What is lipoprotein(a)?
Lipoprotein(a), often abbreviated Lp(a), is a blood fat particle that is similar to LDL cholesterol but also contains the protein apolipoprotein(a). Elevated levels of Lp(a) are linked to an increased risk of atherosclerosis, heart attack, stroke and aortic valve stenosis, even in people who otherwise have normal blood lipids.
Lp(a) is now considered an important and genetically controlled risk marker for cardiovascular disease. Unlike many other blood lipids, Lp(a) is generally very little affected by diet, exercise, weight loss or other lifestyle changes. The level is largely genetically determined and is often relatively stable throughout life.
Why is Lp(a) important to measure?
An elevated Lp(a) value can contribute to increased cardiovascular risk, especially in combination with other risk factors such as high LDL cholesterol, high blood pressure, diabetes, smoking or a family history of early cardiovascular disease. Since Lp(a) is not included in standard blood lipid tests, a person may have elevated Lp(a) without it showing up in a standard cholesterol test.
Many cardiologists and heart doctors therefore believe that Lp(a) is a marker that should be checked at least once in a lifetime. European recommendations also state that Lp(a) should be measured at least once in adults to identify people with a hereditary increased risk of cardiovascular disease.
What can a high Lp(a) value mean?
A high Lp(a) does not mean that you will definitely suffer from cardiovascular disease, but it can be an important risk factor to be aware of. The risk always needs to be assessed together with other factors, such as age, blood pressure, LDL cholesterol, ApoB, diabetes, smoking, heredity and previous cardiovascular disease.
If Lp(a) is elevated, it may be particularly important to optimize other modifiable risk factors. For example, this may involve treating high LDL cholesterol more actively, controlling blood pressure, monitoring blood sugar, avoiding smoking and assessing overall cardiovascular risk.
Who can benefit from checking Lp(a)?
Since Lp(a) is largely genetically determined, the test may be particularly relevant if there is a hereditary predisposition to cardiovascular disease, especially if a heart attack, stroke or vascular disease has occurred at a young age in the family. The analysis may also be valuable in cases of elevated LDL cholesterol, difficult-to-explain cardiovascular disease or when you want to make a more complete risk assessment of cardiovascular health.
- In cases of hereditary predisposition to early heart attack, stroke or vascular disease.
- In cases of high LDL cholesterol or suspected familial risk of blood lipid disorders.
- In cases of cardiovascular disease despite apparently normal blood lipids.
- In known atherosclerotic cardiovascular disease where the risk profile needs to be further investigated.
- In aortic valve stenosis or hereditary valvular disease.
- As part of a more advanced assessment of future cardiovascular risk.
When should Lp(a) be checked?
Since Lp(a) is largely hereditary, the analysis can be valuable to do at least once in a lifetime. The test can be particularly relevant in cases of heredity for early heart attack, stroke or vascular disease, in cases of elevated LDL cholesterol, in cases of suspicion of familial lipid disorders or if cardiovascular disease has occurred despite apparently normal cholesterol levels. Lp(a) may also be relevant as part of a more in-depth risk assessment of cardiovascular health, especially if there are several risk factors at the same time, such as high blood pressure, diabetes, smoking, obesity or a history of cardiovascular disease.
Is Lp(a) affected by lifestyle?
Lp(a) is usually not significantly affected by diet, exercise or weight loss. This does not mean that lifestyle is unimportant, but that the Lp(a) level itself is often difficult to change with standard lifestyle measures. However, a healthy lifestyle and treatment of other risk factors can reduce the overall risk of cardiovascular disease.
Since Lp(a) is relatively stable over time, the test often does not need to be checked repeatedly if the value is normal. In the case of elevated levels, however, the result may be important for the continued risk assessment and for how actively other risk factors should be treated.
How is Lp(a) interpreted?
Lp(a) can be reported in different units, usually nmol/L or mg/dL. Since conversion between units is not exact, the result should be interpreted based on the laboratory's specified reference intervals and decision limits. A high Lp(a) value should always be put in relation to other blood lipids and the overall cardiovascular risk profile.
In the case of elevated Lp(a), it may be relevant to supplement with other markers, such as LDL cholesterol, ApoB, ApoA1, ApoB/ApoA1 ratio, triglycerides, HbA1c, blood pressure and other risk factors. In this way, a more complete picture of cardiovascular health can be obtained.
What can be done about high Lp(a)?
Since Lp(a) is usually difficult to lower with common lifestyle changes, the focus is often on reducing the overall cardiovascular risk. This may mean that other risk factors are treated more actively, for example LDL cholesterol, ApoB, blood pressure, blood sugar, smoking and lifestyle-related factors.
In the case of high Lp(a), it may therefore be particularly important to have good control of other blood lipids and to assess the overall risk profile. In some cases, further medical assessment may be justified, especially in the case of significantly elevated levels, heredity for early cardiovascular disease or previous heart attack, stroke or vascular disease.
Analysis of lipoprotein(a)
Analysis of lipoprotein(a) is done through a regular blood test. The result can provide important information about hereditary cardiovascular risk and can be particularly valuable because Lp(a) is not always reflected in standard cholesterol values.
Lp(a) can be analyzed as part of a broader assessment of blood lipids and cardiovascular health. The result should always be interpreted together with other risk factors, such as LDL cholesterol, ApoB, blood pressure, heredity, diabetes, smoking and previous cardiovascular disease.
In the event of deviating values, further medical assessment or follow-up may be appropriate, especially if other risk factors or heredity for cardiovascular disease are present at the same time.
