve gets some benefit by reduction of cholesterol, whereas in LPA it's an asymmetric distribution curve and the people that are truly at risk are at one end of the curve, and that involves maybe about 10 or 15% of the population who have levels that are, you know, two, three, four, five, even up to 10 times higher than what you would expect. So I don't know if you know those numbers offhand for relatives or for you, if you want to share that, but I think the audience might be interested in understanding that a little bit better.

Speaker 1:

Yeah Well, let's think of accuracy. I'll restrict it to my own numbers. So in 2002, you'll probably recall, lp little a was known. I mean, it's been known as a lipid particle for some time but there's a real struggle to figure out whether it's strictly a biomarker or causative agent for vascular disease. And in 2002, things were every bit as murky as they were before that. But I was kind of a typical LP little a patient and remain so, in that if you look at me and you looked at 10 other people in the room you'd say who's the last guy here to get vascular disease? It would probably be me.

Speaker 1:

I've always been very fit, I've exercised all my life and had virtually no other risk factors. So when I looked into my own situation, I had a maximal stress test. It was normal. I got a basic lipid panel that had a, you know, not ideal LDL. I think it was around 115, 120. But then I got a much more detailed lipid panel and that was kind of the foreshadowing of my future troubles.

Speaker 1:

My LP little a level was about four times the upper limits of normal. I had a CRP done that was elevated and a homocysteine that was slightly elevated, but we really didn't know what to do about any of that in 2002. So I decided, well, I'm going to have to have a calcium scan, because that's going to have to. I've got to have a tiebreaker here in some direction of where where do I stand right now? And I had a calcium score of zero. Really Wow, really Interesting. So, needless to say, I took that as my, that I'm going to be exempt to all this. I'm not going to follow my brother's footsteps or the rest of the family, and my risk calculation then, you know, for a 10-year event was really, really low, because all my other parameters were pretty normal. Five years later, I started down what I describe as 10 years of vascular havoc.

Speaker 2:

We're going to do a cliffhanger here. I love this story actually. And so you had an LPA level that was four times normal, and we're going to actually explain what those numbers mean. And you had a negative coronary calcium count, basically Right. And so the question is are you really at risk, right? So with that cliffhanger question, we're going to stop this part of our session and move on to the next. Okay, great, the Thank you.

Lipoprotein Little a With Dr. Leahy
Vascular Havoc and Risk Assessment