From the Guidelines
A lipoprotein(a) test is a crucial diagnostic tool that measures the level of lipoprotein(a), or Lp(a), in your blood to assess your risk for cardiovascular disease, particularly heart attacks and strokes, with high levels (generally above 50 mg/dL or 125 nmol/L) indicating increased cardiovascular risk 1.
What is Lipoprotein(a) Test
The test requires a simple blood draw, usually after fasting for 9-12 hours, though some labs may not require fasting.
- Your doctor might order this test if you have a family history of early heart disease,
- if you've had cardiovascular events despite normal cholesterol levels,
- or as part of a comprehensive cardiovascular risk assessment. Lp(a) is a unique particle similar to LDL cholesterol but with an additional protein called apolipoprotein(a) attached to it.
Importance of Lipoprotein(a) Test
Unlike other lipid levels, Lp(a) concentrations are primarily determined by genetics and remain relatively stable throughout life, unaffected by diet or standard cholesterol medications 1.
- High levels of Lp(a) are associated with increased risk of cardiovascular disease, including heart attacks, strokes, and peripheral arterial disease.
- The Lp(a) test can help identify individuals who are at high risk of cardiovascular disease, even if they have normal LDL cholesterol levels.
Management of Elevated Lipoprotein(a) Levels
If your levels are elevated, your doctor might recommend more aggressive management of other risk factors, such as blood pressure and LDL cholesterol, or specific medications like PCSK9 inhibitors or niacin that can modestly lower Lp(a) 2.
- The goal of treatment is to reduce the risk of cardiovascular disease and improve overall health outcomes.
- Lifestyle modifications, such as a healthy diet and regular exercise, may also be recommended to help manage elevated Lp(a) levels.
From the Research
Lipoprotein(a) Test
- The lipoprotein(a) (Lp(a)) test measures the level of Lp(a) in the blood, which is a low-density lipoprotein (LDL) cholesterol-like particle bound to apolipoprotein(a) 3.
- Elevated Lp(a) levels are associated with an increased risk of cardiovascular disease, including atherosclerotic cardiovascular disease and calcific aortic valve stenosis 3, 4.
- The test is used to identify individuals with high Lp(a) levels, which can help guide treatment decisions and reduce the risk of cardiovascular events 5, 6.
Indications for Testing
- The test is recommended for individuals with a personal or family history of premature cardiovascular disease, familial hypercholesterolemia, or recurrent cardiovascular events 5.
- It is also recommended for individuals with elevated LDL cholesterol levels despite maximum-potency statin therapy 5.
- The European Atherosclerosis Society recommends measuring Lp(a) levels in individuals with a family history of premature cardiovascular disease or elevated Lp(a) 3.
Interpretation of Results
- Lp(a) levels of 50 mg/dL or higher are considered elevated and are associated with an increased risk of cardiovascular disease 3, 4.
- The results of the test can be used to guide treatment decisions, including the use of lipoprotein apheresis or other therapies to lower Lp(a) levels 6, 7.
Treatment Options
- Lipoprotein apheresis is a treatment option for individuals with elevated Lp(a) levels and progressive cardiovascular disease despite maximal drug therapy 6, 7.
- Emerging nucleic acid-based therapies, such as antisense oligonucleotides, have shown promise in lowering Lp(a) levels and reducing cardiovascular risk 3, 4.