Most people know about LDL cholesterol. Far fewer have heard of lipoprotein(a), or Lp(a).
Lp(a) is a particle that carries cholesterol in the blood. It is similar in some ways to LDL, but it has an additional protein called apolipoprotein(a). This difference matters because high levels of Lp(a) are linked to a higher risk of cardiovascular disease.
One of the most important things to know about Lp(a) is that your level is largely inherited.
Unlike LDL cholesterol, Lp(a) is only minimally affected by diet, exercise or weight loss. Someone can exercise regularly, eat well and have otherwise favorable cholesterol results, yet still have a high Lp(a) level.
High Lp(a) can contribute to the development of plaque in the arteries. It is also associated with inflammation and processes involved in blood clot formation. Over time, elevated levels are associated with a greater risk of heart attack and stroke.
There is another practical difference from ordinary cholesterol testing: Lp(a) is not usually included in a standard cholesterol panel. It requires a separate blood test.
Current cardiovascular guidelines recommend measuring Lp(a) at least once in adulthood. A level of 125 nmol/L or 50 mg/dL or higher is considered a factor that increases cardiovascular risk.
Finding a high Lp(a) does not mean that a heart attack will occur. It adds another piece of information to the individual cardiovascular risk assessment.
Because Lp(a) itself is difficult to change through lifestyle, knowing that it is elevated makes attention to the factors that can be changed even more important. These include LDL cholesterol, blood pressure, smoking, diabetes, physical activity and other cardiovascular risk factors. Current guidelines recommend more intensive management of LDL cholesterol and other modifiable risk factors when Lp(a) is elevated.
