You give blood to check your cholesterol and get the report. LDL, HDL, triglycerides... It's a great relief to see that everything is normal, right? "Oh... I don't have cholesterol, I won't have heart problems," you might think. But, did you know about a hidden enemy that doesn't show up in this normal cholesterol report, but has a big impact on heart disease? Today we're going to talk about that.
What is Lipoprotein(a) or Lp(a)?
Simply put, Lipoprotein(a) , or Lp(a) for short, is a fat-containing particle in our blood, just like cholesterol. But this one is a little special. This Lp(a) particle can stick to the walls of our blood vessels (arteries) more severely than the LDL cholesterol we all know as "bad cholesterol", and gradually clog them. Imagine a traffic jam on a road, when this Lp(a) increases, blood flow inside our blood vessels is obstructed. In medicine, we call this atherosclerotic cardiovascular disease (ASCVD) . This condition is what leads to serious diseases like heart attack and stroke over time.
The biggest problem with this is that the level of Lp(a) increases more than what we eat or exercise, but rather because of our genes . That is, it is something we inherit from our parents. No matter how healthy you live, your Lp(a) level can be genetically high. That is why, even if your normal cholesterol report is good, it is essential to be aware of this hidden risk.
It is estimated that one in five people in the world have dangerously high levels of Lp(a), but many people are unaware of it.
Why is this test so important? Who is at higher risk?
Until recently, the Lp(a) test was mostly discussed among cardiologists. But that's changing. The world's leading medical associations now recommend that every adult should have the Lp(a) test at least once in their lifetime .
Imagine, there are some patients who have had two or three heart attacks, stents, bypass surgery, but no reason can be found for why this is happening. In such cases, when the Lp(a) level is checked, it is found to be very high. That means, this could be the main reason that has been hidden for so long.
Let's look at the table below to see the difference between a regular cholesterol test and an Lp(a) test.
| Feature | General Cholesterol Test (Lipid Profile) | Lp(a) test |
|---|---|---|
| What is being tested? | Measures things like LDL, HDL, Total Cholesterol, and Triglycerides. | Only a specific particle called Lipoprotein(a) is measured. |
| Influencing factors | Diet, exercise, and body weight can make a big difference. | It is mainly determined by genes. Lifestyle has very little influence. |
| How often to check | On medical advice, periodic check-ups (e.g. once a year) are required. | A once-in-a-lifetime checkup is often sufficient. |
Who is at greater risk?
Although anyone can have elevated Lp(a) levels, some groups may be at slightly higher risk:
- People with a family history of heart disease: If a close relative, such as your mother, father, or siblings, has had a heart attack or stroke at a young age (under 55 for men, under 65 for women), you are more likely to have high Lp(a) levels.
- Some ethnic groups: Studies have shown that people of African descent may have higher Lp(a) levels than other ethnic groups.
- Postmenopausal women: Lp(a) levels may increase slightly in women after menopause.
- Patients with diabetes: The combination of diabetes and high Lp(a) levels significantly increases the risk of heart disease.
What do we do if the Lp(a) level is high?
Okay, now you're probably wondering, "What if my Lp(a) level is high? Is there a cure for this?" This is a very important question.
Currently, drugs that directly target and lower Lp(a) levels are still in the final stages of research. There is great hope for drugs like Pelacarsen , whose results are expected to be available by 2025.
But, you can't just wait for it to happen. The only big thing is knowing that your Lp(a) level is high. That way, you and your doctor can take other steps to reduce your overall heart disease risk.
Knowing your Lp(a) level is like knowing in advance about a dangerous bend in the road. Even if you can't avoid the bend, you can slow down and drive through it with caution.
If your Lp(a) level is high, your doctor will likely recommend the following:
1. Strictly control LDL cholesterol: If your Lp(a) is high, it is extremely important to keep LDL ("bad cholesterol") levels as low as possible. This may be done by prescribing medications such as statins .
2. Controlling other risk factors: All other risk factors such as high blood pressure, diabetes, smoking, and obesity should be well controlled.
3. Informing family: Since Lp(a) levels are genetic, if your Lp(a) levels are high, it is very important to inform your children, siblings, and parents to also get this test done.
A special note about statin drugs
There is a misconception among some that statin cholesterol medications can slightly increase Lp(a) levels. This may be true. However, the benefits of statins in lowering LDL cholesterol and reducing overall heart disease risk far outweigh the potential side effects of a slight increase in Lp(a) levels. Therefore, never stop taking your statin without medical advice.
Talk to your doctor about getting your Lp(a) tested. Although this is not a routine test, they will likely refer you for this test after discussing your family history and risk factors. This is a valuable step you can take for your future health.
Take-Home Message
- Lp(a) is a hidden risk: Even if your average cholesterol level is good, a high Lp(a) level may put you at risk for heart disease.
- Get tested once in your life: Since Lp(a) levels are largely determined by genetics, it is usually enough to get this test done once in your life. Talk to your doctor about this.
- Don't panic if your levels are high: Knowing your Lp(a) levels are high can help you take steps to reduce your overall heart disease risk.
- Control other risks: If Lp(a) is high, it is essential to strictly control all other risk factors, such as LDL cholesterol, blood pressure, diabetes, and smoking.
- Tell your family: Since this is a genetic condition, if your Lp(a) level is high, tell your immediate family members (parents, children, siblings) and encourage them to get tested too.
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