Hidden Risk Factor for Heart Disease
Recent studies suggest that approximately one in five Americans may unknowingly carry a significant risk factor linked to heart disease and heart attacks. This factor is lipoprotein(a), or Lp(a), a type of LDL particle responsible for transporting cholesterol to tissues, which can infiltrate and damage arterial walls.
Commonly referred to as ‘bad’ cholesterol, LDL has a harmful variant known as Lp(a), which possesses an additional protein called Apo(a). This structure increases the stickiness of Lp(a) particles, causing them to adhere to blood vessel walls. Once trapped, they facilitate the development of artery-clogging plaques, leading to inflammation and narrowing of the aortic heart valve.
Consequences of Elevated Lp(a)
Clogged arteries can create obstructions in both coronary arteries, potentially resulting in heart attacks, and carotid or cerebral arteries, leading to ischemic strokes that can cause brain damage.
While LDL and HDL cholesterol levels can generally be managed through diet, exercise, and medications like statins, Lp(a) levels are predominantly dictated by genetics. Thus, those with elevated Lp(a) must focus on managing other modifiable risk factors.
Testing Recommendations
Experts highlight that Lp(a) is among the most potent indicators of genetic predisposition to cardiovascular disease, which affects over 120 million Americans and remains the leading cause of death in the U.S. An estimated 63 million Americans have elevated Lp(a) levels, defined as 50 milligrams per deciliter (mg/dL) of blood or higher. However, this testing is often omitted from standard blood panels due to a lack of direct treatments and insurers’ hesitance to cover the cost.
Healthcare providers recommend Lp(a) testing for individuals with a family history of early heart disease or unexplained heart attacks or strokes before age 65, as well as for patients whose LDL-lowering medications have proven ineffective. Early detection is vital for minimizing the risk of heart disease.
Importance of Healthy Lifestyle Choices
While lifestyle modifications cannot reduce Lp(a) levels, adopting healthier habits becomes crucial for individuals with elevated levels. Focusing on controlling other cardiovascular risk factors—such as high LDL cholesterol, high blood pressure, and diabetes—can significantly decrease overall health risks.
Data from Harvard University indicates that only 0.3 percent of the population underwent Lp(a) screening between 2012 and 2019, with a minimal subset of physicians ordering these tests. Fortunately, most insurers now cover Lp(a) testing, increasing access for patients, although patients may need to request a test based on their family history and risk factors.
Cardiovascular Risk and Family History
Individuals with the highest Lp(a) levels exhibit more than double the likelihood of experiencing a major cardiovascular event, such as a heart attack, each year. They also face a 65 percent greater chance of suffering such events by age 65.
Dr. Supreeta Behuria from Northwell Staten Island University Hospital’s Preventive Cardiology Program stated, ‘Knowing what your risk is will encourage you to change your lifestyle.’ She emphasized that awareness of one’s cardiovascular risk motivates individuals to maintain a heart-healthy diet and exercise regime.
Lp(a) levels below 30 mg/dL are considered healthy, while those exceeding 50 mg/dL correlate with an increased risk of heart problems. A recent study published in the journal Atherosclerosis discovered that routine Lp(a) testing could reclassify 20 percent of participants as high-risk for cardiovascular disease, thereby allowing for earlier and more proactive intervention.
New Insights and Recommendations
Further research in the European Heart Journal corroborated that high Lp(a) is a significant heritable risk factor for cardiovascular events. Swedish researchers traced over 61,000 first-degree relatives of individuals with known Lp(a) levels for nearly 20 years and found that a close relative with elevated Lp(a) corresponded with a 30 percent higher risk of cardiac events.
Dr. Sonia Tolani of Columbia University Women’s Heart Center remarked, ‘If your cholesterol levels are high, lifestyle changes and medications can help lower them and reduce your risk of heart disease.’ It is crucial for patients to discuss Lp(a) testing with family members, given the genetic nature of this cholesterol type.
Despite the absence of specific medications targeting high Lp(a), emphasis on managing overall heart risk continues to grow. This includes treating associated conditions like high blood pressure and diabetes comprehensively, as well as making lifestyle changes to foster heart health.
Dr. Gregory Schwartz, a cardiologist at the Rocky Mountain Regional VA Medical Center in Colorado, concluded: ‘Will doing this change your Lp(a)? No, but we should encourage it because lowering overall cardiovascular risk is what counts in the end.’ Promising future treatments are on the horizon, with new drugs under development aimed at significantly reducing Lp(a) production in the liver, potentially lowering levels by 70 to over 90 percent.
