Lp(a): the inherited heart risk marker worth testing once

Some people do everything right, with a healthy weight, a good diet, no smoking and normal cholesterol, and still have a heart attack young. In a share of these cases, the missing piece is lipoprotein(a), usually written Lp(a) and said “L P little a”. It is one of the most common inherited risk factors for heart disease, and a standard cholesterol test does not measure it.

What Lp(a) is

Lp(a) is a particle similar to LDL, with an extra protein attached. That extra protein seems to make it more likely to lodge in artery walls, to promote inflammation, and to encourage blood clots. A high Lp(a) is linked to heart attacks and strokes, and also to narrowing of the aortic valve in the heart.

Why testing once is usually enough

Your Lp(a) level is set mainly by the genes you inherited from your parents. It reaches its adult level in early childhood and then stays fairly stable for life. Diet, exercise and weight loss have little effect on it. That is why the European Atherosclerosis Society (EAS) 2022 consensus statement recommends that every adult has Lp(a) measured at least once.

There are some exceptions. Lp(a) can rise somewhat after menopause, in pregnancy, and with some kidney conditions and hormone changes, so your doctor may occasionally want a repeat.

The ranges LifePrint uses

LifePrint follows the EAS 2022 thresholds, in nmol/L:

• Below 75 nmol/L: desirable. Lp(a) is unlikely to be adding meaningfully to your risk.
• 75 to 125 nmol/L: grey zone. Risk may be modestly raised, and the result is best read together with your other risk factors.
• 125 nmol/L and above: raised, with a clearly higher risk of heart disease. The higher the level, the higher the risk.

Who should think about testing

• Anyone who has never had it measured, as the EAS 2022 statement recommends.
• People with a parent, brother or sister who had a heart attack or stroke at a young age.
• People with a close relative known to have a high Lp(a).
• People with heart disease that is not explained by their other risk factors.
• People with familial hypercholesterolaemia or a very high LDL.
• People whose LDL stays stubbornly high on treatment, since part of what labs report as LDL includes cholesterol carried in Lp(a).

What to do with a high result

A high Lp(a) is not a diagnosis of heart disease. It is a risk factor, like a family history. Many people with a high level never have a heart attack. It does mean the rest of your risk deserves more attention.

At present, the main approach is to lower everything else you can control. That usually means a lower LDL target, careful blood pressure control, not smoking, managing blood sugar and staying active. The EAS 2022 statement suggests using Lp(a) to refine a person's overall risk estimate, which can change the decision about whether to start cholesterol lowering treatment.

Standard cholesterol medicines do not meaningfully lower Lp(a). Several medicines designed to lower it specifically are being studied in large trials, and whether they reduce heart attacks is still being tested. A doctor can advise whether any new option is appropriate for you.

Where to find it

Lp(a) is included in the Heart and Metabolic panel, and can be added to other panels. Since most people only need it once, it is worth doing at the same time as your first full lipid profile.

If your Lp(a) is raised, speak to a registered healthcare practitioner who can assess it alongside your full risk profile. Your LifePrint report is health information, not a diagnosis.