High lipoprotein(a)

What is lipoprotein(a)?

Lipoprotein(a) (also known as Lp(a)) is a type of particle found in your blood made by the liver. Lipoproteins are made of fat and protein, and their job is to carry fats (also called lipids) around the body in the blood.

It is a lipoprotein similar to LDL cholesterol, sometimes referred to as ‘bad’ cholesterol. What makes Lp(a) unique is an additional protein, apolipoprotein(a), attached to it.

High levels of Lp(a) in your blood can increase your risk of developing issues, such as heart disease, heart attacks, or strokes.

This is because it can contribute to the buildup of plaques in the arteries by making the lipids more adherent to the vessel wall and by increasing the likelihood of localised clot formation.

Symptoms

High levels of Lp(a) do not cause any direct or noticeable symptoms. Unlike conditions such as high blood pressure or diabetes, there are no specific warning signs associated with elevated Lp(a).

Instead, the main concern with high Lp(a) is its connection with a higher risk of developing conditions like heart attacks, strokes, or narrowing of the arteries.

As high Lp(a) has no symptoms, and you may be at higher risk of heart events, you need to be aware of general symptoms related to heart disease. These can include symptoms such as chest pain, shortness of breath, unexplained fatigue, or sudden weakness.

Since you may not feel any symptoms from high Lp(a) alone, regular screening and management of your cardiovascular risk factors are key steps for maintaining your heart health.

Causes

Unlike regular cholesterol, Lp(a) levels are determined mainly by your genes and are not greatly impacted by diet or exercise. The amount of lipoprotein (a) you have as a child will most likely be the level you have for years to come.

Lp(a) levels have been found to be lower in some populations, including Chinese and Japanese, and higher in others, for example, in African and South Asian populations. Lp(a) levels are not affected by your age or sex.

There are also ‘secondary causes’ that can affect your Lp(a) levels. These include conditions such as chronic kidney disease, nephrotic kidney disease, and hypothyroidism.  If you are an assigned female at birth, going through menopause can also increase your risk.

Diagnosis

High levels of Lp(a) are diagnosed through a blood test that measures the amount of this lipoprotein in your bloodstream. We may recommend this test if you have a personal or family history of early heart disease, high cholesterol that runs in families, or unexplained cardiovascular events.

During the test, a small sample of blood is drawn from your arm and sent for analysis. Because Lp(a) levels are determined mainly by genetics, if your results show that they are high, it’s recommended that close family members get screened as well.

Understanding your Lp(a) levels helps us more accurately assess your cardiovascular risk and guide our prevention or treatment plan specific to your needs.

Treatment

As Lp(a) is determined by genetics, holistic treatment options such as lifestyle changes (like diet and exercise) are generally not effective for lowering high levels directly.

The best way to protect your heart if you have high Lp(a) is to control other risk factors, like keeping your ‘bad’ cholesterol (LDL) low, not smoking, eating healthy, staying active, and treating high blood pressure or diabetes if you have them.

Some medicines that lower cholesterol, such as statins, may offer some help. For some people with very high levels, there is a special blood filtering treatment called lipoprotein apheresis. New medicines that lower Lp(a) are being studied and may be available in the near future.

For now, committing to a healthy lifestyle and following your healthcare professional’s advice about medications is the primary focus of treatment.