Lp(a)
The basics
What is Lp(a)?
Lp(a) is a lipid particle composed of an LDL particle with an apolipoprotein(a) tail. The Lp(a) plasma concentration is largely genetically determined and stable throughout life. Approximately 20% of all people have elevated Lp(a) levels >105 nmol/l (50 mg/dl).
Lp(a) essentially acts as a 'multiplier' for an individual's inherent risk. Therefore, if someone already has several risk factors (such as a previous heart attack, smoking, being overweight, or high LDL cholesterol), a significantly elevated Lp(a) further multiplies the risk from these other factors. This then results in a very high overall risk of cardiovascular disease for these individuals.
Sources
- Figure: https://familyheart.org/lipoprotein-a-5-things
Practical steps
What can you do if you have elevated Lp(a)?
An elevated Lp(a) essentially acts as a 'multiplication' factor for the baseline risk, as shown in the figure on the left. Elevated Lp(a) can increase the risk of cardiovascular diseases by up to three times.
A healthy lifestyle does not lower Lp(a), but it helps reduce other risks. While existing cholesterol-lowering drugs have little effect on Lp(a), they do lower LDL cholesterol. Therefore, treating with these cholesterol-lowering medicines has a good effect on reducing the overall risk of cardiovascular disease in patients with high Lp(a). New medicines that specifically lower Lp(a) are not yet available in the Netherlands, but they are expected to become available in the foreseeable future.
European and Canadian guidelines recommend measuring Lp(a) concentration at least once in every patient's life. Measuring Lp(a) is important for accurately assessing an individual's risk of cardiovascular disease.
Sources
- Figure: from Lp(a) consensus paper (EAS, 2022).
Want to learn more?
Information about Lp(a)
- See LP(a) explainer with Shirin Ibrahim. Here, she explains what LP(a) is in an accessible way.
- See Lp(a) consensus paper (EAS, 2022).
- Assess risk using Lpaclinicalguidance. This is a useful calculation tool for Lp(a) risk.
- See also information on Lipidtools
- Lp(a) International Task Force
