Are you a patient looking for help treating your conditions?
At the Lipids and Primary Prevention Clinic (LAPP), we provide specialized virtual medical care for patients across Ontario, with a primary focus on cholesterol management, lipid disorders, and cardiovascular disease prevention.
Our Internal Medicine physicians assess and manage conditions such as high cholesterol, dyslipidemia, elevated lipoprotein(a) [Lp(a)], and other risk factors for heart disease and stroke. We also offer medical weight management and care for select related General Internal Medicine conditions.
With a referral from your family physician, walk-in clinic physician, nurse practitioner, or specialist, you can access personalized medical assessment and evidence-based treatment recommendations tailored to your health needs. Through convenient virtual consultations, we help you better understand your cardiovascular risk and explore strategies to manage cholesterol, improve metabolic health, and support long-term well-being.
A referral is your first step toward specialized lipid and cardiovascular risk care. Speak with your healthcare provider about a referral to LAPP Clinic to get started.
How to become a patient:
Family Doctor Referral: Ask your family doctor to refer you to our clinic for lipid and cardiovascular risk management.
Walk-In Clinic Physician Referral: You can obtain a referral from a walk-in clinic physician for telehealth services at LAPP Clinic.
Specialist Referral: If you’re under the care of a specialist, they can provide a referral for our services.
Nurse Practitioner Referral: Nurse practitioners are able to refer you to our clinic for specialized care.
Hypercholesterolemia (High Cholesterol)
What is Cholesterol?
Cholesterol is a waxy substance found in the blood, necessary for building healthy cells. However, too much cholesterol can increase the risk of heart disease.
Why is High Cholesterol Concerning?
Excess cholesterol can form plaque in the arteries, which narrows them, making it harder for blood to flow. This condition, known as atherosclerosis, can lead to heart attacks and strokes.
What are the Types of Cholesterol?
- LDL (Low-Density Lipoprotein) – “Bad” Cholesterol. LDL carries cholesterol from the liver to cells. However, if there is too much LDL, it can deposit excess cholesterol in the walls of arteries, leading to plaque buildup. Risk: High levels of LDL increase the risk of atherosclerosis (narrowed, hardened arteries) and heart disease.
- HDL (High-Density Lipoprotein) – “Good” Cholesterol. HDL helps remove excess cholesterol from the bloodstream and transport it back to the liver for disposal. Benefit: Higher levels of HDL are linked with a lower risk of heart disease because HDL helps keep arteries clear.
- VLDL (Very Low-Density Lipoprotein). VLDL mainly carries triglycerides (fats) from the liver to tissues for energy or storage. Risk: Like LDL, VLDL can contribute to plaque formation in the arteries. VLDL also plays a role in high triglyceride levels, which can be harmful in excess.
- Total Cholesterol: Total cholesterol is a combined measure of LDL, HDL, and other lipid components in the blood. It provides a general overview but doesn’t distinguish between “good” and “bad” cholesterol. Total cholesterol levels can help assess overall cholesterol health, but the breakdown of LDL and HDL provides a more complete picture of heart disease risk.
- Non-HDL Cholesterol: Non-HDL cholesterol is the total cholesterol minus HDL. It includes all cholesterol that has the potential to form plaques
What are Some Risk Factors for High Cholesterol?
- Unhealthy diet (especially high in saturated fats, trans fats, and processed sugars)
- Lack of physical activity
- Smoking and excessive alcohol intake
- Genetic predisposition
What are the Symptoms of High Cholesterol?
High cholesterol usually doesn’t have symptoms, which is why routine blood tests are essential.
What are the Treatment and Prevention Strategies for High Cholesterol?
- Dietary Changes: Emphasize a heart-healthy diet with fruits, vegetables, whole grains, and lean proteins. Reduce saturated and trans fats.
- Exercise: Aim for at least 150 minutes of moderate aerobic exercise per week.
- Medications: Statins and other medications can help lower cholesterol for those who need it.
- Lifestyle Adjustments: Quitting smoking and limiting alcohol.
Hypertriglyceridemia (High Triglycerides)
What are Triglycerides?
Triglycerides are fats in the blood that the body uses for energy. Excess calories from food are converted into triglycerides and stored in fat cells.
