Key Takeaways

• Lipoprotein(a), or Lp(a), is a type of particle found in the blood, which is made up of both fats and proteins.

• Lp(a) is particularly likely to stick to the insides of arteries, making them narrower and stiffer.

• The levels of Lp(a) are strongly correlated with heart disease risk.

• A person’s levels of Lp(a) are almost entirely determined by genetics.

• For those with high Lp(a) levels, lifestyle changes and/or medications may be recommended.

• Lp(a) testing is not included as part of standard screening blood tests, but is recommended for those at a higher risk for heart disease or those who want a more comprehensive understanding of their heart health.

Introduction to Lipoprotein(a)

Lipoproteins are small packages that the body uses to transport fats in the bloodstream.

There are several different types of lipoproteins, and they have different impacts on your overall health. One specific type, known as Lipoprotein(a) or Lp(a), has a particularly strong influence on your risk for heart disease. People with high Lp(a) levels are at a high risk for having a serious medical event like a heart attack or stroke.

This article will explain what Lipoprotein(a) is and why it’s so dangerous. You’ll also learn how you can find out your Lp(a) level, and what you should do if your level is high.

Understanding Lipoproteins

In the human body, there are a few different types of fats that are important for tissue maintenance and metabolism. These include triglycerides, which are used for energy, as well as cholesterol, which is a structural component of cell membranes and is also used to create certain hormones. 

These fats need to be transported through the bloodstream to be carried to cells, where they’re used. However, blood is made up primarily of water, and fats don’t dissolve well in water. That’s why lipoproteins are important. A lipoprotein consists of a shell made up of proteins and phospholipids, with fatty substances like triglycerides and cholesterol carried inside.

Your body makes several different types of lipoproteins, which have different functions. In general, low-density lipoproteins, or LDL, act to bring fats out to the tissues, where they can be used. High-density lipoproteins, or HDL, act to gather excess fats from the tissues and bring them back to the liver, so they can be processed and eliminated.

Lipoprotein(a) is a specific type of LDL. The difference between Lp(a) and other types of LDL is that it has an extra protein on the outside, which is known as apolipoprotein(a) or apo(a). This extra protein makes Lp(a) stickier than other types of LDL, so it’s more likely to stick to the walls of arteries.

Why is Lipoprotein(a) Important?

In general, high levels of LDL in the blood increase the risk of heart disease, because excess LDL particles tend to deposit in the walls of arteries throughout the body. This makes the arteries narrower and stiffer. 

When this process becomes severe, blood flow through the artery may be reduced, which can lead to heart disease symptoms like chest pain. The artery also becomes more likely to be blocked by a blood clot. If this occurs in the arteries of the heart or brain, a heart attack or stroke will result.

Because Lp(a) has the extra apo(a) protein on the outside, it’s stickier than other types of LDL. This makes it even more likely to deposit into the walls of the arteries. As a result, people with high levels of Lp(a) are at a particularly high risk for having heart disease, a heart attack, or a stroke.

In fact, research has discovered that people with high levels of lipoprotein(a) (above 150 nmol/L or 70 mg/dL) have about a 50% increased risk of heart disease. Although Lp(a) is not the only influence on your risk for heart disease, it does play a major role.

Lipoprotein(a) and Longevity

In Singapore as well as many other developed countries, heart disease is the most common cause of death. If you’d like to increase your odds of living a long life, it’s essential to reduce your risk of heart disease as much as you can.

Because Lipoprotein(a) levels are so strongly correlated with heart disease risk, it’s not surprising that people with higher levels of Lipoprotein(a) have been found to have a shorter lifespan than those with lower levels. Research shows that having high Lp(a) levels reduces your lifespan by about 1.5 years.

Factors Influencing Lipoprotein(a) Levels

Your level of Lp(a) is almost entirely determined by genetics. This is different from other lipoproteins, such as LDL and HDL, which do have a genetic component but can be strongly influenced by lifestyle. With Lp(a), genetics is the primary influence on your levels.

