Quick answer: Lipoprotein(a), or Lp(a), is a genetically inherited marker of cardiovascular risk that isn’t part of a standard cholesterol test. Raised levels substantially increase heart attack and stroke risk — especially in people with no other diagnosed heart disease — and because it’s inherited rather than lifestyle-driven, it’s a test you typically only need once.
Originally written in July 2024.
You will notice that I have a number of videos on cholesterol on my website, which is one of the commonest topics I get asked about. These days though, we have moved well beyond standard cholesterol panels. I discuss such things as Apolipoproteins and Lipoprotein (a) -Lp(a) for short- in those videos, but in brief as a reminder, Lp (a) is a marker of increased risk of cardiovascular disease. Importantly however, it is genetically inherited.
If I see a young person with a heart attack who has normal cholesterol and no other risk factors, Lp (a) is always something I think about. I was therefore interested to read a research paper in the highly respected Journal of the American College of Cardiology this week on just this topic. We already know that having a having a raised Lp (a) increases the risk of a heart attack or stroke, but now it appears that the magnitude of that increased risk varies whether a person does or does not already have cardiac disease. You may recall from previous blogs that doctors call this primary or secondary prevention.
How much does raised Lp(a) increase heart disease risk?
To put some numbers on it, if a patient already has cardiovascular disease of some sort, and also has a blood test showing their Lp (a) is in the highest third, their risk of further heart attacks, a stent or bypass operation, a stroke, or even dying, increases by about 25%.
By contrast, in a patient without a history of any heart issues, as the levels of Lp (a) rise, so does the risk of the outcomes above rise, but by a whopping 93% in those whose levels are the in the top tenth of the population! It’s important to state these study were from a retrospective cohort analysis, of 16,000 patients with Lp (a) measured in the US.
Should everyone get their Lp(a) checked?
To put it another way, if a person does not have any heart issue, this blood test can really add additional important information to their risk assessment. European guidelines do recommend that everyone gets it checked, and hopefully in time that will be the case, but at the current time I’m not aware if any country in the world that does so. It’s not necessarily a test that needs repeating (due to the nature of it being inherited). If you would like your Lp (a) checked, hit reply and Sarah can get you booked in.
Lp (a) testing currently costs under £100 on its own; the full advanced lipid profile (which also includes Apolipoprotein levels and measures of inflammation) costs a bit more. As prices can change, the exact cost will always be confirmed with you before booking.
What can be done if Lp(a) is high?
All very interesting you might say, but what can we actually do about it? Although drugs are in development to treat Lp (a), we don’t actually have a treatment yet. However, what we do have, is the ability to make individualised assessments of risk. We also know that patients who have higher Lp (a) levels do better if they have lower LDL and lower blood pressure. There is also a debate to be had about the use of low dose aspirin, which in my view very much depends on a careful risk assessment of a person’s heart attack and stroke risk on one hand, and bleeding risk on the other.
Patients are becoming better and better informed about their health, options for diagnosis, and management. Only this week I consulted for a man younger than me who brought his own Lp (a) blood results to me to interpret for him. I love this proactive approach! I am turning 46 on Thursday, and being nearer 50 than 40 certainly gives me pause to consider my own risk. I know my Lp (a), and thankfully it is low, but it doesn’t stop me addressing other areas of my own risk.