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Lipoprotein (A) – The Heart-Attack-Risk Evaluator

Lipoprotein (A) – The Heart-Attack-Risk Evaluator

Even though your lifestyle significantly impacts your well-being, certain genetic aspects hold risks that you can not influence through diet and exercise. One of those risk factors is lipoprotein (a). Did you know that this specific blood protein can help you evaluate your risk of heart disease? In this article, CARE explains what lipoprotein (a) is and how a lipoprotein (a) test can assess your risk factors for coronary artery disease.

Blog Author Elena Health Coach at CARE
Elena Iagovitina

Health Coach

Published in General Health
6 min read · Feb 06, 2024

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What Is Lipoprotein (a)?

Lipoprotein (a), shortly referred to as Lp(a), is a type of LDL (low-density lipoprotein) that carries cholesterol through your bloodstream to the cells of your arteries. High levels of lipoprotein (a) are an independent risk factor for cardiovascular disease, the leading cause of death and disability worldwide, according to the American Heart Association. [1]

Lipoproteins are made out of fats (lipids) and proteins and can build up in your arteries as plaque, slowing down your blood flow and potentially blocking it at some point, leading to a heart attack. Plaque buildup can also contribute to high blood pressure. Lp(a) is formed by a molecule of a carbohydrate-rich protein named apolipoprotein A linked by a single disulfide bond to the apolipoprotein B of an LDL-like lipoprotein. [2]

You might know that LDL is generally referred to as “bad cholesterol,” so what makes this one form of LDL, lipoprotein (a), so unique?

What makes Lp(a) an independent risk factor is that the particles of lipoprotein (a) are even “stickier” than other types of LDL. Therefore, lipoprotein (a) is even more inclined to form “speed bumps” in your arteries. [1] [2] Furthermore, having high levels of lipoprotein (a) can increase the risk of developing cardiovascular disease even when LDL cholesterol (LDL-C) levels are within the normal range, which is referred to as residual cardiovascular risk. Despite the inclination of lipoprotein (a) to build up in arteries when present in high amounts, it is also more likely to make your blood clot and hinder the natural breakdown of blood clots. [2] [3]

Conclusively, the amount of lipoprotein (a) in your blood is associated with cardiovascular risk and atherosclerosis.

But can you not just eat healthier and work out to lower the high lipoprotein (a) levels in your blood?

Unfortunately, your genetics determine the amount of lipoprotein (a) your body makes and, consequently, your cardiovascular risk prognosis. [1] Therefore, a lipoprotein blood test can be a valuable tool to assess your levels of Lp(a) and give you an insight into your hereditary risk of coronary heart disease.

How Do I Test my Lipoprotein (a) Levels?

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You can assess your Lp(a) levels through a Lipoprotein (a) Blood Test. A lipoprotein (a) test determines the concentration of lipoprotein (a) in your bloodstream. It is not a routine screening test, even though it can give you crucial insight into your cardiovascular prognosis. Elevated levels of lipoprotein (a) indicate an increased risk of developing heart disease and stroke. [3]

If you have a family history of heart disease or wish to assess your hereditary cardiovascular risk, making a lipoprotein (a) test to detect potential high levels of Lp cholesterol levels can be a valuable tool.

What Is a Normal Range of Lipoprotein (a)?

Regular Lp(a) levels are considered to be below 30 mg/dL. [4] Factors such as menopause and certain medications, including oral estrogen supplements and niacin, can influence Lp(a) levels.

Lp(a) Levels are categorized as follows: [4]

  • No risk: below 30 mg/dL
  • Borderline risk: 14 to 30 mg/dL.
  • High risk: 31 to 50 mg/dL.
  • Highest risk: above 50 mg/dL.

Some experts advocate for measuring Lp(a) particle numbers in nanomoles per liter (nmol/L) instead of by mass (mg/dL) for greater accuracy, with levels above 100 nmol/L considered high. [4]

Please consult with us or your healthcare provider about which measurement standard is being used.

What Do High Levels of Lipoprotein (a) Mean?

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If you have high levels of Lp(a) blood cholesterol, you have a higher risk of atherosclerotic cardiovascular disease. As you have already learned, lipoprotein (a) can block your blood vessels and hinder circulation, leading to a heart attack, stroke or peripheral artery disease, and deep vein thrombosis.

