What is Lipoprotein(a)?

We frequently talk about two types of cholesterol –

  1. HDL-cholesterol - HDL-C helps the body get rid of excess cholesterol that may otherwise collect in blood vessels.
  2. LDL-cholesterol - Commonly referred to as “bad” cholesterol. When the LDL-cholesterol blood level is high, it can cause damage by clogging or blocking blood vessels as you age.

However, other types of cholesterol are also found in the blood. One example is Lipoprotein(a), referred to as “Lp(a)”, which, although similar to LDL-cholesterol, is a slightly different kind of “bad cholesterol”. The level of Lp(a) in our blood typically is determined at birth and remains relatively constant throughout life. Those with abnormally high levels of Lp(a), with or without elevated levels of LDL-cholesterol, have an increased risk of developing heart disease as an adult, which may cause a heart attack or stroke. By identifying at a young age those at risk, individuals with abnormally high levels of Lp(a) can take steps to help avoid heart problems in the future.

What level of Lp(a) is considered “high” or worrisome?

Lp(a) is measured in milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). The National Lipid Association recommends measurement of Lp(a) in nmol/L where possible for greater accuracy. A level higher than 50 mg/dL or 100 nmol/L is considered “high”, although some labs may report Lp(a) as “high” if the level is greater than 30 mg/dL or 75 nmol/L.

What are the effects of having abnormally high blood levels of Lp(a)?

Abnormally high levels of Lp(a) may contribute to two major problems with your health:

Damage to blood vessels – Due to the severe and lifelong exposure, those with abnormally high levels of Lp(a) often develop “clogged arteries”. This ultimately causes damage by reducing blood flow to organs, including the heart and brain. This damage can result in a heart attack or stroke at a very early age (for example 40-50 years of age or younger). While symptoms of clogged arteries don’t usually occur during childhood, the risk of experiencing health problems as children enter adulthood is very high.

Blood clots – When a blood vessel is injured, the body normally causes blood to clot, preventing excessive bleeding. This occurs, for example, after an injury or cut. As the body heals, the clot is dissolved, restoring normal blood flow.

Clots can also occur in blood vessels that have been clogged by abnormally high levels of LDL-cholesterol. Abnormally high levels of Lp(a) may cause these blood clots to form or interfere with the way the body “dissolves” them, potentially reducing blood flow to vital organs, such as the heart and brain. When a clot forms in a clogged artery and is not dissolved properly, the decreased blood flow to the heart and brain may result in a heart attack or stroke.

What causes levels of Lp(a) to be high?

The amount of Lp(a) in our blood is determined by our body’s blueprint or genes. Genes help determine everything from the color of our eyes to how our bodies work. Your blood level is determined by a gene from either your mother or father, one of whom also has an abnormally high Lp(a). Sometimes both parents may have abnormally high Lp(a).

The elevated Lp(a) trait is passed down when the child receives a copy of the culprit gene causing abnormally high blood levels of Lp(a) from a parent. The presence of 1 affected copy of the gene is all that is needed to cause the level of Lp(a) to be abnormally high. The risk of having an affected child when a parent has an elevated Lp(a) is 50%, each time the mother becomes pregnant. Parents with an elevated level of Lp(a) should have their children tested. Because abnormally high blood levels of Lp(a) is genetic, other family members, such as parents and siblings, can be affected and should also be tested.

How can you tell if someone has abnormally high Lp(a)?

The level of Lp(a) in your blood can be determined with a simple blood test, available in most commercial medical laboratories. It is important to note that it is not necessary to fast before taking this blood test.

You should ask your healthcare team to request a Lp(a) blood test if:

  • You are concerned about your health or risk of having premature heart disease.
  • Have a personal or family history of premature cardiovascular disease, such as a heart attack or stroke, or have a chronic medical condition such as diabetes.
  • If someone in your family is known to have an abnormally high blood level of Lp(a).

Because Lp(a) increases risk of premature heart disease but may not cause unique symptoms in children and young adults, many healthcare professionals recommend that everyone have a blood test to determine their level of Lp(a), at least once in their life.

Is an abnormally high level of Lp(a) treatable?

Although promising treatments are in development, currently there are no drugs that will specifically lower Lp(a) in those with abnormally high blood levels. However, there are many things that individuals with high levels of blood Lp(a) can do to stay healthy, including management of other risk factors factors for cardiovascular disease. For example, drugs to lower levels of LDL-cholesterol, which can damage blood vessels and lead to heart disease at an early age, are important. Although they have little to no effect on blood levels of Lp(a), developing good health habits such as eating a heart-healthy diet, engaging in daily physical activity, avoiding excessive weight gain, and not smoking or quitting smoking, are all vital to good heart health. There is some new research that supports that diet may affect Lp(a) levels, mostly in people who have elevated LP(a) levels. However, more research is needed to clarify our understanding.

Parents can help children stay healthy by:

  1. Getting involved:
    1. Help set realistic goals for a healthy weight, food consumption, and activity levels.
    2. Talk to your child about healthy eating:
      • Pay attention to what your child eats.
      • Learn what snack foods your child most often chooses.
      • Consider how foods are prepared and which methods of preparation have the most health benefits.
      • Encourage appropriate portions of healthy foods, snacks and beverages. Avoid sugar sweetened beverages and encourage fruits and vegetables at all eating occasions.
      • Increase daily physical activities for the entire family.
  2. Avoid smoking or, if you smoke, quit. Teach your child to avoid smoking, or if the child smokes or uses e-cigarettes/vaporizer pens, offer to help them quit.
  3. Make healthy living a family affair.
  4. Be a good role model for your child!