Lp(a)

What is Lp(a)?

Lipoprotein (a) is a vehicle for transporting cholesterol in the bloodstream similar to the more widely known LDL-P. Also known as Lp(a) (pronounced "L-P-little-A"), high levels can cause atherosclerosis (plaque-filled arteries) and lead to life-threatening events associated with heart disease such as heart attack and stroke. High Lp(a) levels are thus associated with increased cardiovascular risk. According to the American Heart Association, about one in five people worldwide have high Lp(a) levels, including 63 million people in the US alone.

Why is Lp(a) included in Heart Health?

Unlike other lipoproteins that are known to be influenced by both genetics and lifestyle, Lp(a) is considered genetically determined and not affected by lifestyle changes. Some factors may influence Lp(a) levels in some individuals. For example, diabetes, chronic kidney disease, and post-menopause may alter Lp(a) levels. A family history of early heart attacks or strokes could also indicate that your Lp(a) might be elevated. Additionally, individuals of African and South Asian descent are at a higher risk of abnormal Lp(a).

According to the CDC, high Lp(a) can cause:

cholesterol deposits, called plaque, to build up in blood vessel walls.
increased clotting which can lead to rapidly formed blockages in blood vessels.
increased inflammation which can cause plaques to rupture.

How can I better understand my results?

Lp(a) is often measured in either nanomoles per liter (nmol/L) which is based on the number of particles or milligrams per deciliter (mg/dL) which is based on the mass concentration. Although the latter is often used to measure Lp(a), research suggests that the methodology used to measure the mass concentration may be inaccurate and that the former unit (nmol/L) is most appropriate. According to the American College of Cardiology, there is no reliable conversion factor between the two measurements.

In terms of interpreting results, the American College of Cardiology covers the lack of a generalized consensus across America, Canada, and Europe, with more conservative ranges in Europe as compared to America. To err on the side of caution, since high Lp(a) has been associated with atherosclerosis and cardiovascular disease, the following ranges from the National Library of Medicine are a bit more conservative:

Optimal: < 14 mg/dL
Borderline risk: 14-30 mg/dL (30 mg/dL ≈ 75 nmol/L)

European Atherosclerotic Society considers < 30 mg/dL (< 75 nmol/L) to be normal

High risk: 31-50 mg/dL (50 mg/dL ≈ 125 nmol/L)

European Atherosclerotic Society considers this range to be intermediate risk

Highest risk: > 50 mg/dL (50 mg/dL ≈ 125 nmol/L)

European Atherosclerotic Society considers this range to be abnormal

Lp(a) is considered to be solely impacted by genetics, and research trying to elucidate the effects of lifestyle changes remains inconclusive. However, lifestyle may be important in order to reduce other risk factors associated with atherosclerosis. Best practices for people who are concerned about their heart health, predisposed to heart disease, or who have high Lp(a) are to:

1. Eat a heart-healthy diet.

A few tips from Mayo Clinic include:

Control your portion size— eat more low-calorie, nutrient-dense foods (fruits and veggies) and eat less high-calorie, high-sodium, highly processed foods
Choose low-fat protein sources— opt for fish, poultry, lean ground meats, and legumes/soy
Limit unhealthy saturated and trans fats— choose monounsaturated fats (olive oil, canola oil) or polyunsaturated fats (fish, avocados, nuts, seeds) over animal fats, hydrogenated fats, and tropical oils (coconut, palm kernel, palm, cottonseed)

2. Be physically active.

According to Johns Hopkins Medicine, the following exercises can boost heart health:

Aerobic— ≥ 30 mins/day, 5 days/week
Resistance/Strength— ≥ 2 nonconsecutive days/week
Stretching/Flexibility/Balance— daily and before/after other exercises

3. Maintain a healthy weight.

Using the lifestyle tips here is a good start to maintain a healthy weight, along with staying motivated, finding a support system, and holding yourself accountable for your actions and decisions.

4. Stop tobacco use.

According to the NIH's National Heart, Lung, and Blood Institute, smoking is a major risk factor for heart disease. Even occasional smoking can damage your heart and blood vessels by increasing the likelihood of developing atherosclerosis.

5. Get enough sleep.

The American Heart Association includes quality sleep as one of eight essential lifestyle behaviors that drive optimal cardiovascular health. In a 2018 study of over 60,500 adults aged 40+, short sleep duration and poor sleep quality were both associated with coronary heart disease risk.