In contrast to Hdl (high-density lipoprotein), considered “good cholesterol,” elevated Ldl cholesterol concentrations, especially elevated lp, indicate an increased risk for heart disease. [1] [2]

Suppose someone in your family has familial hypercholesterolemia (FH), a genetic disorder that affects about 1 in 250 people and increases the likelihood of having coronary heart disease. In that case, you should also have your Lp(a) blood levels checked. People with familial hypercholesterolemia have higher chances of having increased Lp(a) levels. [6]

How Can I Lower my Lipoprotein (a) Levels?

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If you want to lower Lp(a) levels, only a few methods have proven helpful, including drugs based on RNA technology apheresis and general measures to manage cardiovascular risks.

Lowering lipoprotein (a) levels is challenging because its concentration in the blood is determined by your genetics, making it less responsive to lifestyle changes and currently available lipid-lowering medications. [7]

Statins Do Not Lower Lp(a) But Can Be Valuable

Due to the LDL-like core of Lp(a), it is often hypothesized that statins may also reduce Lp(a) levels by lowering the cholesterol content of Lp(a) through the LDL receptor pathway. However, while statins are well-established for lowering LDL-C levels, statins have not been shown to lower Lp(a) levels similarly. [5]

Still, for people with high Lp(a), using statins to reduce LDL-C and mitigate the risk of heart attacks can aid in the adverse effects associated with elevated lipoprotein (a) even though statins do not directly decrease Lp(a) levels. [6]

Apheresis

Apheresis is a modern medical procedure that filters the blood to remove specific harmful substances, such as lipoprotein (a), from your bloodstream. It operates similarly to dialysis, where blood is drawn out, processed to remove the unwanted components, and then returned to the body. This process is particularly effective in lowering high levels of lipoprotein (a) by directly removing the lipoprotein particles from your blood circulation. [5] It must be noted that apheresis also lowers LDL cholesterol, which can have side effects. [6]

Drugs Based on RNA Technology

Clinical trials are underway for RNA-based drugs like pelacarsen, olpasiran, SLN360, and LY3819469, which have shown significant effectiveness in reducing serum Lp(a) levels and demonstrate a promising safety profile. This advancement indicates that these drugs are poised to address a crucial unmet need in the spectrum of lipid-lowering therapies in the near future. [7]

Niacin (Vitamin B3)

Niacin has been shown to reduce Lp(a) levels to some extent, although its effectiveness can vary among people. It works by inhibiting the liver's synthesis of Lp(a). However, niacin treatment can have side effects, and its impact on reducing cardiovascular events related to high Lp(a) levels is still under investigation. [5] [6]

Managing Other Cardiovascular Risk Factors

Since directly lowering Lp(a) without lowering LDL is challenging, focusing on managing other cardiovascular risk factors is crucial. This includes managing high blood pressure, controlling blood sugar levels in diabetes, and adopting an overall heart-healthy lifestyle. [5] [6]

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Get Up-to-Date on Your Heart Health with CARE

CARE is your trusted companion in preventative healthcare. A CARE membership gives you access to regular health assessments, blood analysis, and face-to-face consultations with our healthcare providers, who discuss your individual results with you.

Your health is your greatest asset that determines how you will spend the rest of your life. Taking your preventative healthcare into your own hands means that you acknowledge that your present life shapes your health as you grow older. Assessing your cardiovascular health and risk with our in-depth blood analysis and an Lp(a) test allows you to get a comprehensive picture of your health, optimize it, and fill potential health gaps.

Please do not hesitate to contact us about an Lp(a) test and optimizing your cardiovascular health. With CARE, you stay up to date with the latest findings in science and medicine, allowing you to cherish your health and stay fit and healthy as you age.

Unlock your health potential with CARE!

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Blog Author Elena Health Coach at CARE

Elena Iagovitina

Health Coach at CARE Zurich

About the author

Elena is an enthusiastic Health Coach and blog writer at CARE, with a passion for holistic medicine and health. Previously, Elena worked for almost five years as a coach leading retreats, workshops, and seminars. These included mind-body therapy: breath work, meditation, and massage; as well as energy force therapy: reiki, and qi gong; and third expressive therapy: movement, writing and support groups. Elena shares exciting articles on the blog, on the topic of where the alternative and traditional medicine intersect with Western Medicine. Elena is also the driving force behind the CARE community. In her spare time, she enjoys hiking, traveling to remote locations and dancing. You might also see her on the lake of Zurich as a coast guard. Join her on her journey to learn more about health and discover the world of preventive medicine! Visit all articles written by Elena!