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By Nicol Vaizman
Nicol Vaizman is a Master’s student in Medical Genetics at UBC, based in the Brunham Lab at the HLI. Her research explores how genetic testing can identify and manage inherited lipid disorders, aiming to prevent cardiovascular disease and translating genetic data into practical tools for clinicians and patients.

Doctors often use a routine lipid panel – a blood test that measures levels of fat in the blood – to assess cardiovascular risk. Cardiovascular disease remains the leading cause of death worldwide. Among the many numbers a lipid panel reports, one is often missing despite its strong ability to predict heart disease. That number is Lipoprotein(a) or Lp(a). Though elevated Lp(a) levels are found in around 1.6 billion people globally, it is almost never measured. 

A recent review paper published in the European Journal of Preventive Cardiology, led by physician-scientists at the Centre for Heart Lung Innovation (HLI) and McGill University, argues that it is time to change how and when we test for this overlooked risk factor. 

The review, written by Drs. Iulia Iatan and Gordon Francis, with co-authors Drs. Liam Brunham and John Mancini, presents a comprehensive case for testing Lp(a). It draws on clinical guidelines, epidemiologic and genetic data, and public health principles.

As Dr. Gordon Francis notes, “It is now recommended that Lp(a) be measured at the same time as the first cholesterol profile.”

How Lp(a) is unique and why it matters

Lp(a) is not your typical cholesterol biomarker. Unlike low-density lipoprotein (LDL) cholesterol – the “bad” cholesterol that raises heart disease risk and can change with diet or lifestyle changes – Lp(a) levels are genetically determined and remain stable throughout life.

Years of large-scale and genetic studies have shown that Lp(a) is an independent, causal risk factor for atherosclerotic cardiovascular disease and aortic stenosis. In other words, Lp(a) is associated with the development of both blocked arteries and narrowing of the heart valves. The higher someone’s Lp(a) is, the greater their risk is. Importantly, this risk is present even in individuals with low LDL cholesterol levels.

“The risk of atherosclerotic cardiovascular disease with markedly elevated Lp(a) is equal to that of untreated familial hypercholesterolemia.” – Dr. Gordon Francis

The authors cite a major study of 5.5 million U.S patients, where less than 1% had their Lp(a) levels measured. Yet, it is estimated that 1 in 5 people worldwide have elevated levels (Lp(a) > 125 nmol/L), making it as common as high blood pressure or smoking in some populations.

The evidence is clear, but underused

When evaluating Lp(a) against classical and modern population-level screening principles, the authors’ conclusion was clear: Lp(a) screening checks nearly every box. It is common, easy to measure with a reliable and simple blood test, provides actionable information to guide patient care, and is cost-effective.

In British Columbia, a one-time Lp(a) test costs just $29.61. As the authors note, “the value of knowing the result of the test is likely to be higher than the cost of the test.” That value includes helping doctors better predict who is most at risk so that they can intervene earlier and potentially prevent cardiovascular events and reduce associated healthcare costs.

While there is not yet an approved treatment that directly lowers Lp(a), several therapies are in late-stage clinical trials and expected to report outcomes within the next year. Still, the authors emphasize that Lp(a) testing can already be useful in informing care. Knowing a patient’s Lp(a) level can help clinicians decide whether to lower other modifiable risk factors more intensively, such as lowering LDL cholesterol levels or prioritizing imaging.

Test results can also prompt screening of family members, especially when there is history of premature cardiovascular disease or inherited high cholesterol (familial hypercholesterolemia).

According to Dr. Iulia Iatan, “When we identify a patient with elevated Lp(a), it’s not just about that individual – it’s an opportunity to screen family members and intervene earlier.”

As Dr. Francis notes, “When elevated Lp(a) is found, it is recommended to review the family history for premature cardiovascular events, try to reduce all other risk factors like smoking or elevated blood pressure, possibly perform a blood vessel imaging study like a carotid ultrasound or coronary calcium score, and consider initiating statin therapy to mitigate the risk of the high Lp(a).”

Global guidelines already recommend Lp(a) screening

International guidelines are beginning to reflect the growing consensus on the importance of Lp(a). Canadian and European lipid guidelines, as well as the American National Lipid Association, now recommend one-time Lp(a) testing for all adults, preferably when they get their first lipid panel.

Yet, as the paper highlights, “this recommendation has not been incorporated into a formalized screening programme in any health jurisdiction to our knowledge.” The authors suggest that Lp(a) testing could serve as a catalyst to reevaluate how lipids are screened at the population level.

Awareness isn’t enough

The authors conclude with a clear call to action: “The time has come to qualify Lp(a) as a routine screening test for cardiovascular risk assessment based on these cornerstone criteria.”

This paper reflects the ongoing leadership of physician-scientists at HLI, who continue to shape the future of proactive preventive medicine. Their efforts are helping change how inherited cardiovascular risks are detected, managed, and ultimately prevented in routine care.

