What is Lipoprotein A?

Lipoprotein (a), or Lp(a), is a type of low-density lipoprotein (LDL). You might know LDL as the "bad cholesterol." Lp(a) is similar but has some unique features.

How Lp(a) Contributes to Plaques in Arteries

Lp(a) can lead to the buildup of plaques in your arteries. Plaques are fatty deposits that can block blood flow. When Lp(a) levels are high, more plaques can form. This increases the risk of heart disease and stroke.

Lp(a) and Blood Clots

Lp(a) makes your blood clot more easily. Blood clots can block your arteries and cause serious problems like heart attacks or strokes. Lp(a) adds to this risk by making it harder for your body to break down blood clots.

Lp(a) and Inflammation

Lp(a) can cause inflammation in your body. Inflammation makes plaques in your arteries more likely to break open. When plaques break, they can cause more blood clots to form.

Genetics and Lp(a) Levels

Your Lp(a) levels are mainly determined by your genes. If your parents have high Lp(a) levels, you are likely to have high levels too. Unlike other cholesterol levels, Lp(a) doesn't change much with diet or exercise.

Why It's Important to Know Your Lipoprotein A Level?

Knowing your lipoprotein (a) or Lp(a) level is crucial for several reasons. This specific measurement can provide insights that standard cholesterol tests might miss.

Beyond Standard Cholesterol Tests

1. Additional Information: Standard cholesterol tests measure LDL, HDL, and triglycerides, but they do not include Lp(a). Even if your other cholesterol numbers are normal, elevated Lp(a) can still pose a significant risk. Knowing your Lp(a) level provides a more comprehensive picture of your cardiovascular health.
2. Unique Risks: Lp(a) has unique properties that make it particularly harmful, such as promoting blood clot formation and inflammation, which are not captured by standard cholesterol tests.

Early Detection and Management

1. Preventive Measures: Early detection of high Lp(a) levels allows you to take preventive measures. These can include lifestyle changes, medications, or more frequent monitoring to manage your cardiovascular risk.
2. Targeted Interventions: With early detection, you and your healthcare provider can discuss targeted interventions that specifically address the risks associated with high Lp(a).

Personalized Health Plans

1. Tailored Strategies: Discussing your Lp(a) levels with your healthcare provider can help tailor a personalized health plan. This plan can address not only your Lp(a) levels but also other risk factors such as high blood pressure or diabetes.
2. Holistic Approach: A personalized plan can include a combination of lifestyle changes, medications, and regular monitoring, ensuring a holistic approach to managing your cardiovascular health.

Why Should You Test for Lipoprotein A?

Testing for lipoprotein (a) is crucial because high levels can significantly increase your risk of heart and blood vessel diseases. Unlike standard cholesterol tests, a specific blood test is needed to measure Lp(a). In Canada, this test is not included in a typical lipid panel, which makes it essential to request it separately. As it is not covered by OHIP, the cost is usually $15 to $30 depending on the lab provider. Both our longevity panel and metabolic panel includes testing for lipoprotein (a).

Increased Risk of Heart Disease

High Lp(a) levels can escalate the risk of various cardiovascular conditions. These include:

• Heart Disease: Elevated Lp(a) levels contribute to the formation of plaques in arteries, making heart disease more likely.
• Stroke: The increased clotting ability linked with high Lp(a) can lead to strokes.
• Aortic Valve Stenosis: High Lp(a) levels can also cause the narrowing of the aortic valve, affecting blood flow.

Family History and High Cholesterol

If you have a family history of heart disease or high cholesterol, testing for Lp(a) becomes even more critical:

• Inherited Levels: Since Lp(a) levels are largely genetic, knowing your family history can help predict your risk.
• Early Detection: Early testing can lead to better management and preventive measures.

Recurrent Heart Events and Other Risk Factors

For individuals who have experienced recurrent heart events or possess other risk factors, knowing Lp(a) levels can be especially beneficial:

• Recurrent Heart Events: If you've had multiple heart attacks or strokes, testing for Lp(a) can help identify an underlying cause.
• Other Risk Factors: Conditions like high LDL levels, high blood pressure, and diabetes can compound the risks associated with high Lp(a).

How to Interpret Lipoprotein A Levels?

What is a Normal Lipoprotein A Level?

Understanding your lipoprotein (a) levels is vital for assessing your heart health. Here's how you can interpret these levels:

• Normal Levels: Less than 30 mg/dL is considered normal. If your levels fall below this range, your risk for heart disease related to Lp(a) is lower.
• Borderline Risk: Levels between 14 to 30 mg/dL are in the borderline risk category. While not immediately alarming, it's essential to keep an eye on these levels and discuss them with your healthcare provider.
• High Risk: Levels above 30 mg/dL indicate an elevated risk. Specifically, if your levels are:
  • Above 30 mg/dL: You are at a high risk.
  • Above 50 mg/dL: You fall into the highest risk category. This significantly increases your chances of developing heart-related issues.

