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Your Guide to Lowering High Cholesterol

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Lipoprotein(a) and Heart Attack Risk

Medically Reviewed By Megan Soliman, MD

Your Lp(a) levels are determined by your genes and can provide insight into your risk of developing heart or blood vessel disease.

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If you’ve had your cholesterol checked, you may have heard of high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is sometimes referred to as “good” cholesterol because it carries cholesterol to your liver to be removed from your body. However, LDL is considered “bad” cholesterol because it can lead to a buildup of plaque deposits in your arteries, a condition called atherosclerosis.  

Lipoprotein(a), or Lp(a), is a particular form of LDL cholesterol. Research suggests high levels can increase your risk of heart attack and stroke.

How does lipoprotein(a) affect your heart attack risk?

Compared with other kinds of LDL, Lp(a) seems to be especially “sticky.” This makes it more likely to build up and form plaques on your blood vessels. These plaques can reduce or block blood flow to your organs and parts of your body. When the blood supply to your heart is diminished, you can experience a heart attack.

What causes elevated Lp(a)?

Your Lp(a) levels are primarily controlled by genetics, meaning it’s inherited from your parents. Diet and activity level can improve your LDL levels, but they don’t have much of an effect on your Lp(a). 

High Lp(a) levels are common. About 1 in 5 U.S. adults Trusted Source AHA/ASA Journals Peer reviewed journal Go to source  have elevated Lp(a). It’s found across ethnicities but appears to be most common in Black people.

Should I be screened for high Lp(a) levels?

Lipoprotein(a) is not included in a regular blood test to measure your cholesterol. However, your doctor may suggest a test if you fall into one of the following categories:

  • You have a family member with high Lp(a).
  • You have a family history of early heart attack or stroke.
  • You have an inherited condition called familial hypercholesterolemia (very high blood levels of cholesterol).
  • You have heart or blood vessel disease but standard cholesterol and triglycerides.
  • You have high cholesterol that doesn’t respond to medication to treat it.

If you have a personal or family history of heart or blood vessel disease, talk with your doctor about checking your Lp(a) levels. High Lp(a) doesn’t cause symptoms, but your test results can help your doctor evaluate your overall risk of experiencing heart-related problems.  

What can I do to lower my lipoprotein(a)?

In some circumstances, a procedure called apheresis may be used to treat high Lp(a). A machine removes your blood, filters out lipoproteins, including Lp(a) and LDL, and returns your filtered blood.

Though effective at lowering your levels, apheresis must be done at a specialty center, and not everyone is a candidate. It also takes a few hours, must be performed every few weeks, and may not be covered by insurance.

Currently, no medications are approved for treating elevated Lp(a). Niacin, a B vitamin, and hormone therapy may help lower Lp(a). However, neither has been shown to decrease your risk of heart attack or cardiovascular disease. They may also have undesirable side effects.

Drugs called PCSK9 inhibitors, such as evolocumab (Repatha), appear promising. They can lower Lp(a) and LDL levels. More research is needed to better understand their effect on Lp(a). Research is also ongoing to develop therapies targeting Lp(a).

With limited treatments for high Lp(a), how can I improve my heart attack risk?

You can take the following steps to improve your heart health and lower your overall risk:

  • Enjoy regular physical activity.
  • Eat a heart-healthy diet.
  • Follow your doctor’s suggestions for treating other medical conditions, like high blood pressure, diabetes, and high cholesterol.
  • If you smoke, quit.
  • Find ways to manage stress levels.

Your doctor can suggest other ways to stay healthy and live a full and active life.

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Medical Reviewer: Megan Soliman, MD
Last Review Date: 2023 Apr 14
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