Why are High Triglycerides Concerning?
High triglyceride levels can increase the risk of cardiovascular disease and pancreatitis, especially when combined with other conditions like diabetes.
What are Some Causes of High Triglycerides?
- High-sugar and high-fat diets, particularly with added sugars
- Excessive alcohol intake
- Obesity and lack of physical activity
- Uncontrolled diabetes and certain medications
How do you Manage High Triglycerides?
- Diet: Focus on healthy fats (like those from nuts, seeds, and fish) and reduce intake of refined carbs and sugary foods.
- Weight Loss (if you have increased BMI): Losing 5-10% of body weight can significantly lower triglycerides.
- Physical Activity: Regular exercise improves fat metabolism.
- Alcohol: Limit or avoid alcohol, as it raises triglyceride levels.
- Medications: In some cases, medications like fibrates, niacin, or omega-3 fatty acids may be recommended.
Lipoprotein(a) / Lp(a)
What is lipoprotein(a), or Lp(a)?
Lp(a) is a particle in your blood that carries cholesterol. It resembles LDL (“bad” cholesterol) but contains an additional protein called apolipoprotein(a). Elevated Lp(a) is an independent risk factor for cardiovascular disease, meaning it can contribute to risk even when other cholesterol levels appear normal.
Is high Lp(a) genetic?
Yes. Lp(a) levels are largely determined by genetics and are generally stable throughout adulthood. You can have elevated Lp(a) even if you eat well, exercise regularly, and maintain a healthy weight. Lifestyle habits remain important for overall cardiovascular health, but they usually have little effect on your Lp(a) level.
Who should get an Lp(a) blood test?
Canadian cardiovascular guidelines recommend measuring Lp(a) at least once in adulthood as part of cardiovascular risk assessment. Testing may be particularly informative if you have a family history of early heart disease or stroke, known cardiovascular disease, or other risk factors. Ask your healthcare provider whether Lp(a) testing is appropriate for you.
What does a high Lp(a) level mean for my heart health?
Elevated Lp(a) can increase your lifetime risk of heart attack, stroke, and other cardiovascular conditions. The higher your level, the more important it may be to consider your overall risk profile. Your healthcare provider can interpret your result alongside LDL cholesterol, blood pressure, diabetes status, family history, and other factors. A high result does not mean that you will necessarily develop cardiovascular disease.
Familial and Genetic Cholesterol Disorders
What is familial hypercholesterolemia (FH)?
FH is an inherited condition that causes high levels of LDL cholesterol, often beginning at birth. Without appropriate treatment, it can substantially increase the risk of developing cardiovascular disease at a younger age. FH is different from high cholesterol that develops primarily because of lifestyle, although both genetic and lifestyle factors can influence cardiovascular health.
Can high cholesterol run in families?
Yes. Genetic factors can influence cholesterol levels, and inherited cholesterol disorders may affect multiple members of the same family. A family history of very high cholesterol, heart attacks at a young age, or early cardiovascular disease may indicate an inherited risk. Sharing this information with your healthcare provider can help determine whether further assessment is needed.
How do I know if my high cholesterol is genetic?
Persistently high LDL cholesterol, especially at a young age, or a strong family history of early cardiovascular disease may raise suspicion of an inherited cholesterol disorder. A healthcare provider will review your cholesterol results, medical history, and family history. Depending on the findings, additional testing or specialist assessment may be recommended.
Is genetic testing available for inherited high cholesterol?
Genetic testing can help identify certain forms of familial hypercholesterolemia. However, not everyone with inherited or persistently high cholesterol will have an identifiable genetic variant on testing. Your healthcare provider can determine whether genetic testing is appropriate and explain what the results could mean for you and your family.
What should I do if inherited high cholesterol runs in my family?
If you or a close relative has familial hypercholesterolemia or very high LDL cholesterol, discuss cholesterol screening and cardiovascular risk assessment with your healthcare provider. When FH is diagnosed, testing and assessment of close relatives may be recommended because early identification and treatment can reduce long-term cardiovascular risk. Treatment may include cholesterol-lowering medication alongside healthy lifestyle habits.