According to the American Heart Association, cholesterol is a waxy, fat-like substance that your body needs in the right amounts to maintain good health. The key words here are “right amounts”.
Cholesterol travels through your bloodstream on carriers called lipoproteins. You may remember from grade school science class that fat and water do not mix. So, fats in the blood, which is water, must be bound to proteins to stay in solution and be carried smoothly through the body to the target tissue where they will be used. High-density lipoprotein (HDL) cholesterol, known as “good” cholesterol, carries excess cholesterol in the blood to the liver for removal. Low-density lipoprotein (LDL) cholesterol, also called “bad” cholesterol, can build up in the arteries and raise your risk of heart conditions like stroke, blood clots and cardiovascular disease. Most people have their cholesterol checked with what is commonly known as a lipid profile or lipid panel. This checks the level of Total Cholesterol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Triglycerides but does not break them down to the smaller parts that make up these total levels.
We have been focused on LDL for too long and have not looked at the smaller components that make up LDL. Recently, studies have shown that a specific part of the total LDL, known as Lipoprotein(a) or Lp(a) has been shown to be the main culprit in the development of cardiovascular disease. This type of “bad” cholesterol might increase your heart disease risk without your knowledge.
Read on to learn more about Lp(a) and why testing your Lp(a) levels can help you protect your heart health.
What is Lp(a)?
Lp(a) is a specific type of LDL (i.e., “bad”) cholesterol. It’s a similar structure to an LDL particle and contains a protein called apolipoprotein (a). This combination makes Lp(a) stickier than regular LDL, causing it to build up easily in the walls of blood vessels.
Routine Lipid Panels typically don’t check for Lp(a) levels. Even if your LDL, HDL and total cholesterol results are in the healthy range, you can still have elevated Lp(a) levels that can contribute to plaque buildup in artery walls, increasing your risk of blood clots, heart attack, stroke and other cardiovascular conditions. This is because part of the total LDL level is made up of Lipoprotein(a) and if you do not check then you have no idea how much Lipoprotein(a) is in the LDL level.
Genetics
Lipoprotein(a) levels are largely determined by genetics, not lifestyle factors. In fact, research shows that Lp(a) levels are 70% to 90% genetically determined.
If you have high Lipoprotein(a) levels, there’s a possibility that other members of your family do too. If you have an elevated Lipoprotein(a) level, you can encourage your family members to get screened as well.
Testing
Testing for Lipoprotein(a) is the only way to know if your levels are elevated, because high Lipoprotein(a) often has no symptoms.
An Lp(a) screening test may be recommended if you have:
- A personal history of heart disease or stroke before the age of 55 (men) or 65 (women)
- Women in your family who have had a heart attack or stroke before the age of 65
- Men in your family who have had a heart attack or stroke before the age of 55
- High LDL cholesterol
- Heart or blood vessel disease
- Hardening of the arteries (i.e., atherosclerosis)
- A family history of high cholesterol (i.e., hypercholesterolemia)
- A personal history of multiple heart attacks and/or procedures to open up blocked arteries.
- Known family history of high Lp(a)
There are ways to reduce your overall risk of heart disease including lifestyle changes (such as well-balanced nutrition, physical activity, healthy weight, stop tobacco use, limit alcohol intake, get adequate sleep), medications, and OTC supplements.
Don’t let this stealthy cholesterol jeopardize your heart health. Empower yourself by work with your healthcare provider to create a plan to check your Lipoprotein(a) levels and optimize your heart health.
References
Reyes-Soffer G, Ginsberg HN, Berglund L, Duell PB, Heffron SP, Kamstrup PR, Lloyd-Jones DM, Marcovina SM, Yeang C, Koschinsky ML; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2022 Jan;42(1):e48-e60