Lipoprotein(a)
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Understand Inherited Lipoprotein(a)
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What is inherited high Lipoprotein(a)         Download our patient brochure here

            Lipoprotein(a), is a particle in your blood which carries cholesterol, fats and proteins.  The amount your body makes is inherited from one or both parents and is determined by the genes passed on from your parent(s) when you are born.  It does not change very much during your lifetime except if you are a women, levels increase as the natural estrogen level declines with menopause.  Diet and exercise seems to have little to no impact on the lipoprotein(a) level.

Lipoprotein(a) is also known as

                 -  Lp(a)                                            -  Lipoprotein-little-a

                          -  L-p-a                                            -  L-p-little-a    

          Some cholesterol and Lp(a) in your blood is normal. A high level of LDL cholesterol increases your risk of a heart attack or stroke. 

         Lipoprotein(a) is a type of lipoprotein/cholesterol and high levels increase your risk for atherosclerosis (build up of fatty deposits in the wall of the artery, also called atherosclerotic cardiovascular disease or CVD) including coronary heart disease (blockages in your heart arteries) or heart attack,  peripheral vascular disease (PAD, blockages in the leg arteries), aortic stenosis (damage to the aortic valve of the heart), thrombosis (blood clots) and stroke (blockages in the neck arteries). In children, a high level of Lp(a) is a leading risk factor for strokes but strokes are very rare in any child, even those with a high level of Lp(a).

 

 

         About 20% or one in five people have high levels of Lp(a) greater than 50mg/dL from birth based on genetic factors they inherited from their parents, and most don’t know they have it. As high levels of Lp(a) travel through the bloodstream, it collects in the arteries, leading to gradual narrowing of the artery that can limit blood supply to the heart, brain, and kidneys as well as the legs. It can increase the risk of blood clots, heart attack or stroke.

 

Carotid artery in the neck, blockages in this artery can result in a stroke

 

Testing for Lipoprotein(a)

     A simple blood test can measure your Lp(a) level; however, it is not included in most standard cholesterol or lipid panels.  Unfortunately, not all insurance companies cover testing for Lp(a) at this time so check with your insurance company or provider.

     Levels of Lp(a) are reported in different units, either mg/dL or nmols/L.  A normal level is less than 30 mg/dL or less than 75 nmols/L. Levels higher than this are associated with an increased risk of heart attack, stroke, or narrowed arteries supplying blood to vital organs, often at an early age (younger than 55 in men and 65 in women). Your doctor or nurse cannot tell you have high Lp(a) by examining you. 

Reasons an Lp(a) test may be right for you.  Ask your nurse or doctor if you have questions:

  • You or a family member have had a heart attack or stroke at an early age including circulation trouble in the legs and/or narrowing of the aorta. For men it would be younger than 55 years of age and women less than 65 years of age.
  • Someone in your family has high Lp(a).  If an adult has high Lp(a), their children have a 1 in 2 chance of inheriting it.
  • Heart attack or stroke with no other known risk factors such as smoking, high LDL or “bad” cholesterol, diabetes or obesity. An estimated 50% of people who have heart attacks have normal levels of LDL-cholesterol.

  • High LDL-cholesterol levels even while taking statins or other LDL lowering medications.
  • Having FH, Familial Hypercholesterolemia, an inherited condition of very high LDL cholesterol levels.

         A high level of Lp(a) is a genetic condition. As a result, when one person is diagnosed with high Lp(a) it is important to also test other blood-related family members including parents, siblings (brothers and sisters) and children.

 

Action can save lives

Diagnosis and Screening

Although high Lp(a) is a common condition, most people who are affected are undiagnosed. Approximately 30% of patients with FH (Familial Hypercholesterolemia) have high Lp(a). Many doctors do not routinely test for it. The Lp(a) Foundation supports broader access to testing for Lp(a) levels for all people. And because it is inherited it is important to test all members of a family where one member is found to have high Lp(a) levels.  It may only need to be tested once in a person's lifetime because it's genetic.

Treatment

If you have high levels of Lp(a), your nurse or doctor will discuss what treatments work best for you.  There is no one treatment that works for all patients.

Even though a healthy lifestyle may not lower Lp(a) it is important for reducing your overall risk of cardiovascular disease.

 

What can you do about lifestyle?

  • Eat a healthy diet.  People with high Lp(a) appear to benefit from good fats in their diet from nuts, fish, avocado, olive oil, etc. so a Mediterranean Diet might be a good option. Or visit ChooseMyPlate.gov for ideas.    
    • Lots of vegetables and whole fruits
    • Whole grains instead of simple carbohydrates and processed foods
    • Limit sweets and sugary drinks
    • Limit foods high in trans fats

     

  • Aim for at least 30-60 minutes of moderately vigorous physical activity every day.
  • Stop smoking. Visit smokefree.gov or call 1-800-QUIT-NOW.  Ask your nurse or doctor for help.
  • Control your weight.  Ask your nurse or doctor for help.
  • If you drink alcohol.  Limit yourself to 1 drink per day for women (none if you have a personal or strong family history of breast cancer) and 2 drinks per day for men.
  • Manage stress with regular physical activity and relaxation exercises such as yoga or meditation.

What about medications and procedures?

  • It is important to manage all your other risk factors. 
    • High LDL cholesterol or triglycerides
    • High blood pressure
    • High blood sugar/diabetes
    •  
  • There isn't a medicine available that just lowers high Lp(a) yet. The good news is that lowering all your other risk factors may lower your overall risk of a heart attack or stroke.
  • Medicines called statins only lower LDL cholesterol.
  • Niacin is sometimes used to lower Lp(a). It can also lower LDL cholesterol.  Talk with your nurse or doctor before taking over-the-counter niacin.
  • Ask your doctor about the benefit of taking a 81 mg coated aspirin per day to combat the blood clot risk from high Lp(a)

Medical procedures

  • In certain cases, apheresis may be used.  This procedure is used to filter the blood to remove LDL cholesterol, and Lp(a).  The effects are temporary and often need to be repeated every 1 to 2 weeks.

Future treatments

Researchers are still studying why people with high Lp(a) level are more likely to have heart attacks, strokes and aortic stenosis.  But there are now promising therapies in development that could help reduce Lp(a) levels.

Through screening, aggressive management, and the possibility of treatment in the future to lower their Lp(a) these people can have the opportunity to live longer, healthier lives.

Ask your doctor to test you for high Lp(a).

  

Important facts about Lp(a)

  • High Lp(a) is not rare. One in five people globally and 63 million people in the U.S. have high Lp(a) levels, and most do not know they are at risk.

  • High Lp(a) is the strongest, single, inherited risk factor for early coronary artery disease (CAD) and aortic stenosis, or narrowing of the aorta.

  • People living with high Lp(a) have a 2-4 times higher risk of early heart and blood vessel disease compared to people with normal Lp(a) levels.

  • High Lp(a) occurs in all ethnic groups, but is more common among African Americans and South Asians.

  

 

 

The Lipoprotein(a) Foundation is here for you!

         The Lipoprotein(a) Foundation is the only national non-profit organization dedicated to advocacy, community education, patient support and research into the causes and health consequences of high levels of lipoprotein(a).

         The AHA, ACC and EAS guidelines acknowledge the significance of Lp(a) as an independent, genetic risk factor for early cardiovascular disease.

         Our mission is to expand awareness of this inherited lipid/cholesterol risk for early cardiovascular disease, educate and empower patients, and save lives. We are advocating to include Lp(a) testing in the standard lipid blood testing panel to increase the rate of early diagnosis and provide a more accurate prediction of risk.

Thank you to our patient advocates.

 

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