1 Hidden Heart Health Risk: Understanding Lipoprotein(a) and Taking Control of Your Health

Date

08.04.25

When it comes to heart health, the general population knows about the risks of high blood pressure and we hear the warnings of high cholesterol. We’ve been taught about the signs of a heart attack and might even have an awareness of a “heart healthy diet.” But, there is a factor that puts people at high risk for heart related disease (and other disease) and is NOT often checked. If heart disease seems to run in your family, there may be a logical explanation why! Lipoprotein(a), often called Lp(a) could be a missing piece of the puzzle.

This often-overlooked risk factor is gaining increasing attention in the world of cardiovascular health. Unlike your regular LDL “bad” cholesterol, Lp(a) is largely determined by your genes and has some unique, potentially harmful properties. Understanding what Lp(a) is, the risks it carries, and how it fits into a broader, whole-person approach to health can empower you to take even more effective steps towards protecting your heart (and your loved ones).

What is Lipoprotein(a) (Lp(a))?

Let’s break it down simply. Imagine your bloodstream has tiny delivery trucks carrying cholesterol around. One of the main types is LDL (low-density lipoprotein), often called the “bad” cholesterol because it can contribute to plaque buildup in your arteries. Now, picture some of these LDL trucks having an extra, sticky protein attached to them. That extra protein is called apolipoprotein (a), and when it is attached to an LDL particle, the whole thing becomes Lipoprotein(a), or Lp(a).

Think of it like an LDL particle wearing a Velcro suit. This “Velcro” (apolipoprotein (a)) makes the Lp(a) particle stickier than regular LDL. So now, your ‘delivery truck’ may be attracting an ‘extra load’ because of the ‘sticky factor.’ It may be creating a buildup much faster and might be needing a “wide load” sign on the back of the truck. It may be taking up way too much space in your arteries, leading to blockages.

The crucial thing to understand is that your Lp(a) level is primarily determined by the genes you inherit from your parents. While lifestyle factors like diet and exercise have a significant impact on your regular LDL cholesterol, they don’t tend to lower Lp(a) levels very much.

The Risks: Why Should You Care About Lp(a)?

This “sticky” nature of Lp(a) can lead to several problems in your cardiovascular system:

Plaque Buildup (Atherosclerosis): Like regular LDL, Lp(a) can contribute to the formation of plaque in your arteries. However, due to its stickiness, it’s believed to be even more aggressive at this process. Some research suggests that on a particle-for-particle basis, Lp(a) could be six times more likely to cause plaque than regular LDL.
Increased Clotting Risk (Thrombosis): The apolipoprotein (a) part of Lp(a) has a structural similarity to a protein involved in blood clotting called plasminogen. This similarity might interfere with the body’s natural ability to break down blood clots, potentially increasing the risk of dangerous clots forming.
Inflammation: Lp(a) carries a higher amount of oxidized phospholipids compared to regular LDL. These oxidized fats can trigger inflammation in the walls of your arteries and even in heart valves, contributing to damage and disease.
Aortic Stenosis: Elevated Lp(a) is strongly linked to aortic stenosis, a condition where the aortic valve (the main exit valve for blood leaving your heart) narrows and hardens. This can put significant strain on your heart.
Other Cardiovascular Issues: High Lp(a) has also been associated with an increased risk of peripheral artery disease (PAD), where blood flow to the limbs is reduced, and ischemic stroke, a type of stroke caused by a blockage in a blood vessel in the brain. It’s also been linked to chronic kidney disease.
“Residual Risk”: This is a really important concept. Even if you diligently work to lower your LDL cholesterol through diet, exercise, and medication, if your Lp(a) is high, you might still have a significant remaining risk of cardiovascular events. This “residual risk” is what makes understanding and addressing Lp(a) so crucial.

Who is Most at Risk? It Might Be You

It’s estimated that around 1 in 5 people worldwide have elevated Lp(a) levels. This is a significant portion of the population! What’s interesting is that Lp(a) levels can vary considerably depending on your ethnicity, with individuals of African ancestry often having the highest levels. East African friends and clients, this is too important to overlook!

The concerning part is that you can be otherwise healthy and still have high Lp(a). It doesn’t discriminate based on your fitness level or how “cleanly” you eat. Because it’s largely genetic, even individuals with seemingly perfect lifestyles can be at increased risk.

