Can you imagine prioritizing your health with annual preventive screenings, staying physically active, eating a healthy diet, and still having a heart attack before the age of 40? What are some of the questions you’d ask your doctor? Perhaps, ‘What happened? Was there something in my genetics to blame for this?’ would be some that come to mind. This was one person’s experience that led to the discovery and increased awareness of Lipoprotein(a) and its significance in heart health.1
What is Lipoprotein(a)?
Lipoprotein(a) or Lp(a) is genetically inherited and a common independent risk factor for heart disease. Lipoproteins are made up of protein and fats; they contain cholesterol and triglyceride particles (tiny pieces in your blood that carry fats), and they are responsible for helping cholesterol and triglyceride movement and absorption throughout the body. Lp(a) helps to facilitate the development of Low Density Lipoprotein or LDL (bad cholesterol) and it is stickier than other types of LDL. Lp(a) promotes the buildup of plaque within the walls of your arteries. This makes high levels of Lp(a) dangerous.
High levels of Lp(a) 50 mg/dL or more promote clotting and inflammation, increasing risk of heart attack, stroke, and peripheral artery disease.1,3
Risks factors for elevated Lipoprotein(a) levels
- Family history of heart disease before age 55 in men or age 65 in women Lp(a) is one of the leading inherited risks for cardiovascular (heart) disease.1,3,4
- Personal history of heart attack, coronary artery disease, or stroke.1,3,4
- African or South Asian ancestry.5, 6
- Poor circulation in your legs because of peripheral arterial disease.1
- Diagnosis of aortic stenosis, a narrowing of the valve between the heart’s lower left chamber and the aorta artery.1
- Women over age 50.1
- High LDL cholesterol, even if you take medication to lower it.3
If you are at increased risk for high Lp(a) levels, you should talk to your doctor about getting tested. Lp(a) isn’t usually included in your normal blood work or cholesterol testing. It requires a separate blood test.
Download this checklist from the Family Heart Foundation to see if you may be at risk for elevated Lp(a) levels.7
Can Lp(a) levels be lowered?
Diet and exercise will not lower your Lp(a) levels. To lower your risks for developing heart disease, you should maintain healthy habits including, eating healthy foods, staying physically active, getting quality sleep, try to avoid red meats and dairy products, stop cigarette smoking, don’t drink more than two drinks a day for men or one drink a day for women. These changes can help to keep your LDL, blood pressure, and weight at healthy levels. 8, 9
How Does Lipoprotein(a) Affect Black Communities?
Black people of African descent have the highest levels of Lp(a) of all ethnicities.6, 7 Black people are also disproportionately affected by high blood pressure, obesity, diabetes.10 These other conditions put Black communities at a significantly greater risk of developing heart disease.
Black communities with decreased access to healthcare, healthy foods, poor quality housing, few gyms, community centers or walking paths increase the chances of heart disease.11
Elevated Lp(a) levels further increase the risk of developing heart disease. Since Black people already have an increased risk for heart disease, this makes high Lp(a) levels especially dangerous.
Those with the highest levels of Lp(a) are at a 1.5x increased risk of cardiovascular-related (heart-related) death, 1.6x increased risk of stroke, and up to 4x risk of heart attack when compared with those with the lowest levels.12
Treatment for Elevated Lipoprotein(a) levels
If you have elevated Lp(a), your physician may start you on one of the following:
- A statin to lower your LDL levels.3
- A PCSK9 (Proprotein convertase subtilisin/kexin type 9) inhibitor. These medications have been shown to decrease Lp(a) levels by about 20-30%. 4, 13, 14
- Niacin has been shown to decrease Lp(a) levels by 23% although clinical benefit has not been proven.14, 15
- A procedure called lipoprotein apheresis, which is an efficient but expensive procedure that removes excess Lp(a) and LDL from the body. 4, 6
FAQs
If I have high cholesterol levels, does that automatically mean I have elevated Lp(a) levels?
- The cholesterol levels that are checked in routine blood work does not include Lp(a). Unless you have specifically asked for an Lp(a) blood test, you probably haven’t been tested. Elevated LDL levels, especially if it’s hereditary does put you at an increased risk for elevated Lp(a) levels, but it doesn’t automatically mean your levels are elevated.
Can I eat healthier to lower my Lp(a) levels?
- Lifestyle changes like diet and exercise won’t impact your Lp(a) levels. It is still advised to make healthy choices to lower other factors that can contribute to heart disease.
How do I have my Lp(a) levels tested?
- Testing your Lp(a) levels simply takes a blood test. It is separate from normal blood work that happens during your yearly check-up, so you’ll need to ask your physician to include that in your lab work.
References
- American Heart Association (2024) Lipoprotein a risks https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a-risks
- Endotext (2024) Introduction to Lipids and Lipoproteins https://www.ncbi.nlm.nih.gov/books/NBK305896/
- Medline Plus (2022) Lipoprotein (a) Blood Test https://medlineplus.gov/lab-tests/lipoprotein-a-blood-test/
- National Heart, Lung, and Blood Institute (2024) Lipoprotein(a): What to know about elevated levels https://www.nhlbi.nih.gov/news/2024/lipoproteina-what-know-about-elevated-levels
- Current Opinion of Lipidology (2021) The impact of Race and Ethnicity on Lipoprotein (a) Levels and Cardiovascular Risk https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087179/
- Atherosclerosis (2022) Lipoprotein(a) and ethnicities https://www.sciencedirect.com/science/article/abs/pii/S0021915022001824
- Family Heart Foundation (2024) Black American Risks for Heart Disease and Stroke https://familyheart.org/black-american-risks
- National Heart, Lung, and Blood Institute (2024) Blood Cholesterol Diagnosis https://www.nhlbi.nih.gov/health/blood-cholesterol/diagnosis
- National Heart, Lung, and Blood Institute (2024) Blood Cholesterol Causes https://www.nhlbi.nih.gov/health/blood-cholesterol/causes
- American Heart Association (2024) Black People, Heart Disease, and Stroke https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/african-americans-and-heart-disease-stroke
- National Heart, Lung, And Blood Institute (2023) The Truth About African American Women and Heart Disease https://www.nhlbi.nih.gov/resources/truth-about-african-american-women-and-heart-disease-fact-sheet
- American College of Cardiology (2019) Lipoprotein (a) in Clinical Practice https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/02/08/05/Lipoproteina-in-Clinical-Practice
- Pokhrel Binod et al. PCSK9 Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK448100/
- Lampsas Stamatios et al. (2023) Lipoprotein (a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918959/
- Medline Plus (2024) Niacin for cholesterol https://medlineplus.gov/ency/patientinstructions/000788.htm
- Thompson Gilbert et al (2019) Current Role of Lipoprotein Apheresis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491397/
