Understanding Lp(a): a key heart biomarker

Lipoprotein(a), or Lp(a), is a biomarker that gives you information about your risk of heart disease. But unlike cholesterol, it's not something that you have much control over. Your level of Lp(a) is mostly determined by your genes. So, what can you do if your level is high?

In this article, we explore what your result means and how you can offset your risk if your result is abnormal.

• What is Lp(a)?
• What does Lp(a) mean for your health?
• What causes a high Lp(a) level?
• How can I check my Lp(a) level?
• How do I lower my Lp(a) level?

What is Lp(a)?

Lp(a) is a type of low-density lipoprotein (LDL) made by the liver. Lipoproteins help to transport fats around the body.

Lp(a) is very similar to LDL cholesterol, except it's even "stickier". That's because it contains a protein called Apo(a). To clarify, Apo(a) is not the same as ApoA1 - they are two different proteins. 

Apo(a) likely plays an important role in the blood's clotting system. But because of its sticky properties, it also has implications for heart health.
 

What does your Lp(a) level mean for your health?

Lp(a) speeds up the narrowing of the arteries because of its "sticky" Apo(a) protein. It may also increase the development of blood clots. Both these properties mean that a higher level of Lp(a) increases your risk of cardiovascular disease. This includes conditions like heart disease and strokes, which can impact not just your lifespan, but how many years you spend in good health.

What causes a high Lp(a) level?

Around one in five people worldwide have a high Lp(a) level, which is mostly due to genetics [1]. 

You're more likely to have a high Lp(a) level if:

• You’re of African descent
• You have a strong family history of heart disease
• A condition called familial hypercholesterolemia runs in your family

Other causes of high Lp(a) include: 

• Chronic kidney disease (CKD)
• Nephrotic kidney disease
• Hypothyroidism (an underactive thyroid)

It's important to consider and treat these conditions if you have an abnormal result. Levels may also increase during menopause. 

How can I check my Lp(a) level?

The only way to know if your level is high is with a blood test. You can check your level from home with our Lipoprotein(a) Blood Test.

If you'd like even more detailed insights into your health and heart disease risk, we recommend our Optimal Health Blood Test. This test includes other heart disease markers like the ApoB:ApoA1 ratio, triglyceride to HDL ratio, and HbA1c.

How do I lower my Lp(a) level?

Because Lp(a) is mostly determined by your genetics, lifestyle changes will only have a small impact on your level. But they're so important in reducing your likelihood of cardiovascular disease by reducing other risk factors.

You can reduce your cardiovascular risk by: 

• Exercising regularly – this can help maintain a healthy blood pressure, weight, and balance of lipids in the body.
• Eating a Mediterranean diet – the Mediterranean diet is rich in omega-3, unsaturated fats, and whole grains. One study found that dietary improvements may reduce Lp(a) levels by as much as 10-15% [2]. 
• Quitting smoking – smoking is one of the biggest contributors to heart disease. Quitting can dramatically reduce your risk. 
• Considering a statin – lipid-lowering treatment like statins don't reduce your Lp(a) level, but they can reduce the size of these harmful lipoproteins. They also lower non-HDL cholesterol levels to reduce your overall risk. 

Find out other ways you can protect your heart health.

Treatments to lower Lp(a) include:

• Lipoprotein apheresis – this treatment is similar to dialysis and is very effective. However, it's only considered in people who have had multiple cardiovascular complications despite optimising their other risk factors.
• PCSK9 inhibitors – these drugs may reduce Lp(a) levels by 20-30%, but they're not currently licensed for this kind of treatment. 

Research looks promising for new treatments. Some of them work by stopping Lp(a) production at a genetic level. These include antisense oligonucleotide therapy and siRNA (gene silencing) treatments. 

Lp(a) and your long-term health

If you're worried about your risk of cardiovascular disease, it's never too late to make changes. A consistently healthy lifestyle can significantly improve your lifespan and reduce your risk of chronic disease.

If you're not seeing an improvement in your results, visit your GP. They may be able to give you additional advice as well as consider medications. 
 

References

1. Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart Journal. 2019;71: 99–112. doi:10.1016/j.ihj.2019.03.004
2. Enkhmaa B, Berglund L. Non-genetic influences on lipoprotein(a) concentrations. Atherosclerosis. 2022;349: 53–62. doi:10.1016/j.atherosclerosis.2022.04.006