Take a look at the full open-access article here:

Iulia Iatan, Marlys L Koschinsky, Logan Trenaman, Wei Zhang, George Thanassoulis, Liam R Brunham, G B John Mancini, Gordon A Francis, Rationale for the routine screening of Lipoprotein(a) in cardiovascular risk assessment, European Journal of Preventive Cardiology, 2025;, zwaf342, https://doi.org/10.1093/eurjpc/zwaf342

By Jinelle Panton
Jinelle Panton is a PhD student in the Camp lab.
By Darren Sutherland
Darren Sutherland is the lung registry manager at the James Hogg Lung Biobank.

Holding a donor lung instantly educates. The delicate nature of the organ leads to an understanding of its vulnerability to the environment and, at the same time, revealing its perfect tissue architecture. Our lungs do gas exchange in the blood capillaries, nourishing the body with vital oxygen. Our lives depend on sufficient lung function, and research on lung disease contributes significantly to the advancement of medicine.

Since 1977 the James Hogg Lung Biobank (JHLB) has been collecting a growing inventory of donor lung tissue and associated clinical data. This collection has made a significant contribution to science and the diagnosis of lung disease contributing to over 700 research publications to date with a current average of 10 per year. The acquisition of new donor specimens is ongoing with approximately 12 donations per year. One example is idiopathic pulmonary fibrosis, a rare and fatal disease with limited treatment options to slow its progression. The JHLB tissue samples provided to researchers at the HLI in recent years have led to high impact scientific publications related to the early stages of chronic obstructive pulmonary disease (COPD) and lung fibrosis.

Patient confidentiality is paramount in biobanking and all donors are assigned a 4-digit identifier when donating so that no identifying information is ever used past the time of donation and all donors become anonymous. Since we are often asked, let me tell you where the lungs come from and what happens when they arrive at our biobank.

Our donor lungs are sourced from several locations both within Canada and internationally; one of the more recent sources is the International Institute for the Advancement of Medicine. This respected organization provides non-transplantable human organs and tissues for research. Our collaboration with this organization has led to the collection of healthy lungs free of disease; these specimens are essential for research as they provide a control to compare with cases of lung disease. One example of a recent lung donation was the case of a man suffering from idiopathic pulmonary fibrosis who made the selfless decision to donate at end of life.

Whenever the biobank is notified that a lung may be available, we begin our preparations for receiving the organ. We work together as a team and upon arrival, graduate students will prepare to culture cells lining the inner airways. To collect the cells, they will take brushings of the bronchus, the large airway the leads to the right or left lungs. The cells can be cultured in a dish, allowing them to divide and grow, so that we can use them for future experiments. These cells can potentially be used to model the human airway epithelium for evaluating novel drugs. After taking the brushings, the lung can be further examined and processed.

As I prepare for the next steps in the preservation of the lung, I have the oversight and advice of a research associate, an expert in respiratory research and image analysis, who can spot every fine detail of my technique. This process helps ensure everything is done with precision and accuracy resulting in an optimal specimen for future research. We air-inflate the lung to a specific pressure through the main bronchus to preserve the natural tissue architecture of the organ. The lung is then frozen over liquid nitrogen vapor in its inflated state to allow for a controlled rate of freezing to optimize its preservation. Each step in this process is carefully documented with images.


Once a lung is frozen it will be scanned by computed tomography (CT), which allows us to obtain a detailed 3D map of the entire donated lungs. This step is important as in most cases disease is heterogenous; there are sites of disease and spared normal tissue throughout the lung. Lung function, such as airflow and gas exchange, can vary significantly across different regions of the lung as well. Specific sites of disease activity or tissue sparing can be selected for research.

Donor lungs can be stored indefinitely in ultracold freezers but are usually processed into individual tissue samples collected at specific sites in the lung. These samples are collected with precision using procedures developed over years in our biobank. Frozen lungs are sectioned and then cylindrical core samples are collected at sites determined by software developed at HLI. The dimensions of the core sample are selected to accommodate taking a thin section for mounting on a microscope slide. By randomly sampling the locations to image, we add to the statistical significance of future findings. Shown below is an image of a core sample taken from a whole lung:

Some selected lung tissue core samples will be further processed into formalin-fixed paraffin-embedded tissue blocks. These tissue blocks can be stored indefinitely at room temperature with preserved tissue morphology and cellular details for future research. These techniques allow for a wide array of analysis to be done on a small sample of lung tissue including the tissue structure and cellular composition, gene expression and proteins present in the tissue. With the imaging previously done with the donor lung specific sites of disease can be selected for study.

Historically most of our specimens were collected from lung surgeries preformed at St. Paul’s Hospital between 1977 and 2007. The most common surgery historically was a lung cancer resection; these patients most often have an additional diagnosis of COPD. The JHLB has collected tissue and associated clinical data from over 3000 patients to date, including the whole spectrum of lung disease. Before their surgeries most patients underwent lung function testing at which time the patient would be given a detailed interview regarding their full occupational history and past exposures to potential lung toxins. This information has given us an invaluable database of occupational exposures related to lung disease.

The technology and tools available to researchers have advanced exponentially in the last decade. We often release tissue samples for analysis using technology which did not exist at the time the lung was donated! The donations being received today could very well be used for research in the future using technology which currently does not exist. Donor lung tissue can also play an important role in the development of new drugs and treatments by studying how they interact with human tissue before a clinical trial.