Although they’re under genetic control, Lipoprotein(a) levels do change over time. As people age, their Lp(a) levels generally rise. Studies have found that this occurs for both men and women, but there’s a particularly sharp rise in women around the age of 50, which is around the time of menopause. As you get older, it becomes more and more important to pay attention to your heart health, and to take steps to protect yourself from heart disease.

Testing and Diagnosing Elevated Lipoprotein(a)

Testing for Lipoprotein(a) is generally not included as part of a standard screening blood test panel. This test is ordered separately, and is not generally given to everyone.

Testing for Lp(a) is recommended for people who are at a higher risk for heart disease. This includes those with a strong family history of heart disease, meaning that they have multiple family members who had events like heart attacks, particularly if this occurred at relatively young ages (under age 50 for men or 60 for women). 

Those who have already shown symptoms of heart disease or have already experienced a heart attack or stroke may also benefit from testing. In addition, people with high LDL cholesterol levels may benefit from Lp(a) testing. 

Although testing is recommended for these groups, anyone who wants to more fully understand their heart health and their risk for heart disease could consider Lp(a) testing as part of a complete assessment. 

It’s important to talk with a doctor about the results of your testing, as these will need to be interpreted in context. This is why a doctor’s orders are needed to get the Lipoprotein(a) test.

Although it is clear that higher levels of Lp(a) indicate a higher risk for heart disease, there’s not a universally accepted cutoff for what your level should be. In addition, because testing methods vary slightly from one laboratory to another, the results vary a bit as well. In our laboratory as well as many others, Lp(a) levels above 75 nmol/L (30 mg/dL) are considered elevated.

Managing Elevated Lipoprotein(a)

If your Lp(a) levels are high, then you may be looking for natural ways to lower these levels, to reduce your risk of heart disease.

Because your levels of Lp(a) are mostly determined by genetics, they tend to stay stable over time. Changes in lifestyle generally won’t have a meaningful impact on your Lp(a) levels.

However, this doesn’t mean that there’s nothing you can do. If you have high Lp(a) levels, then your risk of heart disease is higher. Lifestyle changes can help to lower your risk of heart disease in many ways, including by lowering your overall LDL levels and raising HDL levels. This includes getting plenty of physical activity (at least 20 to 30 minutes of exercise on most days), as well as eating a healthy diet with plenty of fruits and vegetables and reduced saturated fat.

Even though these lifestyle changes won’t change your Lp(a) levels much, they will help to reduce your overall risk of heart disease.

For those with high Lp(a) levels, new medications are being developed that can help to reduce levels, but are still undergoing clinical trials and currently not approved for use yet.. 

In order to lower the overall risk of heart disease, doctors may prescribe medications such as statins, ezetimibe and PCSK9 inhibitors to lower the LDL levels to target levels.
Like all medications, cholesterol-lowering medications can have side effects in some people. It’s important to balance the potential risks of the medications against the potential benefit of reduced heart disease risk. You will need to talk with your doctor to get personalized advice about whether or not these medications are recommended for you.

Managing your heart disease risk

Knowing your Lp(a) levels is only one part of understanding your overall heart health. To get a comprehensive picture of your heart disease risk, you’ll need a full panel of blood tests, including testing your levels of LDL, HDL, and triglycerides.

Testing can help you to understand your risk for heart disease, as well as to make an informed plan for how to protect your heart health. This might include lifestyle changes and/or medications. Reducing your risk of heart disease will help you to live the longest and healthiest life possible.

Our NOVI Assessment Max clients receive a comprehensive panel of blood tests, along with other evidence-based tests (such as imaging). This will give you a complete picture of your risk for heart disease as well as many other health conditions. A physician will help you to understand and interpret the results of your testing, and to make a plan for protecting your long-term health. Our health coaches will then help you to design and implement a lifestyle plan that will work for you.

Testing will help you to uncover hidden risks to your health, so you can make an informed plan to help keep you vibrant and active for many years to come.