Lipoprotein(a), also call Lp(a) is a type of low-density cholesterol that is genetically inherited and can increase your chances of a heart attack or stroke. Unlike other forms of cholesterol like high-density lipoproteins (HLDs) or low-density lipoproteins (LDLs), your Lp(a) number is one that stays almost completely the same for your entire life. Here, Cori Russell, M.D., a cardiologist and lipid specialist at Henry Ford Health, explains what we know about Lp(a) and what that number means for your long-term health and wellbeing.
Understanding Cholesterol And Your Lipoprotein(a) Risk
When explaining Lp(a) to her patients, Dr. Russell describes cholesterol as a tennis ball.
“If you imagine a particle of LDL cholesterol as a tennis ball, then imagine Lp(a) as a hand that is holding the tennis ball,” says Dr. Russell. “The ‘hand’ part of this is responsible for increasing your chance of a heart attack or stroke even more so than your LDL level.”
While there aren’t always clear risk factors for the presence of Lp(a) in your body, some indicators that you could have it include:
- A known history of Lp(a) in your immediate family
- A family history of heart attack or stroke, especially with no sign of LDL cholesterol being high
- Having had a heart attack or stroke already
There isn’t a single gene mutation that is responsible for Lp(a). If you or someone in your family does have this protein, there is about a 50% chance that it will be passed down to future generations. If you have Lp(a), it is important that your children are screened for it as well.
Dr. Russell stresses that everyone should be checked for Lp(a) at some point in life, though she usually recommends everyone getting tested at age 18. “This is something that you only need to test for once,” she says. “It is better to not wait for a family member or yourself to have a heart event before checking for this particle.”
What Does Your Lipoprotein(a) Number Mean?
A Lp(a)-specific blood test can be used to measure your levels of this particle. Your primary care provider or preventive cardiologist can order this blood test, but a cardiologist will be able to explain what the results mean and how to proceed. If your Lp(a) number comes back greater than 30 mg/dL (75 nmol/L), it can put you at increased risk of a heart attack or stroke.
“Your Lp(a) number lives with you forever, and diet and exercise won’t change this number the way that these lifestyle changes impact your HDL or LDL levels,” says Dr. Russell. “As of now, there are no medications approved to lower this number either, though there are exciting clinical trials ongoing.”
About 20% of people tested for Lp(a) come back with levels over 30 mg/dL. If this is the case for you, don’t lose hope. Your primary care doctor or a preventive cardiologist can work with you to prevent a future heart attack or stroke. If you have already had a major heart event, your doctor will want to make sure that doesn’t happen again.
“Even if we can’t change that number now, you should still work to take care of your overall health,” says Dr. Russell. “Being aggressive with health-benefiting lifestyle changes can improve the cholesterol levels you can control and can lower blood pressure, help maintain a healthy weight, and build stronger muscles, etc.”
Cholesterol medication can also be used to help keep your LDL cholesterol levels in check to reduce your risk of a heart event with high Lp(a). One medication type (called PCSK9 inhibitors) is FDA-approved to treat high LDL levels and has been found to lower LDL levels by up to 60%. It has also been found to lower Lp(a) levels by up to 30%. The only issue – this medication is not currently available to treat Lp(a) and can only be prescribed if you have high levels of LDL cholesterol.
The Future Of Treating Lipoprotein(a)
There are several medications in clinical trials now that if approved, are expected to lower Lp(a) levels as much as 80%. While these trials are ongoing, it may be years before these products make it to market for regular patient use.
“It is important to be aware of your level now even though we can’t directly treat it yet,” says Dr. Russell. “Our approach is to do everything else we can to manage your health until these medications are available.”
In the meantime, Dr. Russell encourages people to get tested for Lp(a) and not get discouraged with the results. Instead, work with your doctor to make sure you are keeping your health in check and are staying up to date with the latest on Lp(a) treatment options.
Reviewed by Dr. Cori Russell, Director of the Lipid Clinic at Henry Ford Health. She sees patients at Henry Ford Hospital in Detroit.
