Embarking on a journey toward a healthier heart, many of us diligently adjust our diets, increase our physical activity, and moderate our indulgences, expecting these changes to shield us from heart disease. However, for Black women, the shadow of genetic predisposition looms large, suggesting that despite our best efforts, our genes may place us at an elevated risk of cardiovascular complications.
Central to this conversation is a lesser-known player in the realm of cardiovascular health: Lipoprotein (a), or Lp(a). This unique lipoprotein variant, carrying cholesterol through the bloodstream, diverges from its more familiar counterparts with its genetic roots and its independent impact on heart disease risk.
Keith C. Ferdinand, MD, a distinguished cardiologist and professor at Tulane University School of Medicine, highlights the genetic underpinnings of Lp(a) and its role in predisposing individuals to heart disease and stroke, irrespective of lifestyle choices. “It’s genetic, and because it’s genetically determined, it can cause a risk for premature or sudden heart disease or strokes,” Ferdinand explains.
The issue of Lp(a) complicates the already challenging landscape of heart disease for Black women, who face a significantly higher risk of hypertension compared to their white counterparts—a key driver of heart disease. Notably, Black and South Asian women exhibit higher average levels of Lp(a), though the reasons behind this remain a subject of speculation. Ferdinand posits a historical perspective, suggesting that Lp(a) might have offered protective benefits in ancestral environments, such as enhanced blood clotting during childbirth or injury.
Despite the intrigue of its evolutionary backstory, Lp(a) remains a critical but underexplored factor in heart health, often overlooked in standard cholesterol screenings. Ferdinand urges the medical community to integrate Lp(a) testing into routine cardiovascular risk assessments, emphasizing the need for Black women to advocate for themselves by requesting this test, particularly if there’s a family history of heart disease.
The revelation that genetics may undermine our lifestyle modifications can be disheartening. However, Ferdinand reassures us that not all hope is lost. Maintaining a healthy lifestyle remains crucial, as it can indirectly mitigate the risks posed by Lp(a). He recommends maintaining a healthy weight, abstaining from smoking, opting for nutritious foods, and staying active as essential strategies for overall heart health.
As we observe American Heart Health Month, let’s broaden our approach to heart wellness by incorporating an understanding of our genetic blueprint. Engage in discussions with your healthcare provider about Lp(a) testing, especially if your family history suggests a predisposition to heart disease. This knowledge, coupled with proactive health measures, can significantly impact our heart health journey, offering a more nuanced path to safeguarding our well-being.