A patient can have an Lp(a) level of 690 nmol/L with an LDL particle concentration of 1800 nmol/L, meaning over one-third of their LDL particles were Lp(a).

“the LP little a cholesterol it sounds a lot like when we're measuring ldl-c so LP little if you're measuring LP little a cholesterol you're measuring the amount of cholesterol that's carried within the LP little a particles and similarly with LDL see you're measuring the amount of cholesterol that's carried within the LDL particle similarly you would rather know the LDL particle”

“I believe LP little a mass was the first way that this was quantified and whether it was the first or not I don't know but what I can certainly say is it's by far the most ubiquitous I'm sure that 19 out of 20 times when a patient is having their LP little-a checked it is the mass that is being checked”

“the LP little a mass is directionally a reasonable test but it's not a great test and the reason is it's measuring for particles that carry a PO a it's measuring the mass of everything which is the a PO a the a PO be the phospholipids the cholesterol the triglycerides the dog's the cats through whatever it's measuring the mass of the entire structure”

“this is this is actually what makes it so problematic is it's even worse than the discordant between LDL P and LDL see because at least when you're dealing with LDL you know the molecular weight you don't know the molecular weight of LP wittily this is actually the point I forgot that I wanted to make a moment ago I remember once having a patient come to me with everything but the LP little AP and I remember thinking well I used to be a smart little organic chemistry whippersnapper I should be able to convert this from milligrams per deciliter into Nana mole per liter and of course anyone listening to this who knows more about chemistry than me well remember that all you need to know is like avocados number and the molecular weight and you're ready to go but of course you don't know the molecular weight that's the problem because the APO a is don't look the same the whole calculation goes to hell in a handbasket you can't actually calculate the molecular you don't know the molecular weight that's the problem because the APO a is don't look the same the whole calculation goes to hell in a handbasket you can't actually calculate the molecular you don't know the molecular weight because I've had Kringle sub-segment the Kringle for segments too because it's got such a variability it's not like you can say the molecular weight of sodium is X or the molecular weight of tests drone is wise so with the a PO a and how it comes in different isoforms can you measure the a PO a yes but it would be for a given individual that's the point yes you could absolutely measure the molecular weight of an ape away but it would be like yours and mine would probably be different so therefore at least to my knowledge and again I don't want to speak out of turn”

“so it separates with the ldls and lp little a is basically you have your ldl part of this macromolecule but co-attached to the apob structural protein is another protein that shouldn't be there and it's called apoprotein little a and by little a we mean small case not a capital a and that molecule that attaches apoa you know can vary in molecular weight size length etc but that's beyond this discussion so it's an ldl that's carrying an extraneous passenger”

“i had a patient once when we were measuring both in nanomole per liter who had an lp little a of 690 nanomole per liter in the context of an ldl particle concentration of about 1800 nanomole per liter so a little over one third of his ldl were lp little a”

“the hdl particle by contrast has multiple apoas on it and this is totally different from apo little a so we're not going to talk about that other than to say it's apo big a and therefore you don't have a unique number and then of course with lp little a you have the problem that you raised which creates enormous challenges there is no molar weight for apo little a”

“there is no molar weight for apo little a right this is this is the fundamental problem in the assay of trying to measure this thing exactly”