From the Guidelines
I strongly recommend that individuals with borderline normal LDL and elevated Lp(a) levels, such as 113 mg/dL, discuss their results with a healthcare provider to determine the best course of action for reducing cardiovascular risk. Borderline normal LDL cholesterol is typically in the range of 100-129 mg/dL, which represents a slight elevation above optimal levels but isn't yet in the high-risk category [ 1 ]. An Lp(a) level of 113 mg/dL is considered elevated, as the European Society of Cardiology guidelines recommend targeting levels below 50 mg/dL [ 1 ].
Some key points to consider in managing these levels include:
- Heart-healthy dietary changes, such as reducing saturated fats and increasing fiber
- Regular exercise, aiming for 150 minutes weekly of moderate activity
- Weight management if needed
- Avoiding smoking
- Considering medications like statins if overall cardiovascular risk warrants it, as statins are the usual first-line treatment to reach LDL-C goals [ 1 ]
It's also important to note that Lp(a) levels are mainly determined by genetic traits and have pro-atherogenic and pro-thrombotic properties, suggesting a causal association between Lp(a) levels and cardiovascular disease events [ 1 ]. Regular monitoring of lipid profiles is crucial to track changes over time and adjust management plans accordingly. Given the potential risks associated with elevated Lp(a) levels, it's essential to work closely with a healthcare provider to develop a personalized plan for reducing cardiovascular risk.
From the Research
Lipoprotein(a) and LDL Cholesterol Levels
- Lipoprotein(a) (Lp(a)) is an independent and causal risk factor for atherosclerosis and major cardiovascular events, with elevated levels (≥50 mg/dL) affecting over 20% of the population 2.
- A borderline normal LDL level and an Lp(a) level of 113 mg/dL may indicate an increased risk of cardiovascular disease, as Lp(a) is associated with residual cardiovascular risk in patients receiving standard-of-care LDL-lowering therapy 2.
- PCSK9 inhibitors have been shown to significantly reduce Lp(a) levels by up to 30%, and may be a potential treatment option for patients with elevated Lp(a) levels 2, 3, 4, 5.
Treatment Options
- Statins have neutral or detrimental effects on Lp(a) levels, and may not be effective in reducing cardiovascular risk in patients with elevated Lp(a) levels 2, 3, 4, 5.
- Lipoprotein apheresis (LA) is a treatment option that efficiently lowers Lp(a) levels and has been associated with a reduction in incident cardiovascular events 2.
- Antisense oligonucleotides (ASO) have shown good safety and strong efficacy in reducing Lp(a) levels by up to 90%, and may be a promising avenue for reducing cardiovascular risk in patients with elevated Lp(a) levels 2.
Cardiovascular Risk
- The baseline LDL cholesterol level may provide a means to better understand the results of recent cardiovascular outcome trials and the expected benefits of lipid-lowering therapies 6.
- Mortality is reduced in a log-linear fashion only when LDL-C > 100 mg/dL, suggesting that more attention should be given to the baseline LDL-C level when assessing cardiovascular risk 6.