A strong indicator that you might have elevated Lp(a) is a family history of early heart disease, stroke, or aortic stenosis, especially if other common risk factors don’t seem to fully explain the family history. However, given how common it is, even without a strong family link, it’s something worth knowing about.

Beyond the Standard Cholesterol Test: Why Lp(a) Matters in Functional Medicine

Traditional approaches to heart health often heavily focus on standard lipid panel markers like total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. While these are important, they don’t directly measure Lp(a). This means a crucial piece of your individual risk profile could be entirely missed.

Functional medicine takes a broader, more personalized approach to health. It seeks to understand the root causes of disease and recognizes the unique interplay of genetics, lifestyle, and environment in each individual. Lp(a) perfectly exemplifies why looking beyond standard markers is essential.

Knowing your Lp(a) level can:

Provide a more complete picture of your cardiovascular risk.
Help explain a family history of early heart disease.
Motivate more targeted and proactive prevention strategies.
Highlight the importance of addressing other modifiable risk factors even more diligently.

Knowing Your Lipoprotein (a) Level: Screening and Diagnosis

The good news is that measuring your Lp(a) level is relatively simple. It requires a single blood test. You’ll want to ask your doctor specifically to include “Lipoprotein(a)” in your lipid panel.

Lp(a) levels are typically reported in either milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). Many experts believe that nmol/L provides a more accurate picture because mg/dL measurements can be influenced by the size variations of the Lp(a) particle. An elevated Lipoprotein (a) level is generally considered to be above 50 mg/dL or 125 nmol/L.

Because your Lp(a) level is largely genetically determined and relatively stable throughout your life, you generally only need to be tested once. Think of it as establishing your baseline.

If you have a family history of early heart disease, stroke, or aortic stenosis, or if you’re experiencing symptoms that don’t quite fit with standard explanations, it’s definitely worth having this test done. Even without these specific risk factors, considering the prevalence of elevated Lp(a), discussing testing with your doctor could be a valuable step in understanding your overall heart health.

Taking Control: Managing Elevated Lipoprotein (a) with a Whole-Person Approach

While there isn’t yet a magic bullet to drastically lower Lp(a) levels, that doesn’t mean you’re powerless. A comprehensive, whole-person approach is key to managing the risks associated with elevated Lp(a):

Aggressively Manage Other Risk Factors: This is paramount. If your Lp(a) is high, it becomes even more critical to control other modifiable risk factors like high blood pressure, diabetes, smoking, and physical inactivity. Think of it as reducing the other stressors on your cardiovascular system to compensate for the increased risk from Lp(a).
Optimize LDL Cholesterol: Lowering LDL cholesterol with statins is still a cornerstone of treatment. While statins don’t significantly reduce Lp(a), they are very effective at lowering overall LDL and have been shown to provide benefit even in individuals with high Lp(a). Your doctor might aim for lower LDL targets in the presence of elevated Lp(a).
Consider PCSK9 Inhibitors: These newer injectable medications are very effective at lowering LDL cholesterol and can also lead to a modest reduction in Lp(a) levels, typically in the range of 15-30%. While this isn’t a dramatic drop in Lp(a), it might still offer additional benefit in managing overall risk, especially in individuals with established cardiovascular disease or very high LDL.
Lifestyle Still Matters: While diet and exercise might not drastically change your Lp(a) number itself, they are absolutely essential for overall heart health. Focus on a heart-healthy dietary pattern rich in soluble fiber, and engage in regular physical activity. These habits support your blood vessels, reduce inflammation, and improve other metabolic markers.
Low-Dose Aspirin: Some preliminary research suggests that low-dose aspirin might help reduce the risk of cardiovascular events in individuals with elevated Lp(a). However, aspirin also carries a risk of bleeding, so this needs to be a carefully considered decision made in consultation with your doctor, weighing the potential benefits against the risks.
Functional Medicine Perspective: A functional approach will also look at underlying factors that can contribute to cardiovascular risk in the context of high Lp(a). This might involve addressing chronic inflammation through diet and lifestyle, optimizing gut health, managing stress, and ensuring adequate levels of key nutrients.
Monitor for Aortic Stenosis: Given the strong link between high Lp(a) and aortic stenosis, discuss with your doctor the possibility of regular monitoring of your aortic valve health, potentially starting with an echocardiogram, especially as you age.

