Many Americans at Risk for Heart Disease from Lp(a)

About one in five Americans may have a significant risk factor for heart disease, often without realizing it.

Lipoprotein(a), or Lp(a), is a variant of LDL cholesterol, which primarily transports cholesterol to various body tissues. It can infiltrate arterial walls, contributing to health issues. LDL is frequently called ‘bad’ cholesterol.

Lp(a) is particularly concerning because it includes an additional protein, Apo(a), which makes it stickier. This stickiness leads to the accumulation of Lp(a) particles in blood vessel walls, promoting the formation of plaques that can clog arteries.

This plaque buildup can lead to inflammation, causing thickening and narrowing of the aortic heart valve— a real problem.

Clogged arteries can create blockages in coronary vessels, depriving the heart muscle of oxygen and potentially resulting in a heart attack. Such blockages can also occur in cerebral or carotid arteries, raising the risk of ischemic strokes that can cause brain damage.

Unlike the cholesterol types we often hear about—LDL and HDL, both of which can be improved through lifestyle and medications—Lp(a) is largely influenced by genetics.

If someone has high Lp(a) levels, managing controllable risk factors becomes crucial. This is where diet, exercise, and medication can play a pivotal role.

Some cardiologists emphasize that Lp(a) levels may be key indicators of genetic risk for cardiovascular disease, an issue affecting over 120 million Americans and a leading cause of death in the country.

An estimated 63 million Americans have elevated Lp(a) levels, defined as 50 mg/dL or higher. However, screening for it is not typically included in standard blood tests, primarily because, until recently, there were no treatments available, and insurance companies have been hesitant to cover it without one.

Doctors still advocate for testing—which is a one-time requirement—for individuals with a family history of early heart issues, unexplained heart attacks or strokes under 65, or those who haven’t seen results from standard LDL-lowering medications.

Early testing can significantly reduce the chances of heart disease or other cardiovascular complications. Although genetic factors are predominant, awareness from testing may encourage healthier lifestyle choices that could lessen overall health risks.

While maintaining a healthy lifestyle is essential for heart health, it’s important to note that it won’t lower someone’s Lp(a) levels due to its genetic basis.

However, for those with elevated Lp(a), lifestyle measures become even more critical. The goal is to manage other controllable risk factors like high LDL cholesterol, blood pressure, and diabetes to help mitigate overall cardiovascular risks.

Recent findings show that only 0.3 percent of individuals were screened for Lp(a) between 2012 and 2019, and a small group of doctors accounted for most of these tests.

Now that tests are more widely covered by insurers, they are more accessible. Yet, patients usually need to request the screening or have a doctor order it based on family history and other risk factors.

Dr. Supreeta Behuria, a cardiologist, noted that understanding one’s cardiovascular risk can inspire lifestyle changes. Increased awareness fosters motivation to adhere to heart-healthy practices.

Lp(a) levels below 30 mg/dL are typically considered healthy; above 50 mg/dL poses higher risks for heart conditions.

A recent study in a medical journal found that routine Lp(a) testing could identify about 20 percent of individuals as high-risk for cardiovascular disease, despite normal other cholesterol levels. This could lead to earlier interventions again.

In fact, research projected that screening people aged 40 to 69 could translate into significant health benefits, including longer lifespans and healthier years for the population by preventing heart attacks and strokes.

A different major study corroborated that high Lp(a) is a notable genetic risk factor for cardiovascular issues. Researchers followed over 61,000 first-degree relatives of those with known Lp(a) levels for nearly two decades.

The study showed a clear risk gradient: by age 65, eight percent of those from families with high Lp(a) had faced major cardiac events, compared to six percent from families with lower levels. Close family links to elevated Lp(a) correlated with a 30 percent increased risk for such incidents.

Dr. Sonia Tolani emphasized the importance of discussing cholesterol levels with doctors, as lifestyle changes and medications can help lower typical cholesterol and mitigate heart disease risk.

It’s advised that every individual gets tested for Lp(a) at least once during their lifetime. Since Lp(a) is inherited, family members should be aware of their relative’s results and consider screening too.

With no current medications specifically targeting high Lp(a), it becomes even more vital to manage overall heart health, meaning addressing any related conditions—high blood pressure, diabetes, or elevated LDL cholesterol—is essential.

Dr. Gregory Schwartz suggested that while lifestyle changes won’t directly lower Lp(a) levels, they are still necessary for reducing overall cardiovascular risk.

He also mentioned that future treatments may offer effective ways to lower Lp(a) levels significantly, as new drugs are being developed to reduce Lp(a) production in the liver.