How to Lower Lipoprotein A Levels?

Lowering lipoprotein (a) levels can be challenging, as there are currently no FDA-approved medications specifically targeting Lp(a) reduction. However, there are several strategies you can adopt to manage your overall heart health.

Lifestyle Changes

1. Quit Smoking: Smoking increases the risk of heart disease. By quitting, you can improve your heart health significantly.
2. Regular Exercise: Engage in at least 30 minutes of moderate exercise most days of the week. Activities like walking, cycling, and swimming can help.
3. Healthy Diet: Focus on a diet rich in vegetables, fruits, whole grains, and lean proteins. Avoid sugary foods and beverages. Incorporate cholesterol-lowering foods such as oats, nuts, and foods fortified with plant stanols and sterols.

Medications

Although no drugs specifically reduce Lp(a) levels, some medications can help manage overall cholesterol levels:

• Statins: These drugs lower LDL cholesterol but have a limited effect on Lp(a). They can still be beneficial for overall heart health.
• PCSK9 Inhibitors: These medications can reduce LDL cholesterol and have been shown to lower Lp(a) by about 20-30%. However, they are primarily used for managing LDL cholesterol.

Apheresis

In severe and rare cases, apheresis may be an option. This procedure involves filtering the blood to remove Lp(a) and other lipoproteins, similar to dialysis for kidney patients. Apheresis can be time-consuming and is usually reserved for those with familial hypercholesterolemia or extremely high Lp(a) levels.

What Can Affect Lipoprotein A Blood Test Results?

Several factors can influence the results of your lipoprotein (a) blood test. Understanding these factors can help you and your healthcare provider get the most accurate readings.

Biological Factors

1. Menopause: Menopause can cause changes in hormone levels, which may affect your Lp(a) levels. Post-menopausal women often have higher Lp(a) levels compared to pre-menopausal women.

Medications and Supplements

1. Estrogen Supplements: Taking estrogen supplements can lower Lp(a) levels. This effect is significant in post-menopausal women who use hormone replacement therapy.
2. Niacin: Also known as Vitamin B3, niacin can reduce Lp(a) levels. However, it can also interact with other medications and cause side effects.

Other Factors

1. Medications: Some other medications, such as those for lowering cholesterol or blood pressure, can also impact your Lp(a) levels. Always inform your healthcare provider about any medications you are taking.
2. Lifestyle Choices: Factors like diet, exercise, and smoking can indirectly influence your Lp(a) levels by affecting overall cholesterol and heart health.

What Foods Reduce Lipoprotein A?

Certain foods can help manage your lipoprotein (a) or Lp(a) levels. Including specific items in your diet can make a difference.

Vegetable Sources of Protein

1. Pulses and Beans: Lentils, chickpeas, and kidney beans are excellent choices. They provide high-quality protein without the saturated fats found in meat.
2. Lentils: These are rich in fiber and protein, making them a great addition to soups and salads.
3. Soya Products: Incorporate tofu or soy milk into your meals. These are not only protein-packed but also beneficial for heart health.
4. Nuts: Almonds, walnuts, and pistachios can be a healthy snack option. They contain good fats that support heart health.

Avoid Sugary Foods and Sweetened Drinks

1. Sugary Foods: Items like candies, pastries, and desserts can increase your overall cholesterol levels. Cutting down on these can help manage your Lp(a) levels.
2. Sweetened Drinks: Sodas and energy drinks are high in sugar. Opt for water, unsweetened tea, or natural fruit juices instead.

Moderation in Alcohol Consumption

1. Alcohol: Drinking in moderation is key. Excessive alcohol can negatively impact your cholesterol levels, including Lp(a).
2. Recommended Limits: Stick to one drink per day for women and two for men. This can help maintain a healthier heart.

Cholesterol-Lowering Foods

1. Oats: Start your day with a bowl of oatmeal. Oats contain soluble fiber, which helps lower LDL cholesterol.
2. Plant Stanols and Sterols: These are found in fortified foods like certain margarines and orange juices. They can help block the absorption of cholesterol in your intestines.

LDL vs. Lipoprotein A

LDL levels alone are not a precise measure of cardiovascular health because they do not account for the complex nature of cholesterol particles and their varying impacts on heart disease. LDL cholesterol measures the amount of cholesterol within low-density lipoproteins but does not reflect the number, size, or type of these particles, which are crucial factors in assessing cardiovascular risk.

Lipoprotein(a), on the other hand, is a specific type of lipoprotein that carries cholesterol and has a unique protein component, apolipoprotein(a), that makes it more atherogenic. Elevated levels of lipoprotein(a) are a strong, independent risk factor for cardiovascular disease, largely due to its propensity to promote blood clotting and plaque formation in arteries.

While LDL levels provide valuable information about cholesterol, they do not capture the full picture of cardiovascular risk. Measuring lipoprotein(a) offers a more accurate assessment by highlighting genetic risk factors and the atherogenic potential of lipoproteins, which are not reflected in LDL measurements alone.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.