Novel behavioural approaches and implementation science for mitigating genetic risk of cardiovascular disease due to elevated lipoprotein(a)

Abstract

Purpose of review Elevated lipoprotein(a) [Lp(a)] is a genetic trait that indicates higher risk of atherosclerotic cardiovascular disease (ASCVD). We review novel strategies to mitigate behavioural risk-factors in this genetic condition. Recent findings Pharmacological and biological interventions are available for lowering Lp(a). However, the acceptability and feasibility of these approaches are questionable due to cost and lack of clinical evidence for their efficacy. A number of low-cost, minimal patient contact interventions are available for modifying behavioural risk-factors that are associated with increased risk of ASCVD familial hypercholesterolaemia and diabetes. These include lifestyle interventions designed to improve diet and physical activity. These interventions may be particularly important among individuals with elevated Lp(a) to manage their higher risk of diabetes and ASCVD. The following article outlines recent research that has examined such low-cost, minimal patient contact interventions. Summary The current research indicated that such interventions, which are grounded in psychological theory, can assist individuals to improve their diet and physical activity. These findings have implications for developing and implementing similar interventions for individuals with elevated Lp(a), so as to assist in reducing behavioural risk-factors associated with ASCVD.

Cascade testing for elevated lipoprotein(a) in relatives of probands with familial hypercholesterolaemia and elevated lipoprotein(a)

“…This information may be employed in families to recommend earlier programs of children for FH. Our data also showed that adults identified with elevated Lp(a) had a high frequency of smoking, hypertension and type 2 diabetes; this information could be employed to target robust and effective measures for mitigating modifiable cardiovascular risk factors, which is especially important in patients with FH [4,48,49].…”

“…Studies are required to address counselling measures and patients' perceptions of receiving risk notification of an elevated Lp(a) concentration [4,12,19]. Further investigations should assess the corresponding impact on the effectiveness of interventions aimed at co-existent modifiable risk factors on patients detected with high Lp(a) [48,49], as well as the cost-effectiveness of different screening strategies [19]. The value of detecting elevated Lp(a) in children and different ethnicities warrants investigation [19,54].…”

Cascade testing for elevated lipoprotein(a) in relatives of probands with high lipoprotein(a)

“…We showed that adult relatives with elevated Lp(a), particularly in those with Lp(a) ≥100 mg/dL, had a high frequency of smoking, hypertension, and dyslipidemia. This underscores the importance of lifestyle modification and LLT for mitigating modifiable cardiovascular risk in those who screen positive for Lp(a) [20] . We showed that among 30% of affected relatives initiated on LLT, there were clinically meaningful reductions in plasma concentrations of LDL-cholesterol and apoB-containing lipoproteins [21] .…”