Uncovering Lp(a)- The “Bad” Cholesterol You Probably Didn’t Know About
Managing our cholesterol is a familiar topic for many of us, with LDL (or “bad cholesterol") often taking the focus in discussions about heart health. However, there's another type of cholesterol that you might not be aware of – lipoprotein(a), or Lp(a). This lesser-known cholesterol is gaining attention for its potential impact on cardiovascular health.
What is Lp(a)?
If LDL deserves to be called the "bad cholesterol," then Lp(a) could be termed the "sticky complicator." Lp(a) shares many of the trademarks that make LDL bad (building up in your arteries, making them harden and narrow), but Lp(a) is even worse because it’s stickier.
The Risks of Elevated Lp(a) Levels
Having high levels of Lp(a) can lead to a range of cardiovascular issues. Elevated Lp(a) levels contribute to the narrowing of arteries, promote inflammation, and increase the likelihood of blood clots. These factors significantly increase the risk of heart attacks and nearly double the risk of having a stroke.
How Common is High Lp(a)?
Despite the fact that most people have never heard of it, high Lp(a) levels are more common than one might think. Research suggests that approximately 1 in 5 people may have elevated levels of Lp(a). Moreover, genetics play a crucial role in Lp(a), which means it often runs in families. Certain ethnic groups like Blacks and South Asians seem to be more predisposed to having higher levels of Lp(a).
Why is Lp(a) Not Routinely Tested?
Despite the potential risks associated with high Lp(a) levels and the relative ease of checking Lp(a) with a blood test, Lp(a) is not typically a standard part of routine cholesterol testing. One reason for this gap is that most health insurers don’t cover the test. Another reason for the hesitation to learn about Lp(a) levels is that if elevated Lp(a) levels are detected, the available treatment options are limited. Another reason doctors don’t routinely test for Lp(a) is that some aren’t sure what to do about the results. Drugs like statins don’t work for lowering Lp(a). So what can you do if you have high Lp(a)?
Current Approach to Managing High Lp(a) Levels
In the absence of an approved treatment for Lp(a), doctors typically focus on managing a patient's LDL cholesterol and helping them make lifestyle modifications. This approach is not aimed at directly lowering Lp(a) levels but serves as a strategy to reduce overall cardiovascular risk.
The Future of Lp(a) Treatment
The good news is that doctors and scientists are actively engaged in ongoing research regarding Lp(a). A number of promising developments are on the horizon, with potential treatments aimed specifically at lowering Lp(a) levels. Some potential treatments are going through clinical trials now. The Future of Medicine program offers a free heart and kidney screening, which includes a test for Lp(a) levels, and helps participants learn about and access clinical trial opportunities.
If you have concerns about your heart health, discuss your risks, including your Lp(a) levels with your doctor.
Find a location and schedule your screening and help your friends and family get tested.
CONTRIBUTING EXPERTS
Tyler Miller, MD, PhD - Medical Advisor, Patient Access
Dr. Miller is a Clinical Pathologist and Research Fellow at Massachusetts General Hospital, Dana Farber Cancer Institute, and the Broad Institute of MIT and Harvard who works with Care Access to create access to clinical research for communities that are typically left out of the research process.
SOURCES
Miksenas H, Januzzi JL, Natarajan P. Lipoprotein(a) and Cardiovascular Diseases. JAMA. 2021;326(4):352–353. doi:10.1001/jama.2021.3632
Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)–a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. Jan 2006;52(1):5-50.