Do you know about this 'hidden cholesterol'? Let's learn about Lipoprotein (a)!

When you get your blood tested for cholesterol, you've probably seen names like LDL, HDL, and triglycerides in the report you get, right? We often talk about "good cholesterol" (HDL) and "bad cholesterol" (LDL). But there's one that's not on the list that everyone talks about, a little hidden, but can have a big impact on heart health. That's Lipoprotein (a) , or Lp(a) for short. It's like a family secret, and sometimes we can unknowingly cause big problems inside our bodies.

Simply put, what is Lipoprotein (a)?

Okay, let's put it this way. Lipoprotein (a) is a type of LDL (Low-Density Lipoprotein), also known as "bad cholesterol." What happens when LDL cholesterol increases in the body? It builds up on the walls of our blood vessels, forming plaques that are like speed bumps on the road. In medicine, we call this plaque . As these speed bumps build up, the blood becomes less able to flow smoothly. Eventually, these can clog the blood vessels completely and stop the flow of blood. This is a major cause of heart attacks and strokes.

Now, the special thing about Lp(a) is that it's a little more serious than LDL. There are two reasons for that:

1. Blood clots faster: Lp(a) particles help our blood clot faster than normal.

2. Stops blood clots from dissolving: It also prevents the dissolution of a blood clot that has formed.

Imagine, a layer of cholesterol (plaque) has formed inside a blood vessel. If that layer bursts due to Lp(a), there is a high chance that a blood clot will quickly form and completely block the blood vessel. That is why we need to be especially careful about Lp(a).

Is Lp(a) level something that comes from genes?

Yes. That's right. This is the most important and perhaps a little sad thing about this. Your Lp(a) level is determined by the genes you get from your mother and father. This means that no matter how much you exercise or how well you control your diet, you cannot significantly reduce your Lp(a) level. The Lp(a) level you have when you are young is likely to be yours for the rest of your life.

How do I know my Lp(a) level?

This can be determined with a simple blood test. But there's a little thing here. The cholesterol test you usually get, that is, the Lipid Profile , doesn't measure this Lp(a) level. You have to get that test separately, specifically requested. Your doctor can decide if you need it and refer you for it.

Why would a doctor recommend this test?

Not everyone needs this test, but if you have other factors that increase your risk of heart disease, your doctor may decide to look into this as well.

Lp(a) levels and their meaning

There are two ways to measure Lp(a) levels. One is to measure the mass of Lp(a) in the blood. The values ​​are given in milligrams per deciliter (mg/dL). The other is to measure the number of Lp(a) particles in the blood. The values ​​are given in nanomoles per liter (nmol/L). It is important to ask your doctor what units your report is in.

We generally classify mg/dL values ​​as follows:

• Normal level: Less than 30 mg/dL.
• Borderline risk: Between 30 mg/dL and 50 mg/dL.
• High risk: More than 50 mg/dL.

In nmol/L, a value above 100 nmol/L is considered high risk.

Your high Lp(a) level means that you are at higher risk of developing heart disease and blood vessel disease, even if your other cholesterol levels are fine.

Research has found that elevated Lp(a) levels are directly linked to these diseases:

• Heart disease
• Heart attack
• Stroke
• Aortic valve stenosis
• Peripheral artery disease (PAD)

Are there symptoms of high Lp(a) levels?

No. That's the scary part. Many people with high Lp(a) levels don't show any symptoms. They don't know they're at risk until something serious like a heart attack happens. That's why, if you have a family history of heart disease, it's so important to talk to your doctor about it early and get tested if necessary.

Okay, now how do we reduce this Lp(a)?

This is a question that everyone has. To be honest, there is currently no specific drug that has been approved to target and lower Lp(a) levels. Researchers are developing and testing several new drugs for this purpose. So we hope that a good solution will be found in the near future.

Although we cannot directly lower Lp(a) levels, the best thing we can do is to control all other factors that increase the risk of heart disease. In other words, if Lp(a) is the only gun we have, it is like disabling all the others.

Things you can do:

• Stop using tobacco products completely. Smoking is the biggest cause of damage to blood vessels.
• Exercise regularly. Do something like walking or running for at least 30 minutes, 5 days a week.
• Maintain a healthy weight.
• Adopt a heart-healthy diet. Eat less oil, salt, and sugar, and more vegetables, fruits, herbs, and fiber-rich foods.
• Keep your blood pressure and diabetes under control. Use the medications your doctor prescribes for these exactly.
• Control LDL cholesterol levels. Although it is not possible to lower Lp(a), medications that lower LDL cholesterol, such as statins or PCSK9 inhibitors , can greatly reduce overall risk.
• Control stress.

Depending on your risk, your doctor may prescribe a medication such as aspirin to reduce blood clotting.

For those with very high Lp(a) levels, especially those with Familial Hypercholesterolemia, there is a treatment called Apheresis . This is like dialysis when the kidneys fail. You are connected to a machine and the Lp(a) particles are filtered out of the blood. However, this is a treatment that takes several hours, needs to be done once or twice a week, and is only done for very special patients.

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