Healthcare Provider’s Guide to Lp(a)

When assessing heart attack and stroke risks, traditional factors like LDL, HDL, and triglycerides take center stage. However, research reveals another significant contributor—lipoprotein(a) or Lp(a), which can silently block arteries and induce inflammation. Elevated Lp(a) levels significantly increases the risk of cardiovascular disease, including a 50% increased risk for a heart attack.

Who Should Screen for Lp(a)?

It is believed that 20-25% of people have elevated Lp(a). African Americans and South Asians have higher levels of Lp(a), on average, than other groups. Screening your patients for elevated Lp(a) can provide insight about hidden cardiovascular risk, especially in patients who may otherwise appear to have normal lipid levels.

Patients with normal lipid panels yet significant cardiovascular disease or a previous  heart attack, mayLp(a) levels. Lp(a) levels are established at a young age (5 years old), and remain stable over time, meaning a single Lp(a) test can help inform a patient’s cardiovascular risk throughout their life.

Are Lp(a) Tests Covered by Insurance?

While many insurance companies do not pay for Lp(a) tests, your patients can receive no-cost Lp(a) testing through the Future of Medicine program from Care Access. Patients who have elevated Lp(a) may also have an opportunity to participate in clinical trials to evaluate investigational therapies for lowering Lp(a).

What Can You Do for Patients With Elevated Lp(a)?

Risks associated with Lp(a) are just one part of a patient’s overall cardiovascular risk profile. While there are no approved treatments for significantly lowering Lp(a), an elevated Lp(a) is actionable now:

Aggressively manage other risk factors

Console on healthy lifestyle (Consider referral to a dietitian; weight loss, if applicable; aerobic exercise 3-4 times per week; smoking cessation, if applicable)

Lower LDL associated risks

  • Consider starting a statin: high Lp(a) would be another factor to start a statin if on the fence given other factors
  • If already on a max tolerated statin dose, and LDL still elevated, consider adding a PCSK9 inhibitor

Cascade testing for family members

Recommend to the patient that they tell their 1st degree relatives to be tested for Lp(a)

Clinical Trials and/or Referral

For patients with Lp(a) > 125 nmol/L, there may be clinical trials available to the patient. Care Access can provide that information to you and your patient.

You can also refer to a certified lipidologist if you don’t feel comfortable managing, or if your patient has extremely elevated levels (> 200 nmol/L). Care Access may be able to recommend a local lipidologist or you can find them through the National Lipid Association site.

CONTRIBUTING EXPERTS

Irving Loh, MD, FACC, FACP, FAHA, FCCP

Dr. Loh is a distinguished cardiologist based in Thousand Oaks, CA. He is dedicated to preventing cardiovascular disease and enhancing patient outcomes through his clinical practice and research initiatives. Dr. Loh has held appointments at UCLA School of Medicine, Cedar-Sinai Medical Center, and Stanford Medicine.