Lipoprotein(a) — also known as Lp(a) or lipoprotein “little a” — is a particle in the blood that carries cholesterol, fat and proteins. It is a lesser-known type of low-density lipoprotein (LDL), or bad cholesterol, which can increase cardiovascular disease risk, independent of other risk factors. With growing interest in preventive cardiology, testing for this biomarker has gained popularity. If test results show elevated levels, you may be at higher risk for heart attack, stroke or aortic stenosis, which is the calcification and narrowing of the aortic valve.
Froedtert & the Medical College of Wisconsin cardiologists recommend getting your Lp(a) levels checked if you or a first-degree relative have a history of premature heart disease. It is also helpful for any patient interested in personalized cardiovascular risk assessment.
What Is the Lp(a) Blood Test?
The lipoprotein(a) blood test is a simple blood test that doesn’t require a fast from eating. It is usually only needed once in a lifetime, as levels typically remain stagnant throughout your adult life. This test can determine if you’re at risk for a serious heart problem, but many patients aren’t quite aware of it yet.
“Lp(a) is not part of the standard cholesterol panel that most patients complete, so this additional risk with high Lp(a) levels is missed,” said Jacquelyn Kulinski, MD, a cardiologist with the Froedtert & MCW health network. “Because LDL accounts for about 90% of bad cholesterol, it was thought to be a sufficient marker of cardiovascular disease risk. But now, with more research, cardiologists have found that elevated Lp(a) levels confer additional, residual risk.”
One of the main obstacles to more widespread clinical use of Lp(a) is that its measurement and target levels are not standardized. For example, while it’s known that an LDL level below 70 milligrams per deciliter is optimal, we do not know the optimal level for Lp(a). There are also several different measurement assessments available for use, and these are not standardized across medical institutions.
"Current cutoffs for abnormal Lp(a) levels are taken from population percentiles,” Dr. Kulinski said. “A Lp(a) level at or above the 80th percentile is considered elevated. Population cutoffs seem to vary by race and ethnicity. For example, African Americans may have up to three times the level of Lp(a) than Caucasians. So do we use different cutoffs to define abnormal? The research going on now will help us answer these questions.”
Should I Get My Lp(a) Levels Checked?
Knowing your Lp(a) levels can be beneficial in preventing the development of cardiovascular disease (primary prevention) and preventing existing cardiovascular disease from worsening (secondary prevention). You may want to check your Lp(a) levels if:
- You’re worried about your own risk of having a heart attack or needing a stent
- You experienced a cardiac event at a relatively young age (in your 40s) or have had recurrent events despite being on optimal medical therapy
- You have a first-degree male relative who experienced a heart attack, stroke or cardiac death before the age of 55
- You have a first-degree female relative who experienced a heart attack, stroke or cardiac death before the age of 65
“About 80% to 90% of Lp(a) levels come from mom and dad,” Dr. Kulinski said. “Testing in patients helps tailor the appropriate intensity of preventive measures, which always include a healthy lifestyle and sometimes, medications. When elevated, cascade screening of family members may also be recommended.”
Lp(a) levels can also be an important factor for those who may be borderline to intermediate risk, based on a cardiovascular disease risk calculator. Elevated Lp(a) levels may be the deciding factor for patients to start medication therapy.
“Sometimes patients will be uncertain about starting a potentially lifelong medication based on what calculations say,” Dr. Kulinski said. “This Lp(a) biomarker provides more information about one’s risk and can help guide the patient-clinician discussion about preventive medications.”
How Do You Reduce High Lipoprotein(a) Levels?
If your Lp(a) levels are high, cardiologists will strongly emphasize the importance of leading a healthy lifestyle to reduce the risk of cardiovascular disease. A 2018 study showed that a plant-based diet may lower Lp(a) levels by almost 30%, but outside of this small study, the direct impact of other lifestyle behaviors on changes in Lp(a) levels is unknown. Statins, which are drugs to lower cholesterol levels, typically do not lower Lp(a). However, what is very clear is that a healthy lifestyle and statins lower overall cardiovascular disease risk.
“Lp(a) is a really hot area of research right now,” Dr. Kulinski said. “There are promising clinical trials that show up to 98% of participants are able to achieve normal Lp(a) levels after taking targeted medications, some of which are only one dose per month. Safety and tolerability of this new therapy has been demonstrated, and the next phase of this research will look at cardiovascular outcomes. I have several patients in mind, especially those with recurrent cardiovascular events, for when these therapies hit the market!”
Is Lp(a) Testing Covered by Insurance?
Most insurance companies do cover Lp(a) testing, even though it is not yet part of routine care or screening. Consider checking with your insurance company in advance of the test. If your insurance does not cover the test, the cost will be about $100 through the Froedtert & MCW health network.
“You can think about this Lp(a) test as a type of precision medicine,” Dr. Kulinski said. “It can help you fine-tune your individualized cardiovascular disease risk, which is helpful because medications aren’t one-size-fits-all. This risk refinement can really help in deciding whether or not you should start medication or change your lifestyle to prevent a cardiovascular event.”
To learn more about Lp(a) testing, call 414-805-3666 or request an appointment with a cardiologist.