Blood analysis is an essential tool for tracking health. However, some results, like Lipoprotein(a), can seem complex. This marker plays a specific role in the body, and understanding it is an asset for evaluating one’s cardiovascular health profile. This guide explains, in a simple and factual manner, what Lipoprotein(a) is, why doctors measure it, and how to interpret the results.

What is Lipoprotein(a)?

Lipoprotein(a), often abbreviated as Lp(a), is a particle that transports lipids in the blood. It belongs to the large family of lipoproteins, just like LDL cholesterol (often called “bad cholesterol”) and HDL (“good cholesterol”). However, its unique structure distinguishes it from others.

Your liver naturally produces Lp(a). It consists of an LDL particle to which a specific protein, apolipoprotein(a), is added. This particular composition gives it unique properties.

Researchers are still studying all its functions. However, it is known that it participates in fat transport and has an effect on blood clotting. This dual influence places it at the heart of important biological mechanisms for vascular health.

Why do doctors measure this parameter?

Measuring Lp(a) provides key information about cardiovascular risk. Importantly, this risk is independent of other more well-known factors like cholesterol or blood pressure.

Unlike LDL cholesterol, which varies with diet, genetics determines more than 80% of the Lp(a) level. This level therefore remains remarkably stable throughout life. A single measurement is often sufficient to know one’s personal risk level associated with this marker.

Why is it important to measure it?

Lipoprotein(a) interacts with many systems in your body. For example, in case of small lesions on the wall of blood vessels, it can accumulate there. This accumulation contributes to the formation of atherosclerotic plaques. These plaques can reduce the diameter of arteries, which complicates blood circulation to vital organs like the heart or brain.

Research on Lp(a) has progressed significantly. Discovered in 1963, its importance in preventive medicine is now well established. Major studies have shown that a high Lp(a) level significantly increases the risk of myocardial infarction. It is a common risk factor, as approximately 20% of the general population has a high level.

Ignoring an elevation of this marker can have long-term consequences. Atherosclerosis, the process of hardening of the arteries, can evolve silently for decades. A cardiovascular event can be the first manifestation. Therefore, knowing one’s Lp(a) level can influence the prevention strategy, especially in case of a family history of early cardiovascular disease.

How to read and interpret your Lp(a) results

On a lab report, Lipoprotein(a) is generally found in the lipid section. A potential difficulty is the existence of two units of measurement: milligrams per deciliter (mg/dL) and nanomoles per liter (nmol/L). It is therefore essential to correctly identify the unit used by your laboratory.

Laboratories make result reading easier. Generally, a value outside the norm is highlighted, for example in bold or color. A column also indicates reference values for direct comparison.

Understanding reference values

International recommendations help to place one’s result.

• A level is considered desirable when it is less than 30 mg/dL (or 75 nmol/L).
• A level is considered high when it is greater than 50 mg/dL (or 125 nmol/L).

However, interpretation is not limited to a single number. A healthcare professional evaluates this result in the overall context of your profile: age, sex, blood pressure, smoking status, diabetes, and other lipid levels.

What pathologies are associated with Lipoprotein(a)?

The scientific community recognizes that an abnormally high level of Lipoprotein(a) is a risk factor for several cardiovascular pathologies.

Atherosclerosis and coronary artery disease

Excess Lp(a) promotes the deposit of fats on the artery wall, thus initiating atherosclerosis. Furthermore, its structure favors the formation of blood clots on these plaques. If a clot obstructs a coronary artery, it causes a myocardial infarction. A high Lp(a) level is therefore a significant risk factor for coronary artery disease, particularly in younger people.

Aortic valve stenosis

More specifically, Lp(a) can accumulate on the aortic valve, the main output “door” of the heart. Over time, these deposits can lead to narrowing and hardening of the valve, a pathology called aortic stenosis. Symptoms include shortness of breath on exertion or chest pain. Echocardiography is the reference examination for diagnosis.