Over 48 years the James Hogg Lung Biobank has had the opportunity to acquire specimens from rare lung diseases, and accumulated significant cohorts for diverse research. Examples of these cohorts include IPF, acute respiratory distress syndrome, cystic fibrosis and fatal asthma. The patients and families thinking of others in donating their organ or tissue for research are making an incredibly important contribution that will inevitably save lives in the future. A lung donation from a single IPF patient like the one described earlier may not seem significant but it is a contribution to a larger cohort that will undoubtedly have a major impact on our understanding of the disease and contribute to the development of new treatments.

By Eric Xiang
Erix Xiang is a PhD candidate in Experimental Medicine working in Dr. Gordon Francis’ lab at HLI.

Atherosclerosis is one of the main causes of heart disease, which is the leading cause of death in Canada and worldwide. It develops when fat builds up in the arteries, forming plaques that restrict blood flow and can ultimately trigger heart attacks or strokes.

While scientists have long relied on animal- and cell-based models to study atherosclerosis, these models don’t always reflect what actually happens in the human body. To address this knowledge gap, Dr. Ying Wang and her research team have adopted a novel technique called multiplex imaging to validate previous findings in human tissues.

Multiplex imaging is a powerful technique developed for cancer research that allows scientists to closely examine many different cell types within a single tissue sample. Dr. Wang’s team applies multiplex imaging to study real human artery tissue samples, either healthy or atherosclerotic, from the Bruce McManus Cardiovascular Biobank at HLI.

With this technique, the team has shown that smooth muscle cells, the most common cells found in blood vessel walls, are key players in plaque development. This is different from the mainstream belief that human atherosclerosis is primarily driven by immune cells like macrophages. Further, Dr. Wang’s lab showed that there are signs of elevated inflammation in smooth muscle cells, such as the release of key factors (interleukin-1β, tumor necrosis factors) that are known to propagate inflammation. This work supports previous findings made by other researchers and confirms that multiplex imaging can be applied to cardiovascular research as well.

The use of multiplex imaging could improve how we study and treat atherosclerosis in two ways:

Looking towards the future, the Wang lab will use multiplex imaging to improve upon their mechanistic insights of human atherosclerosis and its treatments. The new knowledge gained from human tissues will contribute to the development of new models for cardiovascular research to ensure the relevance of these models to human physiology.  

Check out the full research article here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11255771/.

To learn more about Dr. Wang’s Research, please visit the lab website: https://wanglab.med.ubc.ca/


Dr. Ying Wang (second from the left, corresponding author and HLI investigator) and Maria Elishaev (first from the left, first author and HLI PhD Candidate) demonstrating multiplex imaging to Wang lab trainees.

2024 Research Snapshot

Click a button to view each graphic.

Special thank you to Tiffany Chang, Dr. Evan Phillips and Dr. Katherine Adolphs from the communications team for their work on creating this report!
By Coco Ng
Coco is a biobank technician at the Bruce McManus Cardiovascular Biobank.
*Disclaimer: The name, age, and identifying details in this story have been changed following institutional policies to safeguard patient confidentiality and privacy.

This article is part 2 of a 2-part series. Read part 1: What Happens to a Human Heart After Transplant?

✦ ✦ ✦

Back to… The Day of the Reunion

2:00 PM – THE VISIT

2:30 PM – THE REUNION

2:50 PM – THE DONATION


If you are living in British Columbia, please register to be an organ donor here, it gives people like Asher a second chance at life.

Coco Ng stands holding a fixed, human heart in the BMCB laboratory space. Photo by Tiffany Chang.

By Coco Ng
Coco is a biobank technician at the Bruce McManus Cardiovascular Biobank.
*Disclaimer: The name, age, and identifying details in this story have been changed following institutional policies to safeguard patient confidentiality and privacy.

The Day of the Reunion

2:30 PM – THE REUNION 

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2 Months Earlier – The Transplant

9:00PM – THE CALL

10:00AM – THE PREPARATION

1:00PM – THE BIOBANKING 

But every so often, the impact of these hearts extends far beyond the lab bench. Part 2, coming next week, follows one such moment: a reunion between a person and their own heart.


Coco Ng stands holding a fixed, human heart in the BMCB laboratory space. Photo by Tiffany Chang.

By Rosh Pel
Rosh is an Administrative Assistant to HLI Director Dr. Don Sin and Grants Team member.

“Self-care is not a luxury, it’s a necessity.”

Building a Balanced Work Culture

Beth Whalen, Molecular Phenotyping Core Manager and Workplace Well-being Coordinator

Promoting Workplace Wellness

Gaea Buenaventura, Beth Whalen, Cassie Gilchrist and Claire Smits during a Workplace Well-being Easter Event.

Actionable Recommendations for Staff Self-Care

Creating a Culture of Care: Past Events and Upcoming Activities

Join the Movement!

This post was contributed by Rosh Pel, Administrative Assistant to HLI Director Dr. Don Sin and Grants Team member.