Pathologists seek Medicare funding to test for ‘bad cholesterol’

The Royal College of Pathologists of Australasia has made a formal bid for Medicare funding to test for “bad cholesterol” that runs in families and has been linked to sudden heart attacks in young people.

High-profile cardiologists last week called for better awareness of the impact of heightened levels of lipoprotein(a), or Lp(a), which they say could affect millions of Australians, at least at mild levels.

Andrew Draper was fit and doing ocean swims when he had a heart attack in 2012, aged 52. It was later found he had heightened Lp(a) levels.Credit:

Elevated levels of Lp(a) can be inherited, causing heart disease in people in their 30s, or other younger non-smokers living a healthy lifestyle.

Andrew Draper, a chartered accountant from Sydney, said his problematic Lp(a) levels were identified after he had a heart attack in 2012, aged 52. His brother also had a heart attack around the same age.

“I was at the football and suddenly felt like the worst case of flu I’d ever had in my life. It came on in the space of about five minutes. There was pain in my jaw, pain in my shoulder. There was no real serious chest pain, but I just felt really really unwell,” he recalled.

Draper said he initially went into denial about the symptoms.

“I was really fit. I was doing ocean swims and things like that … I didn’t smoke and I wasn’t overweight.”

Football referee David Lewis said he was told he had Lp(a) levels way above what would be considered a dangerous level after it was discovered that he had four blocked arteries in his heart and had a stroke that caused his temporary blindness. Lewis’ own father had a heart attack aged 33 in the 1960s.

The Australian Health Department confirmed the government’s medical services advisory committee was considering an application from the college of pathologists for Medicare funding of Lp(a) testing as “an independent predictor of cardiovascular disease risk”.

If approved, it could lead to government-funded testing for those with a wide range of risk factors, including those who have developed heart disease before the age of 60, those with a family history of “premature” cardiovascular disease or people with a close relative with high Lp(a).

However, the Royal Australian College of General Practitioners said it would not support the application “at this time”, arguing the testing would “add very little incremental decision-making information” over a new cardiovascular disease risk calculator, currently being updated.

Professor Jason Kovacic, executive director of the Victor Chang Cardiac Research Institute, is supporting pathologists’ push for a Medicare rebate. He said it was imperative that people with a strong family history of early heart disease be tested for Lp(a).

“If they don’t have the means to access that testing, that’s a real problem we need to fix.”

Kovacic said a Lp(a) test cost about $40. Although there is no dedicated treatment, people with elevated Lp(a) are encouraged to eliminate other risk factors and can be considered for off-label drugs such as evolocumab. There are also promising new treatments in development.

Lp(a) is made up of particles that carry cholesterol around the body. It is known to be a major risk factor for atherosclerosis, which is hardening and narrowing of the arteries.

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