Managing Elevated Lipoprotein (a) Levels
Some Background on the Prevalence of Heart Disease
In America, there are 380,000 deaths that occur every year from coronary artery disease, costing the U.S. health system approximately $110 billion. Heart disease causes approximately one-third of the deaths in the United States.
What is Lipoprotein (a)?
Lipoprotein (a), or Lp(a), is a protein attached to LDL particles in the blood. It was first discovered in 1963 and is only found in humans. It is known to be:
1. Pro-thrombotic (increases the risk of blood clots),
2. Pro-atherogenic (increases the risk of heart attacks and strokes),
3. Pro-inflammatory (increases inflammation).
Lp(a) levels are predominantly (>90%) determined genetically.
Prevalence of Elevated Lp (a):
Elevated Lp(a) is defined as a concentration >50 mg/dL (>125 nmol/L) and is present in 1 in 5 people (1.4 billion worldwide). The prevalence is higher in Africans (~1/3) and Southeast Asians (1/4).
Risks associated with elevated Lp (a)
In a study published in JAMA, authors asked the question, “Is long-term exposure to elevated lipoprotein(a) levels associated with a shorter life span?” They concluded that elevated Lp(a) causes a shorter parental life span, reduced health span, and increased all-cause mortality. In addition to increasing the risk of heart attacks, elevated Lp(a) has also been shown to increase the risk of stroke and aortic stenosis.
Patients with elevated Lp(a) usually present with heart attacks early in life. In a study of cardiac rehabilitation patients in Germany, researchers found that 36.48% of patients with myocardial infarction at <60 years of age had elevated Lp(a) levels.
In my experience, patients who have elevated Lp(a) >100 present with heart attacks or strokes in their 60s, and those who have Lp(a) >300 present with heart attacks in their 30s and 40s, although their lifestyle and other risk factors like smoking, exercise, and weight also impact the outcomes.
Does Elevated LDL Combined with Elevated Lp(a) Increase the Risk of Heart Disease Even More?
Although Lp(a) is a much stronger risk factor for heart disease, combined with elevated LDL, it significantly increases the risk of heart disease.
How Can You Check if You Have Elevated Lp(a)?
Lp(a) can be checked with a simple blood test, which costs about $20-$30 without using any insurance. This test is available at most labs and can be ordered by your primary care doctor, cardiologist, or other doctors involved in your care. Lp(a) levels do not change with age, so checking it once in a lifetime is enough.
What to Do About Elevated Lp(a)?
If you have elevated Lp(a), your doctor will evaluate your risk of heart disease based on other risk factors and age, and may prescribe medications or lifestyle changes to lower your particular risk. At this time, there is no therapy to lower Lp(a) itself, although there are many medications in the pipeline. These medications are expected to be available in the next few years.