Managing Lipoprotein(a) and Heart Attack Risks


Lipoprotein(a) is formed when low-density lipoprotein combines with apolipoprotein(a).


Does lipoprotein(a) increase heart attack risks?


Lipoprotein(a) is more dangerous than LDL and other types of cholesterol, and elevated levels double or triple your risk of myocardial infraction or heart attack. Lp(a) is an independent cardiac risk factor. Recent research indicates that the size of Lp(a) is as important as the amount in predicting heart attack risk. As with LDL and HDL, the smaller the Lp(a), the higher your risk of developing heart disease. The association between Lp(a) and increased heart attack risk is the potential missing link that explains heart attacks in individuals with a normal cholesterol panel and no other previous symptoms.


Managing Lipoprotein (a) and Heart Attack Risks

What are optimal values of lipoprotein(a)?


Lipoprotein(a) is measured with a simple blood test. Levels less than 14 milligrams per deciliter are considered optimal. If your Lp(a) is between 14 and 30 milligrams per deciliter, your risk is considered borderline. Levels between 31 and 50 milligrams per deciliter are considered high risk, and levels above 50 milligrams per deciliter are considered very high risk.


When is lipoprotein(a) testing recommended?


Lipoprotein(a) is a measure of your inherited risk for heart disease. Therefore, Lp(a) is regularly measured if you have premature cardiovascular disease or if you have a family history of high cholesterol, premature cardiovascular disease or elevated Lp(a). If your Framingham score is 10 or above according to US guidelines, or above three according to European guidelines, regular Lp(a) testing is recommended.


How do you reduce lipoprotein(a)?


Lipoprotein(a) does not respond to traditional cholesterol-lowering drugs such as statins. Niacin or vitamin B3, generally prescribed to reduce LDL cholesterol, reduces Lp(a) levels by 20 to 30 percent. The dosage recommended is 1 to 3 grams daily in divided doses. Aspirin is also helpful in reducing Lp(a) levels. There is some evidence that alternative remedies such as ginkgo biloba, coenzyme Q-10 and pine bark extract also help lower Lp(a) levels. Treatments in development include CETP inhibitors that also raise HDL and an antisense drug aimed against apolipoprotein B.


While elevated lipoprotein(a) values increase your heart attack risk, there is no evidence that direct treatment or lowering of Lp(a) reduces your risk. This indicates that treating the underlying cause of high Lp(a), such as lifestyle changes and stress, is needed to reduce your risk of heart attack.