The Future is Bright: Emerging Therapies for Lipoprotein (a)

The field of Lp(a) research is rapidly advancing, and there is significant excitement around new therapies specifically designed to lower Lp(a) levels dramatically.

Antisense Oligonucleotides (ASOs): These are injectable medications that target the genetic instructions for making apolipoprotein little a, the “sticky” part of Lp(a). Early studies have shown that ASOs can lead to significant reductions in Lp(a) levels, often as high as 80%. Several ASOs are currently in late-stage clinical trials to see if these dramatic reductions translate into fewer cardiovascular events.
Small Interfering RNAs (siRNAs): Similar to ASOs, siRNAs are another class of injectable drugs that interfere with the production of apolipoprotein little a, leading to substantial lowering of Lp(a). These therapies also show great promise.

These emerging treatments offer real hope for directly addressing the risks associated with high Lp(a) in the future. As these therapies become available, it will be even more important to identify individuals with elevated Lp(a) who could benefit most.

FAQ: Your Questions About Lipoprotein (a) Answered

Q: What exactly is Lipoprotein (a) or Lp(a)?
- A: Think of it as an LDL cholesterol particle with an extra protein called apolipoprotein (a) attached. This makes it stickier and more prone to causing plaque buildup and clots in your arteries.
Q: How is Lp(a) different from regular LDL cholesterol?
- A: While both carry cholesterol, Lp(a)’s extra apolipoprotein (a) gives it unique properties, making it more atherogenic (plaque-forming) and potentially increasing the risk of blood clots. Lp(a) levels are also largely determined by your genes, unlike LDL which can be significantly influenced by diet and lifestyle.
Q: What are the symptoms of high Lp(a)?
- A: Unfortunately, high Lp(a) itself doesn’t usually cause any noticeable symptoms until it contributes to a cardiovascular event like a heart attack or stroke, or the development of aortic stenosis. This is why screening is so important.
Q: How do I know if I have high Lp(a)?
- A: A simple blood test can measure your Lp(a) level. Ask your doctor to include this in your lipid panel, especially if you have a family history of early heart disease or stroke.
Q: Is high Lp(a) genetic? Can I pass it on to my children?
- A: Yes, Lp(a) levels are strongly influenced by your genes and follow an autosomal dominant inheritance pattern. This means if you have a genetic variant for high Lp(a), there’s a good chance your children could inherit it. However, predicting the exact level in your children is not always straightforward, so testing is recommended.
Q: Can diet and exercise lower my Lp(a) levels?
- A: Unlike LDL cholesterol, Lp(a) levels are primarily genetically determined and don’t typically change much with diet and exercise. However, maintaining a healthy lifestyle is still crucial for managing overall cardiovascular risk.
Q: What are the current treatments for high Lp(a)?
- A: Currently, there aren’t specific medications approved solely to lower Lp(a). Management focuses on aggressively controlling other risk factors, especially LDL cholesterol with statins and potentially PCSK9 inhibitors. Low-dose aspirin might be considered in some cases, but discuss this with your doctor. Emerging therapies like antisense oligonucleotides and siRNAs are showing significant promise in directly lowering Lp(a).
Q: Should my family members also get tested if I have high Lp(a)?
- A: Yes, because Lp(a) is inherited, your first-degree relatives (parents, siblings, children) are at increased risk of also having elevated levels and should consider getting tested – this is called cascade screening.
Q: My doctor hasn’t mentioned Lipoprotein (a) or Lp(a). What should I do?
- A: Be proactive and ask your doctor about getting your Lp(a) level checked, especially if you have risk factors like a family history of early heart disease or aortic stenosis.

Don’t let this hidden risk factor go unnoticed. By understanding Lipoprotein (a) and taking a comprehensive approach to your heart health, you can empower yourself to make informed decisions and work towards a healthier future. Talk to your doctor about getting your Lp(a) tested and explore how a functional medicine perspective can complement your preventative health journey, ensuring you’re not just looking at standard markers but at the whole picture of your cardiovascular well-being. Since there is a higher risk for Africans, I want to be sure to let you know I am offering a free functional medicine consultation to my East African friends to help you address your heart health and the health of your family. Please schedule your consult today.