What is Lipoprotein (a) and How Does It Impact My Heart Health?

Read this article in Spanish: ¿Qué es la Lp(a) y cómo afecta mi salud cardíaca? (PDF) 

Sandra Revill Tremulis was committed to avoiding the heart disease that ran in her family. She adopted a healthy lifestyle and made yearly checkups. Even with normal cholesterol levels, plaque built up in her arteries. At age 39, she almost died of a heart attack caused by a 95% blockage.

Further testing showed the likely problem. Tremulis had a high lipoprotein(a), or Lp(a), level.

“That was the beginning of my education and my empowerment,” she said. “I just couldn't believe that people weren't talking about this.”

In the following years, she researched Lp(a), talked to health care professionals and started a foundation to raise awareness of the condition. Tremulis noted that her work led to the Centers for Disease Control and Prevention (CDC) recognizing high Lp(a) levels as a clinical diagnosis in 2018. The CDC approved diagnosis codes for billing and payment related to clinical work and lab testing.

“I wanted to make sure that there's help for every child who inherits this so that they can change their cardiovascular destiny,” she said.

What’s Lp(a)?

Lp(a) is a cholesterol-carrying lipoprotein in your blood. Your level is mostly inherited, and when it is high, it can increase your risk of heart disease and stroke. It is made up of two major proteins:

• Apolipoprotein(a), or apo(a)
• Apolipoprotein B, or apoB-100

ApoB particles are also found in low-density lipoprotein (LDL), or “bad” cholesterol, but they have different traits in Lp(a). High apoB levels are associated with an increased risk of heart disease. Blood tests can show levels of these proteins in your blood. Talk with your health care professional about which blood tests are best for you.

Why does Lp(a) increase my risk of heart disease?

If your Lp(a) level is 125 nmol/L (50 mg/dL) or higher, it can promote clotting and inflammation. This can increase your risk of heart attack, stroke, aortic stenosis and peripheral artery disease. This is especially true if you have coronary heart disease or familial hypercholesterolemia, or FH. FH is an inherited condition in which people may be born with very high LDL cholesterol levels.

Lp(a) can build up in your blood vessels and form plaques, similar to LDL cholesterol. These plaques can block blood flow to organs such as your heart, brain, kidneys and lungs. This can lead to heart attack, stroke and other heart problems.

Long-term studies have shown a possible connection between high Lp(a) levels and the risk of calcific aortic valve disease. If your Lp(a) level is high, it may increase inflammation and calcification in your heart cells. This can lead to calcium buildup in your aortic valve.

How do I know if I am at risk for high Lp(a)?

Many people with high Lp(a) don’t have symptoms. The only way to know your Lp(a) level is with a simple blood test. Current guidelines recommend every adult be tested at least once in a lifetime. Ask your health care professional about ordering an Lp(a) test at your next appointment.

Which factors put me at a higher risk for high Lp(a)?

• Your Lp(a) level may be higher if you are of South Asian or African descent.
• If you have FH, kidney disease, liver disease or thyroid disease, you may be more likely to have high Lp(a).
• If you are a woman, your Lp(a) level may increase during certain life stages such as pregnancy and menopause.

How do I lower my Lp(a)?

Lifestyle changes don’t affect your Lp(a) level. Yet, if you have high Lp(a), your health care professional will recommend that you:

• Stay active
• Eat a healthy diet
• Get enough sleep
• Avoid smoking
• Maintain a healthy body mass index, or BMI

Your risk of heart disease and stroke depends on several factors, not only Lp(a).

“Life’s Essential 8 are the key measures for improving and maintaining cardiovascular health (as defined by the American Heart Association),” said Dr. Gissette Reyes-Soffer of Columbia University Irving Medical Center.

It’s also important to stay on top of your cholesterol, said Reyes-Soffer. She noted that having high levels of LDL and Lp(a) may further increase your risk of heart disease.

There is currently no medication approved just to lower Lp(a). Some medications, such as PCSK9 inhibitors, have been shown to lower Lp(a) and LDL cholesterol. In rare cases, a procedure called lipoprotein apheresis may be used for people with very high cholesterol, such as those with homozygous familial hypercholesterolemia (HoFH). This involves filtering out both Lp(a) and LDL, temporarily lowering their levels. Ask your health care professional about the best treatment options for you.