[Reporter Luo Bi/Taipei Report] "Normal blood lipids and regular diet may also have cardiovascular risks! Doctors remind that about 90% of lipoprotein (a) [Lp(a)] concentration is determined by innate genes. General blood lipid tests may not include this indicator. You cannot think that there is no risk just by looking at the bad cholesterol value. Adults are called on to test Lp(a) at least once in their lives. If they find it to be high, they can discuss it with their doctor as soon as possible and actively control other cardiovascular risk factors.
Mr. Huang, 69, often suffered from chest tightness and asthma when he was playing badminton 23 years ago. Because the pain was located close to his stomach, he initially thought it was a stomach disease. His wife, who is a nutritionist, sensed something was wrong and insisted on accompanying him to the hospital for a check-up. Only then did he discover cardiovascular stenosis and began long-term drug treatment.
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After more than 10 years of treatment, one night, while Mr. Huang was lying in bed chatting with his wife, he suddenly lost response. The wife immediately called her son to help perform cardiopulmonary resuscitation and dialed 119 to send him to the hospital in time to save his life. It wasn't until the eldest son's recent health checkup revealed abnormal blood lipids, and further testing for Lp(a), and he also took blood, that he discovered that both father and son's Lp(a) was on the high side.
Liu Bingyan, chairman of the Lipid and Arteriosclerosis Society of the Republic of China, pointed out that Lp(a) is a lipoprotein that transports fat in the blood. Its structure is similar to low-density lipoprotein, but it has a special apolipoprotein(a) in the outer layer, which is related to the risk of atherosclerosis and calcific aortic stenosis.
Liu Bingyan said that about 90% of Lp(a) concentration is determined by innate genes and is less affected by acquired diet and lifestyle. The purpose of the test is to identify risks that may be underestimated by traditional blood lipid tests. Especially for those who have myocardial infarction at a young age, have repeated cardiovascular events, or have a family history of premature cardiovascular disease, they should discuss the need for testing with their doctor. If one person tests positive, parents, children and siblings can also be evaluated.
Huang Yiqun, a physician at the Department of Cardiology at Linkou Chang Gung Memorial Hospital, said that Lp(a) may increase cardiovascular risk by promoting arteriosclerosis, causing vascular inflammation and affecting thrombosis-related mechanisms. Studies have shown that the risk of ischemic stroke in groups with extremely high concentrations of Lp(a) is more than twice that of those with lower concentrations.
However, if the Lp(a) test is high, it does not mean that the disease will definitely occur. Wu Yizhe, secretary-general of the society, pointed out that there are currently no drugs that specifically target Lp(a) and have been proven to improve cardiovascular prognosis. Therefore, the focus at this stage is to more actively manage other risk factors, including controlling bad cholesterol, blood pressure and blood sugar, quitting smoking, and maintaining healthy lifestyle habits.
Wu Yizhe said that statins are still the basis of blood lipid-lowering treatment. If bad cholesterol control is not up to standard, or if muscle soreness and other intolerance problems occur, treatment adjustments should be discussed with the doctor. Other oral drugs or injections can be combined according to individual circumstances. Bad cholesterol control goals must also be set based on medical history and overall risk.
Mr. Huang said that after long-term medication in the past, his bad cholesterol was still maintained at 130 to 150 mg/dL. After discussing with his doctor, he decided to use PCSK9 inhibitors at his own expense. After half a year of treatment, the bad cholesterol dropped to more than 70 mg/dL, about half. He hopes that relevant units will continue to evaluate the payment conditions to reduce the burden on patients who need long-term treatment.
Liu Linyi, director-general secretary of the National Health Insurance Administration, said that National Health Insurance has provided Lp(a) testing for groups that have been assessed by doctors as having testing needs and that meet the benefit requirements. The National Health Insurance Administration also promoted a plan to improve medical benefits for hyperlipidemia in early 2026, strengthened the tracking care of high-risk patients, and relaxed some payment conditions for blood lipid-lowering drugs on September 1, which is expected to benefit approximately 1.05 million patients.
The association designates October 4 every year as Taiwan's "Lp(a) Awareness Day" and invites the Department of Health Insurance, the Heart Association of the Republic of China and the Taiwan Blood Lipid Health Education Association to jointly respond. Liu Bingyan reminded that adults should have their Lp(a) tested at least once in their lifetime to help understand genetic risks early, and then discuss follow-up management with doctors based on the results to make cardiovascular risk assessment more complete.
