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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) important?

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 Lp(a) levels?

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:

Ranges specific to the Cardiometabolic Program:

  • Optimal: <50 nmol/L
  • Good: 50-74 nmol/L
  • Fair: 75-124 nmol/L
  • Pay attention: ≥125 nmol/L

How can I maintain optimal Lp(a) levels?

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 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:

Dietary Changes: Eating a heart-healthy diet can help to reduce atherosclerosis risk. The Mayo Clinic suggests controlling your portion size by eating more low-calorie, nutrient-dense foods (fruits and veggies) and eating less high-calorie, high-sodium, highly processed foods. Additionally, choosing low-fat protein sources (fish, poultry, lean ground meats, and legumes/soy) and limiting unhealthy saturated and trans fats by choosing 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) can help.

Lifestyle Changes: According to Johns Hopkins Medicine, aerobic (≥ 30 mins/day, 5 days/week), resistance/strength (≥ 2 nonconsecutive days/week), and stretching/flexibility/balance exercises (daily and before/after other exercises) can improve heart health. Additionally, maintaining a healthy weight, getting enough sleep, and stopping tobacco use can improve heart health as well.

Where can I learn more?

DISCLAIMER: IF YOU ARE CONCERNED WITH ANY OF YOUR RESULTS, PLEASE CONSULT WITH YOUR PHYSICIAN.