Lipoprotein(a) and cardiovascular risk

Lipoprotein(a): What It Is and Why It Matters for Heart Health

Lipoprotein(a), often abbreviated as Lp(a), is a particle found in the blood that resembles the better-known LDL cholesterol, commonly referred to as “bad cholesterol.” However, it has a unique feature: an additional protein called apolipoprotein(a), which makes Lp(a) behave in a more “aggressive” way toward the arteries.

Why Lp(a) Is Important

In recent years, Lp(a) has become increasingly relevant in cardiology because:

• It raises the risk of cardiovascular disease, regardless of LDL cholesterol levels.

• It can contribute to both atherosclerosis (cholesterol buildup in the arteries) and thrombotic events.

• It is a genetic risk factor, meaning it cannot be modified through lifestyle.

People with high Lp(a) levels have an increased risk of heart attack, stroke, coronary artery disease, and calcific aortic valve stenosis.

What Makes Lp(a) Different From Other Lipoproteins?

It is largely genetically determined

Lp(a) levels are established at birth and tend to remain stable throughout life. They are not significantly influenced by diet, physical activity, or other environmental factors.

It promotes atherosclerosis

Like LDL cholesterol, it carries cholesterol into the arteries, contributing to the formation of atherosclerotic plaque.

It has pro-inflammatory and pro-thrombotic effects

Apolipoprotein(a) can interfere with the body's natural clot-dissolving mechanisms, promoting thrombotic processes.

It is difficult to lower with traditional therapies

Statins, which are very effective at lowering LDL, have little effect on Lp(a). Specific treatments are currently in development and are in advanced stages of research.

Who Should Have Their Lp(a) Measured?

International guidelines recommend measuring Lp(a) at least once in a lifetime, especially if:

• There is a family history of early heart attack or stroke

• Cholesterol levels remain high despite optimal therapy

• There is premature cardiovascular disease

• A person has aortic stenosis without a clear cause

The test is simple: it only requires a blood sample.

Values: When Is Lp(a) Considered High?

The most commonly used threshold is > 50 mg/dL (or > 125 nmol/L).

Higher values indicate increased cardiovascular risk, which should be assessed in the context of all other factors (LDL levels, blood pressure, glucose, family history, lifestyle).

What Can Be Done if Lp(a) Is Elevated?

Although there are currently no approved medications designed specifically to lower Lp(a), it is still possible to significantly reduce overall cardiovascular risk:

Optimize all other risk factors, especially LDL cholesterol

• Balanced diet

• Regular physical activity

• Smoking cessation

• Lipid-lowering therapies, including statins and — when indicated — PCSK9 inhibitors

Specific Lp(a)-targeted therapies in development

New therapies (antisense oligonucleotides and siRNA) are showing very promising reductions in Lp(a) levels. They may become available in the coming years.

In Summary

• Lp(a) is a genetically determined lipoprotein, distinct from LDL and potentially highly atherogenic.

• Elevated levels increase the risk of heart attack, stroke, and aortic stenosis.

• Measuring it once in a lifetime can help better understand personal cardiovascular risk.

• Even without a specific treatment yet, carefully managing all other risk factors provides effective protection for heart health.