Lipoprotein(a) as a Risk Factor for Heart Disease

Lipoprotein(a), also known as Lp(a), is a type of low-density lipoprotein (LDL, or “bad” cholesterol) that has another form of protein, called a glycoprotein, bonded to it. The name of the specific glycoprotein is apolipoprotein(a).

Researchers are still working to understand lipoprotein(a) and the ways it may affect your health. However, some studies suggest that having high levels of lipoprotein(a) circulating in your blood could put you at a higher risk ​of developing heart disease.

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What Lipoprotein(a) Does

Made in your liver and then entering your bloodstream, lipoprotein(a) has been shown to build up under the inner lining of arteries. This buildup may contribute to the development of atherosclerosis—the formation of fatty plaques in your arteries that can lead to heart disease, heart attack, and stroke. It promotes arterial inflammation (redness and swelling) and the formation of foam cells, which are fat cells that attach to atherosclerotic plaques.

In addition:

  • High levels of lipoprotein(a) are believed to be most damaging to arterial walls when LDL cholesterol is also high.
  • Higher lipoprotein(a) levels have been shown to lower the chances of survival after a heart attack.

Normal Levels

Blood test findings for levels of lipoprotein(a) are expressed in milligrams per deciliter (mg/dL). A level of 30 mg/dL is considered normal. Levels higher than 30 mg/dL may indicate a 2- to 3-fold increased risk for heart disease.

However, lipoprotein(a) levels aren’t part of the routine lipid panel blood test, which measures levels of total cholesterol, LDL, and high density (HDL) "good" cholesterol, and triglycerides (a form of fat found throughout the body).

That said, your lipoprotein(a) levels may be measured if you have:

  • Diagnosed heart disease and normal levels of HDL, LDL, and triglycerides
  • A strong family history of heart disease and normal HDL, LDL, and triglyceride levels
  • Continuing high LDL levels despite receiving treatment

Should You Try to Lower Your Levels?

Lipoprotein(a) levels are mainly influenced by your genes, and the usual recommendations—a healthy diet, regular exercise, and (most) cholesterol-lowering medications—do not have much effect on lowering them. Niacin has shown some promise in clinical studies for lowering lipoprotein(a) levels. However, it’s not routinely used for that purpose.

If you’re trying to lower your risk of developing heart disease, it’s best to put lipoprotein(a) on the treatment “back burner” for now and focus instead on methods for reducing the well-established risk factors for heart disease. As you probably know, these include lowering your blood pressure if it’s too high, lowering high LDL cholesterol, and raising low HDL cholesterol. Multiple studies have shown that targeting these risk factors can help reduce your risk of having a heart attack or stroke.

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  • Boffa MB, Koschinsky ML, Berglund L. Lipoprotein(a): a unique risk factor for cardiovascular disease. Clin Lab Med 2006;26:751-772.
  • Erquo S, Kaptoge S, Perry PL et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA 2009; 302:412-423.
  • Kang S. “What is lipoprotein (a) and what does it mean for you?” HealthCentral (2008).   
  • “Test ID: LIPA-lipoprotein (a) serum.” Mayo Clinic-Mayo Medical Laboratories (2016). 

By Jennifer Moll, PharmD
Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention.