You know, sometimes a patient comes in, they’re doing all the “right” things – eating well, exercising, their usual cholesterol panel looks pretty good. But then, we uncover something a bit hidden, something called Lipoprotein (a), or Lp(a) for short. It can be a real curveball.
So, what exactly is this Lipoprotein (a)? Think of it as a particular type of LDL cholesterol – that’s the “bad” cholesterol we often talk about. LDLs, in general, can cause trouble because they can build up in your arteries, forming these sticky patches called plaque. Imagine them like little speed bumps inside your blood vessels. Enough of these, and they can slow down blood flow, or worse, cause a complete blockage.
Now, Lp(a) is a bit of a double whammy. Not only does it contribute to plaque, but it also seems to make your blood a bit more prone to clotting. And, it can make it harder for those clots to break down naturally. On top of that, Lp(a) can cause inflammation, making those plaque speed bumps more likely to rupture, which then attracts even more clots. It’s a bit of a cascade, unfortunately.
Understanding Your Lipoprotein (a) Levels
One of the key things to know about Lipoprotein (a) is that your level is largely set by your genes. Yep, it’s mostly inherited from your parents. The level you have as a kid is likely the level you’ll carry through life.
How Do We Check Lp(a)?
To find out your Lp(a) level, we need a specific blood test. It’s not usually part of the standard lipid panel (that’s the common cholesterol test) that many people get regularly. So, I’d have to make a special request for it.
Why would I, or another doctor, suggest checking your Lp(a)? Well, we might consider it if you have other things that already put you at a higher risk for heart disease. Things like:
- A strong family history of heart disease, especially at a young age.
- A condition called familial hypercholesterolemia (very high cholesterol that runs in families). Interestingly, over 30% of folks with this also have high Lp(a).
- Your regular LDL cholesterol is stubbornly high.
- You or a close family member had heart problems, like a heart attack or stroke, relatively early in life.
- You’ve had recurrent heart events even though other risk factors seem to be managed.
- A family member is known to have a high Lipoprotein (a) level.
What Can Affect the Test Results?
A few things can nudge the results. For women, going through menopause can sometimes affect it. Certain medications might also play a role, like:
- Oral estrogen supplements
- Niacin (a B vitamin, sometimes used for cholesterol)
What’s a “Normal” Lipoprotein (a) Level?
We generally like to see Lp(a) levels below 30 milligrams per deciliter (mg/dL).
Here’s a rough guide:
- Borderline risk: 14 to 30 mg/dL
- High risk: Greater than 31 to less than 50 mg/dL
- Highest risk: Higher than 50 mg/dL
Now, some labs and researchers prefer to measure it differently, looking at the number of Lp(a) particles. If that’s the case, the results will be in nanomoles per liter (nmol/L). For that measurement, a high Lp(a) is generally considered anything over 100 nmol/L. It’s always good to ask which measurement is being used so we’re on the same page.
If Your Lipoprotein (a) is High, What Does It Mean?
Having a high Lipoprotein (a) level means you might have an increased chance of developing cardiovascular disease – that’s diseases of the heart and blood vessels. And this can be true even if your other cholesterol numbers look okay. It’s one of those independent risk factors.
Research has linked high Lp(a) to a greater risk of:
- Heart disease in general
- Heart attack
- Heart failure
- Peripheral artery disease (PAD) (problems with blood flow in your limbs)
- Aortic valve stenosis (a narrowing of one of your heart valves)
- Stroke
- Coronary artery disease
It’s estimated that about 1 in 5 people worldwide have high Lp(a) levels. So, it’s not incredibly rare. The tricky part? Many people with high Lp(a) don’t have any symptoms at all. That’s why if there’s a family history, it’s worth a chat with your doctor about testing.
Managing High Lipoprotein (a)
This is where things get a bit… well, complex. Currently, there aren’t FDA-approved medications specifically designed to lower Lp(a) levels dramatically. Researchers are working hard on this, and there are promising drugs in development, but we’re not quite there yet.
However, that doesn’t mean we throw our hands up! There’s still a lot we can do to support your overall heart health, which is crucial when Lp(a) is high.
We’ll focus on:
- Quitting smoking or any tobacco use. This is a big one.
- Getting regular exercise.
- Maintaining a weight that’s healthy for you.
- Eating a heart-healthy diet (think lots of fruits, veggies, whole grains, lean proteins).
- Keeping your blood pressure and blood sugar (if you have diabetes) well-managed.
- Using medications like statins or PCSK9 inhibitors if your LDL cholesterol also needs managing. These don’t lower Lp(a) much, but they tackle other important risk factors.
- Sometimes, low-dose aspirin might be considered, but that’s a very individual decision we’d make together.
- Finding healthy ways to manage stress.
In very specific, rare cases, particularly for people with familial hypercholesterolemia and extremely high Lp(a), a treatment called apheresis might be an option. This is a procedure, a bit like dialysis, that filters the Lp(a) directly out of your blood. It’s a commitment, though, taking several hours and needing to be done every week or two.
Take-Home Message
So, to wrap things up, here are the key points about Lipoprotein (a):
- Lipoprotein (a), or Lp(a), is a specific type of cholesterol that’s largely determined by your genes.
- High Lp(a) can increase your risk of heart disease, heart attacks, and strokes, even if other cholesterol levels are normal.
- A special blood test is needed to check your Lp(a) level; it’s not part of a routine cholesterol screen.
- While there aren’t specific drugs to drastically lower Lp(a) yet, managing overall cardiovascular risk through lifestyle and other medications is key.
- If you have a family history of early heart disease or very high cholesterol, it’s worth discussing Lipoprotein (a) testing with your doctor.
It can feel a bit daunting to learn about another risk factor, I know. But knowledge is power. By understanding all the pieces of your heart health puzzle, including Lipoprotein (a), we can work together on the best plan for you. You’re not alone in this.