Lipoprotein (a), sometimes called “Lp little a,” is an independent risk factor for cardiovascular disease. The level of Lp(a) found in your blood is entirely determined by genes passed to you by your parents.
Your Lp(a) level can’t be modified through diet or exercise. It remains stable throughout your life and will be the same at age 45 as it was at age 5, with some exceptions. It may increase during serious illness and produce unreliable measurements. And menopause and chronic kidney disease can lead to a permanent increase. Regardless, if it’s high, it is due to genetics and it’s not your fault.
You or someone you know may be living with high levels of Lp(a). Understanding what Lp(a) is, and how it impacts your risk for heart disease and strokes is important.
What is Lp(a)?
Lp(a) resembles LDL (“bad cholesterol”), except for an added protein attached, called apolipoprotein (a). Like LDL, which is a cholesterol-rich lipoprotein, Lp(a) can clog your arteries by increasing plaque. The apolipoprotein (a) part of this lipoprotein appears to behave like a clotting factor. The combination of plaque and clots can result in you’re an increased risk of heart attacks and strokes.
What level of Lp(a) is considered “high?”
According to the National Lipid Association (NLA), the American Heart Association (AHA), and the American College of Cardiology (ACC), a level of 50 mg/dL or 100-125 nmol/L or greater, Lp(a) is considered elevated. You will notice that Lp(a) can be measured in two ways – mg/dL or nmol/L, so it’s important to take note of the units of measurement, at least until testing becomes more uniform.
How do I lower my Lp(a)?
As of now, there are no medicines or treatments that are definitively known to lower Lp(a), although some have shown some promise. Estrogen and niacin (a B vitamin) have been shown to lower levels of Lp(a) but have not guarded against heart disease, so these treatments are not recommended. A new class of medications, called PCSK9 inhibitors, have been shown to lower Lp(a), and may potentially reduce risk (although more research is needed). Lipoprotein apheresis, a dialysis-like procedure performed biweekly, lowers both LDL and Lp(a) and appears to decrease risk. And some promising medications are currently in clinical trials. To learn more about research on Lp(a), or to find out how to get involved, explore our clinical trials page.
What is the connection between Lp(a) and familial hypercholesterolemia?
Approximately a third of people with Familial Hypercholesterolemia also have high levels of Lp(a). Therefore, if you have FH, you should be screened for Lp(a). This helps your physician get your risk factors in order. Since Lp(a) runs in families, it may benefit your loved ones to be screened as well.
What can I do?
If you have a family history of heart disease, relatives with high Lp(a), or Familial Hypercholesterolemia, you should ask your healthcare provider to test your levels of Lp(a). If your levels are high, your immediate family should also be screened, and you should work to reduce your modifiable risk factors - especially LDL cholesterol.
You’re not alone. For more information, or to get involved, check out our collection of resources.
Journal of Clinical Lipidology: Wilson DP, Jacobson TA, Jones PH, et al. Use of Lipoprotein (a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. Journal of Clinical Lipidology. 2019;13:374-392.
Journal of Renal Care: Hopewell JC, Haynes R, Baiquent C. The role of lin (a) in chronic kidney disease. J Lipid Res. 2018;59(4):577-585.