An estimated one in five Americans harbors a leading risk factor for heart disease and heart attacks, often without even knowing it.
Lipoprotein(a) is a type of LDL particle, the primary transporter of cholesterol to the body’s tissues, that can seep into the walls of the arteries. LDL is commonly known as the ‘bad’ cholesterol.
Lp(a) is a dangerous form of cholesterol because it has an extra protein, Apo(a), attached to it. It makes Lp(a) particles very sticky, causing them to bind to the walls of blood vessels, where they become trapped and promote the formation of artery-clogging plaques.
The process not only drives inflammation within plaques but also contributes to the thickening and narrowing of the aortic heart valve.
Clogged arteries create blockages in the coronary arteries, cutting off oxygen to the heart muscle, causing a heart attack. Clogged arteries also create blockages in the carotid or cerebral arteries, causing an ischemic stroke, which can lead to brain damage.
Unlike LDL (‘bad’) and HDL (‘good”) cholesterol—which can be improved through diet, exercise, and medications like statins—Lp(a) is a unique form of cholesterol that is almost entirely determined by genetics.
If Lp(a) is high, it becomes essential to manage all other risk factors that one can control. This is where diet, exercise, and medication play a crucial role.
Cardiologists have argued that Lp(a) levels are some of the strongest indicators of people’s genetic risk for cardiovascular disease, which affects more than 120 million Americans and kills more people in the US than any other cause.
High Lp(a) dramatically raises the risk of heart attack, stroke, clogged leg arteries, and a narrowed heart valve (stock)
An estimated 63 million Americans have elevated levels, defined as 50 milligrams per deciliter (mg/dL) of blood or higher, but the test is not typically included in standard blood panels because, until recently, there has been no direct treatment for it, and insurers have been reluctant to cover the test without one.
Still, doctors strongly recommend testing, which only needs to be done once, for those with a family history of early heart disease, an unexplained heart attack or stroke under 65, or if standard medications to lower LDL have failed to work.
Early intervention is crucial for reducing the odds of being diagnosed with heart disease or suffering a range of other cardiovascular harms. While levels are primarily determined by genetics, testing can lead to a move toward healthier lifestyle choices that reduce the overall risk of deadly health effects.
While a healthy diet and lifestyle are foundational for heart health, these choices cannot lower someone’s Lp(a) level itself, which is almost entirely determined by genetics.
However, if someone has high Lp(a), those measures become even more critical.
Their purpose is to aggressively control all other risk factors that someone can influence, such as high LDL cholesterol, high blood pressure, and diabetes, which consequently helps lower their overall cardiovascular risk despite having high Lp(a).
Recent data show that only 0.3 percent of people received Lp(a) screening between 2012 and 2019, according to researchers at Harvard University. Additionally, approximately half of those tests, which are very similar to standard blood tests, were ordered by a small number of doctors.
Tests are now covered by most insurers, making them more accessible than ever. Still, patients either have to ask for a test specifically, or a doctor needs to order one based on the patient’s family history and other risk factors.
Individuals with the highest levels of Lp(a) were more than twice as likely to suffer a major cardiovascular event like a heart attack or cardiovascular death during any given year, and they had a 65 percent higher chance of having such an event by the time they turned 65.
Dr Supreeta Behuria, a cardiologist practicing in Northwell Staten Island University Hospital’s Preventive Cardiology Program, said: ‘Knowing what your risk is will encourage you to change your lifestyle.
‘And just increasing your own awareness about your own cardiovascular risk will keep you motivated to keep a heart-healthy diet and exercise. That’s the whole point in doing the testing now.’
Lp(a) levels below 30 mg/dL are considered healthy, while levels above 50 mg/dL are linked to a higher risk of heart problems.
A new study published in the journal Artherosclerosis, using data from the UK Biobank, found that routine Lp(a) testing could reclassify 20 percent of people as high-risk for cardiovascular disease (CVD), even if their other cholesterol levels appeared normal.
The reclassification would enable earlier and more aggressive intervention.
The research model predicted that screening people aged 40 to 69 would lead to substantial health benefits, including 169 years of life gained and 217 more years of healthy living per population group, primarily by preventing heart attacks and strokes.
Meanwhile, another new, major study in the European Heart Journal bolstered evidence that high Lp(a) is a significant and heritable risk factor for cardiovascular events.
Swedish researchers tracked over 61,000 first-degree relatives of individuals with known Lp(a) levels for nearly two decades.
Having a close family member with elevated Lp(a) was associated with a 30 percent higher risk of experiencing such a cardiac event
They discovered a clear gradient of risk: by age 65, eight percent of relatives from families with very high Lp(a) had suffered a major adverse cardiac event, like a heart attack or stroke, compared to only six percent of relatives from families with low Lp(a).
Having a close family member with elevated Lp(a) was associated with a 30 percent higher risk of experiencing such an event.
Dr Sonia Tolani, co-director of the Columbia University Women’s Heart Center, said: ‘If your cholesterol levels are high, lifestyle changes and medications can help lower them and reduce your risk of heart disease. It’s important to talk to your doctor about your cholesterol levels and what you can do to keep them in a healthy range.’
Doctors recommend getting Lp(a) tested once in every patient’s lifetime. Because Lp(a) is inherited, close family members are also at risk. Experts advise patients to discuss elevated test results with their parents, siblings, and children so they can consider getting tested as well.
Since there are no drugs yet that specifically target high Lp(a), managing one’s overall heart risk becomes even more critical.
This means aggressively treating any other conditions a patient might have, such as high blood pressure, diabetes, or high LDL cholesterol, with medication, according to Dr Gregory Schwartz, a cardiologist at the Rocky Mountain Regional VA Medical Center in Colorado.
It also requires a strong commitment to lifestyle changes, including a heart-healthy diet and regular exercise.
‘Will doing this change your Lp(a)? No, but we should encourage it because lowering overall cardiovascular risk is what counts in the end,’ Dr Schwartz said.
He added: ‘In the future, we may have very effective approaches to lower Lp(a) levels. New drugs are in development that specifically suppress Lp(a) production in the liver and lower Lp(a) levels in the bloodstream by 70 percent to more than 90 percent.’
