What Is Lipoprotein(a)? Understanding Its Role in Vascular Health and Cholesterol

“L-p-little-a” sounds like it could be the name of an up-and-coming new rap artist, but unfortunately, it’s nothing as fun as that. “L-p-little-a” is how the abbreviation of lipoprotein a, or Lp(a), is commonly pronounced. Lp(a) is a type of  “bad” cholesterol, or LDL-C, that is an independent cause of heart attack, stroke and other aortic conditions.

The level of Lp(a) present in your body is genetically determined and generally stable by the time you’re five years old. Siblings and children of people with high Lp(a) have a 50 percent chance of having elevated levels. Lp(a) contributes to plaque formation in your arteries and can increase inflammation and clotting. 

Cardiologist Andrew Sumner, MD, with Lehigh Valley Heart and Vascular Institute, explains that Lp(a) isn’t screened on standard cholesterol tests.

“You need to order a separate lipoprotein a test to determine if it is elevated. Some people’s lipid panel results may appear relatively good, but they can have a hidden risk,” Dr. Sumner says. “By identifying an elevated lipoprotein a level, we can do more to lower bad cholesterol overall and screen family members. By doing this, we can help lower the risk of heart attack or stroke.”

Because it is so common, it’s reasonable for all adults to have their Lp(a) level checked, and since levels are generally stable throughout life, most patients only need to be tested once.

“Anyone with a family history of heart disease at an early age, a personal history of a heart attack or stroke prior to age 60 or a parent or sibling with elevated lipoprotein a levels, should be tested. Check with your primary care clinician if you’re concerned,” Dr. Sumner says. “Insurance may or may not cover the cost, so give them a call to check first. If you decide to pay out of pocket, it generally costs between $40 - $90.”

Elevated levels affect one in five people, or about 60 million Americans. Many national societies including the National Lipid Association, The European Society of Cardiology and Canadian Cardiovascular Society recommend that all adults have their levels checked once in their life. At a minimum, people with a personal or family history of heart disease at an early age (prior to 60 years) should have their levels checked. 

Lp(a) levels are measured in two different ways, mg/dl or nmol/L. General guidelines for elevated levels are:

Low risk: Less than 30 mg/dL or 75 nmol/L

Intermediate risk: 30–50 mg/dL or 75–125 nmol/L

High risk: Greater than 50 mg/dL or 125 nmol/L

Currently Lp(a) is used as a marker of risk, but not a target of treatment. Clinical studies are happening now to see if medicines that lower Lp(a) levels will also decrease the risk for having a heart attack or stroke. Until the studies are completed, the goal of treatment is to aggressively lower the overall LDL-C level and minimize factors that contribute to plaque in your blood vessels.

Even if your other heart health indicators look OK, if your Lp(a) is high, you should talk to your primary care clinician since you might benefit from more aggressive treatment of your LDL-C level. It is also vitally important to optimize all aspects of a heart healthy lifestyle. 

A heart healthy lifestyle incorporates:

• Not smoking or using tobacco
• Exercise
• A healthy diet
• Maintain a healthy weight
• Manage your blood pressure
• Lower stress
• Treat your cholesterol levels to goal
• Take medications as prescribed

If your Lp(a) levels is elevated, your doctor may try prescription medications to help lower your LDL-C, including statins, ezetimibe, PCSK9 inhibitors and aspirin.

“Elevated Lp(a) levels are common and hereditary,” Dr. Sumner says. “If we can identify people with high levels, we can more aggressively work to reduce their risks of heart attack or stroke. Getting tested is simple and can help you and your family.”