Ischemic stroke

The mechanism is similar to that of coronary artery disease. Lp(a) increases the risk of atherosclerotic plaques forming in the arteries that supply the brain. If one of these arteries becomes blocked, it results in an ischemic stroke. Several studies confirm that an increase in Lp(a) increases the risk of stroke.

Practical advice and follow-up for high Lp(a) levels

Management depends on the Lp(a) level and the presence of other risk factors.

Follow-up schedule

• Desirable level (< 30 mg/dL): The level being stable, a new measurement is generally not necessary, except in particular situations. A standard lipid panel remains recommended.
• Intermediate level (30-50 mg/dL): Management focuses on optimal control of all other risk factors (blood pressure, LDL cholesterol, diabetes).
• High level (> 50 mg/dL): It is essential to proactively manage other cardiovascular risk factors. Doctors often advise regular cardiology follow-up. You can also discuss family screening with your doctor.

Nutritional recommendations

Diet has very little impact on the Lp(a) level itself. However, a healthy diet is crucial for reducing overall cardiovascular risk.

• Prioritize omega-3 fatty acids (fatty fish, nuts).
• Consume plenty of colorful fruits and vegetables, rich in antioxidants.
• Limit ultra-processed, sugary, and saturated fat-rich foods.
• Adopt a Mediterranean-type diet, which has proven benefits for heart health.

Lifestyle modifications

• Physical activity: 30 minutes of moderate activity, 5 times a week, helps maintain vascular health.
• Stress management: Techniques like meditation or heart coherence can be beneficial.
• Sleep: Quality sleep (7-8 hours per night) helps reduce general inflammation.
• Smoking cessation: Smoking is a major risk factor that significantly amplifies the danger associated with high Lp(a).

Frequently asked questions about Lipoprotein(a)

Can Lp(a) decrease over time or is it fixed for life?

Genetics determines 80-90% of the Lp(a) concentration, making it stable in an individual. Slight variations may exist, but the baseline level remains the same. This is why doctors often believe a single measurement during adulthood is sufficient.

Are there specific medications to treat high Lp(a)?

Currently, no medication is approved with the sole target of Lp(a). Management therefore consists of aggressively controlling all other risk factors. However, very promising therapies, such as antisense oligonucleotides, are in the final phase of clinical trials and could be available in the coming years.

How does Lp(a) interact with statins?

Statins, which are very effective in lowering LDL cholesterol, have little to no effect on Lp(a). Some studies even suggest they might slightly increase it. This does not question their overall benefit on cardiovascular risk, but highlights that the residual risk related to Lp(a) persists even under statin treatment.

Should Lp(a) be measured in children if mine is high?

Since transmission is hereditary, a child has a 50% risk of also having a high level. Most recommendations suggest not measuring it in young children but considering it in adolescence or young adulthood. This allows for early awareness of a healthy lifestyle without generating unnecessary anxiety.

How to interpret a high Lp(a) level after a heart attack?

This situation is very telling. In a patient who has a cardiovascular event without having the classic risk factors (high cholesterol, diabetes, etc.), the discovery of high Lp(a) points to a genetic cause. This then justifies very strict control and screening among first-degree relatives (parents, siblings, children).

Is high Lp(a) a contraindication to hormonal contraception?

Contraceptives containing estrogen slightly increase the risk of thrombosis. In a woman with very high Lp(a), this risk should be carefully evaluated. A discussion with the doctor and/or gynecologist is necessary to choose the safest contraceptive method, often favoring pure progestin or non-hormonal options.

Conclusion

Lipoprotein(a) is an important, independent, and genetically determined cardiovascular risk factor. Long overlooked, its measurement provides valuable information for personalized prevention.

Key takeaways:

• The Lp(a) level is primarily determined by genetics and remains stable.
• A high level increases the risk of heart attack, stroke, and aortic stenosis.
• Its measurement is useful, especially in case of a family history of early cardiovascular disease.
• Current management aims at controlling all other risk factors.
• Specific and effective therapies are expected in the near future.

Additional Resources

To deepen your knowledge of this blood marker, here is a reliable resource:

• Cleveland Clinic

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• More biomarkers articles are available here.