Lp(a) - do your know your level?
Many of us still remember spinning LP records...but this post is about a different kind of LP - Lipoprotein(a). Unlike its vinyl namesake, Lp(a) doesn't play music, but it does play a very significant role in heart health.
Lipoprotein(a), or Lp(a). Pronounced “Lp-little-a” - It is one of the lesser-known cholesterol particles gaining attention for its significant impact on heart health. Let’s dive into what Lp(a) is, why it's a risk factor for heart disease, and what you can do about it.
What is Lp(a)?
Lp(a) is a unique type of lipoprotein that combines low-density lipoprotein (aka LDL cholesterol) with a protein called apolipoprotein. It is one of the most prevalent genetic risk factors for heart disease; it is said to affect approximately 20% of the population worldwide - 1 in every 5 people. It has also recently been identified as an independent risk factor, even in younger adults and otherwise healthy individuals with no other known cardiovascular risks (1), (2).
Why is Lp(a) a risk factor for heart disease?
Lp(a) contributes to heart disease by increasing the following risk factors:
- Plaque build-up: Unlike other LDL particles, Lp(a) is fused with apolipoprotein(a), aka apo(a), making it stickier, and therefore more prone to causing atherosclerosis - the build-up of fatty deposits (plaques) on the inner walls of arteries. This can narrow and restrict blood flow, potentially leading to heart attacks, strokes, and other cardiovascular diseases (CVD) (3).
- Clotting risk: Lp(a) promotes blood clot formation, which can cause sudden blockages in blood vessels.
- Inflammation: Lp(a) promotes inflammation in blood vessels, increasing the likelihood that plaques will rupture. This inflammation also contributes to the narrowing of the aortic valve (aka aortic stenosis).
What can you do about it?
- Find out if you’re at risk - talk to your healthcare provider about testing for Lp(a)
- Lp(a) is not part of a standard cholesterol test - it is still not routinely tested in the U.S. However, in Europe and Canada Lp(a) screenings are now recommended for everyone (4).
- In the US, testing is currently recommended for the following groups (5):
- Anyone who has had a heart attack, stroke, peripheral artery disease, or aortic stenosis before 55 (for men) or 65 (for women)
- Anyone with an immediate family member with premature CVD
- Anyone with very high LDL cholesterol (190 mg/dL or higher)
- And, close relatives (siblings, children, and parents) of someone with elevated Lp(a)
- It has not been routinely tested to date because there aren’t any FDA-approved drugs to lower Lp(a), but this is likely to change in the near future.
- Know what the numbers mean
- A normal Lp(a) level is generally considered to be < 30 mg/dL.
- Levels > 50 mg/dL are associated with a significantly increased risk of heart disease.
How to manage high Lp(a)?
Firstly, remember it’s a genetic risk factor. Therefore, it’s vital to remember that having high levels of Lp(a) does not mean you’re destined to have a cardiovascular issue, it just means you’re at higher risk.
Genetics may set the stage, but your ‘environment’ determines the outcome. Note, in this case, ‘your environment’ refers to how you live your life in general; your lifestyle, what you eat, how you prioritize exercise, how you sleep, how well your gastrointestinal system functions, and of course you manage stress, etc.
In summary, it comes back to mastering the B. I. G.3 - Blood Sugar regulation, Inflammation, and Gastrointestinal health™.
Practical steps to take if you’ve got elevated Lp(a)
Although dietary interventions have shown mixed results in directly lowering Lp(a) levels (6), being proactive about making heart-healthy choices is even more important to help manage overall cardiovascular risk.
The following outlines my top recommendations for anyone with elevated Lp(a):
- “Eat food. Mainly plants. Not too much” (7)
- Regulate your blood sugar by focusing on whole foods, prioritizing protein, healthy fats, fiber, and regular, ideally daily, exercise you enjoy
- Prioritize stress management and sleeping well
- Minimize alcohol
- Avoid the CRAP - Carbonated sodas, Refined sugars, Artificial sugars/flavors/dyes, etc. & Processed foods
Knowing your Lp(a) level can provide valuable insight into your heart health risk. If you don’t already know your Lp(a) status, I recommend contacting your healthcare provider about getting tested.
Remember, knowledge truly is power when it comes to being proactive about protecting your heart!
References:
- Dzobo, K. E. et al (2022). Lipoprotein(a): An underestimated inflammatory mastermind. Atherosclerosis, 349, P 101-109, https://www.atherosclerosis-journal.com/article/S0021-9150(22)00181-2/fulltext#:~:text=Lp(a)%20is%20an%20inflammatory,induction%20of%20arterial%20wall%20inflammation
- Wilson, D. P. (2022). Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. Journal of Clinical Lipidology, 16(5), E77-E95, DOI: https://doi.org/10.1016/j.jacl.2022.08.007
https://www.lipidjournal.com/article/S1933-2874(22)00244-6/fulltext - Vinci, P. et al (2023). Lipoprotein(a) as a risk factor for cardiovascular diseases: Pathophysiology and treatment perspectives. International Journal of Environmental Research & Public Health, 20(18), 6721. doi: 10.3390/ijerph20186721
- NIH, National Heart, Lung & Blood Institute, (2024). Lipoprotein(a): What to know about elevated levels. https://www.nhlbi.nih.gov/news/2024/lipoproteina-what-know-about-elevated-levels#:~:text=But%2C%20what%20is%20Lp
- Corliss, J. (2023). The latest on lipoprotein(a), an inherited cause of early heart disease. Harvard Heart Health, https://www.health.harvard.edu/heart-health/the-latest-on-lipoprotein-a-an-inherited-cause-of-early-heart-disease#:~:text=You%20can%20get%20a%20separate,lower%20elevated%20Lp(a)
- Enkhmaa, B. et al (2024). Diet and Lp(a): Does dietary change modify residual cardiovascular risk conferred by Lp(a)? Nutrients, 12(7), doi: 10.3390/nu12072024
- Pollan, M. (2009). Food rules: An eater’s manual. Penguin books.