Ever Heard of lipoprotein(a)?

Try asking your primary care doctor if they’ve ever checked your lipoprotein(a) level. If it’s high, do they know what to do about it? Lipoprotein(a) (Lp[a]), pronounced literally as ‘little-a,’ is something that rarely gets checked in primary care. It’s not something that gets a lot of attention, in the United States anyway, but it needs to become a routine screening. It only ever needs to be done once – as you either have elevated levels of it, or you don’t. 

What Exactly is It?

Lipoprotein(a) is a type of apoB particle (read about apoB here) – having the same density as an LDL-particle as measured in the lab – that has an extra protein, called a Kringle, attached to it. Lipoprotein(a) can lead to an increase in atherosclerosis (plaque deposited in the artery wall), aortic stenosis (narrowing of a heart valve opening), and a potential for faster development of blood clots (suspected to perhaps be an evolutionary advantage). 

Lipoprotein a

lipoprotein(a) heart attack risk

Apolipoprotein B particles, the right which has the additional Lp(a) kringle attached.


Illustration credit: Thomas Dayspring, MD, FACP, FNLA.


Why You Should Care

To make it simple, there’s an increased risk of having a heart attack or other cardiovascular issues if your Lp(a) level is elevated. There is some good scientific data that has established a strong link between Lp(a) and a number of different adverse cardiovascular problems, maily heart attack (4x increased risk); aortic stenosis (3x increased risk); and coronary atherosclerosis (narrowing of the arteries in the heart) (5x increased risk). 

What Can You Do About It?

There are a few approaches that are routinely used to reduce the risk from Lp(a):

  • Decrease the apoB concentration to <60 mg/dL (<5th percentile) depending on one’s overall cardiovascular risk and if they have established cardiovascular disease;
  • Some data shows that we can get significant reduction of risk from Lp(a) by reducing LDL-C, although apoB is a superior lipoprotein metric for risk reduction;
  • Use a PCSK9i (off-label use);
  • Keep your eye on the novel apo(a) antisense oligonucleotides and other immune therapies.

Lipoprotein a