Why You Should Get Tested for Cholesterol Called Lp(a)

You run around Green Lake regularly, you don’t smoke, and you’ve cut out red meat from your diet. There’s no way you need to worry about high cholesterol, right?

Well, it turns out there’s a type of cholesterol-carrying particle that can increase your risk of heart disease, no matter how healthy your lifestyle is or how low your cholesterol levels are on your lipid panel. It’s called lipoprotein(a), and new guidelines now recommend that everyone get tested for it. Here’s why.  

What is lipoprotein(a)?

Lipoprotein(a), often shortened to Lp(a), is a cholesterol-carrying particle in your blood that’s similar to low-density lipoprotein (LDL), the bad kind of cholesterol that you’ve heard about. About 1 in 5 people worldwide have elevated Lp(a) levels. 

“Lipoprotein(a) is an extra sticky cholesterol particle that’s much more likely to cause plaque buildup in your arteries,” says Rachel Smith, MD, a physician and Global Health Fellow in UW School of Medicine’s Department of Family Medicine. “It can also increase the risk of heart disease by promoting inflammation and making it harder for blood clots to break up.”

Not only do high Lp(a) levels boost your heart disease and stroke risk, but they don’t respond to lifestyle changes like diet and exercise and can be high even when your other cholesterol levels are low. In other words, Lp(a) is a risk factor independent of the LDL levels that are tested by a standard lipid panel.

Should you get tested for Lp(a)?

Your risk of having elevated Lp(a) is primarily genetically determined, so you largely inherit it.  

“If a first-degree relative has high Lp(a) levels, there’s a good chance that you would as well,” says Smith.  

If that’s you, or if you have a family history of early heart disease or genetic high cholesterol, you should definitely get tested. But even if you don’t know of any family risk, you should still consider asking your doctor about getting the test. Lp(a) doesn’t cause symptoms, and while the particle was discovered in 1963, clinical adoption of Lp(a) testing is still relatively new, so many people aren’t aware they have high Lp(a) levels.

In fact, the American Heart Association and the American College of Cardiology updated their guidelines this year, recommending that all adults be tested for Lp(a).

What does it entail? It’s a simple blood test, but not one that’s currently included in your standard lipid panel, so your doctor has to order it separately. The good news is that your Lp(a) levels stay stable over the course of your life, so you only have to take the test once, and if your levels are low, then you don’t have to worry about it again.  

If your levels are elevated, the earlier you know the better, so you can make a plan to manage your heart disease risk, ideally before plaque buildup has progressed.  

A reading of 125 nmol/L or above is considered high, and the more elevated your levels, the higher your risk of heart disease and stroke. So if your levels are 250 nmol/L, then your risk roughly doubles.  

Is there a treatment for high Lp(a)?

One of the reasons Lp(a) hasn’t been widely tested for before now is that there is currently no treatment for it. Again, lifestyle changes don’t affect it, nor do any existing cholesterol medications.

That said, it’s still important to know your Lp(a) levels. For one, there very likely will be a treatment for it soon.  

“There are drugs in development right now,” says Smith. “Within the next few years, I would be surprised if we didn’t have medications that target Lp(a).”

Also, while you can’t lower your Lp(a), you can do everything possible to lower the risk factors for heart disease you do have control over, like quitting smoking, getting enough sleep, staying physically active, managing your blood pressure, eating a heart-healthy diet and treating your LDL levels with a statin if your overall heart disease risk is high.

“Lp(a) is an independent risk factor, but like all risk factors, it’s cumulative,” says Smith. “So if you have an elevated Lp(a) level, but every other one of your heart disease risk factors is under control, that will dramatically decrease your overall risk of heart disease.”

Say your overall risk for heart disease is 5%, and your high Lp(a) increases it by 40% — that means your risk is now 7%, which is not a dramatic difference.

Will your doctor give you the test, and will insurance cover it?

The guidelines recommending that all adults get tested for Lp(a) are still new, so your doctor may ask you about getting tested, but it’s not guaranteed. If your doctor doesn’t bring it up, don’t hesitate to ask about it.  

“I do recommend asking your primary care provider when you go in,” says Smith. “Since these new guidelines have come out, I’ve been offering this for all of my patients who haven’t had it checked.”  

Be sure to check that your insurance covers the test, as well. Most major insurance companies should, but since it’s a newer guideline, some might not yet.  

What else can you do if your Lp(a) levels are high?

The most important thing you can do is tell your family to get tested as well, since there’s a good chance their Lp(a) levels are also high.  

Another thing you could ask about is a coronary artery calcium test. It’s a type of heart scan that measures the amount of calcified plaque that has already built up in your heart’s arteries. If your score is low, you can be reassured that your overall current risk of heart disease is likely low. If it’s high, then you know it’s more urgent to address the heart disease risk factors that you do have control over.  

Either way, if you have high Lp(a) levels, there is no reason to panic.  

“Just because it’s a high test, it doesn’t mean you’re doomed to have heart disease,” says Smith. “There’s so much you can do with lifestyle or a medication if it’s needed.”