Lipoprotein (a) , abbreviated as Lp(a) , is a particle that circulates in the blood and transports cholesterol. In recent years, it has been recognized as an independent cardiovascular risk factor , meaning that it can increase the risk of heart and artery disease even when other levels, such as LDL cholesterol, are controlled.
Lipoprotein(a) is similar to LDL cholesterol — known as "bad cholesterol" — but has an additional protein called apolipoprotein(a) , which gives it special properties related to cardiovascular risk.
Why might Lipoprotein (a) increase cardiovascular risk?
Lp (a) has several characteristics that may favor the development of cardiovascular diseases:
It promotes arterial inflammation.
It transports oxidative substances that can irritate and damage the walls of the arteries.
It may interfere with the removal of blood clots.
Its structure is similar to a protein that helps dissolve clots, but it cannot actually do so , which can promote the formation of thrombi.
It promotes the formation of cholesterol plaques
It contributes to the process of atherosclerosis , in which cholesterol plaques accumulate in the arteries.
It depends little on lifestyle
Unlike LDL cholesterol, diet or exercise barely modify its levels , as it is primarily determined by genetics.
Why is it important to measure Lipoprotein (a)?
In approximately 90% of cases , Lipoprotein (a) levels are determined by genes inherited from parents.
For this reason, international guidelines recommend measuring Lp(a) at least once in a lifetime , especially in people with a family history of cardiovascular disease.
In addition, elevated levels of Lipoprotein (a) have been associated with an increased risk of calcified aortic stenosis , a disease in which the heart's aortic valve hardens over time.
Lipoprotein (a) values
Lp(a) levels are generally interpreted as follows:
- 30–50 mg/dL: Cardiovascular risk begins to increase
- More than 90 mg/dL: increased risk of aortic valve disease
- Very high values: They may be associated with an elevated cardiovascular risk even if LDL cholesterol is normal.
Having an elevated Lipoprotein (a) does not necessarily mean that you will develop a disease, but it does indicate the need to carefully monitor and control other cardiovascular risk factors.
How can I reduce my risk if I have high lipoprotein(a) levels?
Currently, there are few specific treatments approved solely to reduce Lp(a) . However, there are very effective strategies to reduce overall cardiovascular risk:
- Strict control of LDL cholesterol
- Keep a adequate blood pressure
- No Smoking
- Follow one healthy nutrition
- Perform regular physical activity
- Comply with the medical recommendations
Which family members should be tested for Lipoprotein (a)?
It is recommended to perform the test at:
First-degree relatives : parents, siblings, and children (generally, a single measurement is sufficient)
History of early cardiovascular disease
- Men under 55 years old
- Women under 65 years of age with a family history of heart attack or stroke
Discovery familial hypercholesterolemia
Both conditions can coexist and increase cardiovascular risk.
Cases of early severe aortic stenosis , especially before the age of 65.
Knowing your lipoprotein(a) level helps to more accurately assess your cardiovascular risk . An elevated value is not a death sentence , but it is a sign to reinforce preventative measures, control other risk factors, and maintain appropriate medical follow-up to protect your heart health.
By Dr. Martin Young, cardiologist at Quirónsalud Valle del Henares Hospital.