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All of us must have at least once made a search regarding heart health for ourselves or for the ones we love. Much is spoken about the reckless precursors - high blood pressure, high cholesterol, smoking, and diabetic conditions, but, the role of lipoprotein(a), frequently referred to as Lp(a), an important player in heart health often goes unnoticed. Hence, in this blog, we will discuss,
- What Is Lipoprotein A?
- Causes of Lp(a) Elevation
- Who Should Get Their Lp(a) Levels Tested?
- How Can We Control Lp(a) Levels in Our Body?
Synopsis
What Is Lipoprotein A?
Lipoprotein(a), or Lp(a) is not technically a type of cholesterol but a type of lipoprotein that carries cholesterol. Lipoproteins are made of fats (lipids) and proteins. Similar to low-density lipoprotein (LDL), often called "bad cholesterol," Lp(a) has a unique protein called apolipoprotein(a).
Lp(a) is an LDL fraction that moves in the bloodstream and is synthesised by the liver. Lp(a) in high concentration is known to deposit fats on the walls of the arteries. These deposits can block the arteries, hence contributing to cardiovascular diseases such as heart attack and stroke. Even though it is a potent risk factor, Lp(a) is not included in the routine lipid profile panel. Lp(a) evaluation through lipid profile blood test is crucial since it reveals people with elevated risks of heart disease and who are otherwise unrecognised.
What Are the Causes of Lp(a) Elevation?
In a lipoprotein profile test, the desirable/optimum level of Lp(a) is <14 mg/dL. Values > 50 mg/dL are associated with a higher risk of cardiovascular diseases like heart attack & stroke. The cause of elevated lipoprotein(a) levels is mostly genetic. Other causes include:
- Ethnic background might make a difference, too. Africans tend to have higher Lp(a) levels as compared to Americans and Asians.
- Secondary causes like chronic kidney disease, Nephrotic syndrome, and hypothyroidism
- Hormonal Changes like in pregnancy or with hormone replacement therapy
Who Should Get Their Lp(a) Levels Tested?
As the levels of Lp(a) generally remain stable throughout one’s life. Everyone should get it tested at least once in their life. People with a positive family history of heart attack/stroke, those who have suffered heart attack/stroke at a young age, or those with severe hyperlipidemia should undergo Lp(a) testing. The normal value of the Lp(a) is <14. Levels between 14-30 mg/dL are considered borderline risk, and between 31-50 mg/dL are considered moderate risk. Any value > 50 is associated with a very high risk of CVD, which includes stroke and heart attack.
How Can We Control Its Levels in Our Body?
Lp(a) levels stay in the same range in a person’s life and change slightly. Medically, Niacin, intensive lipid therapy, and PCSK9 inhibitors have been beneficial, but deeper research is required. In advanced stages, lipoprotein Apheresis can bring down Lp(a) by 75%. This is a process like dialysis in which the high Lp(a) is filtered out. Some changes in the diet can help with cardiovascular problems, like:
- Avoid eating saturated fat.
- Decrease foods with the highest fats by replacing them with more nutritive monounsaturated or polyunsaturated-rich options.
- Eat vegetables and fruits in addition to meat and dairy
- Eat two fish servings a week, where one is oily (e.g., the mackerel, sardines, and salmon).
- Prefer leguminous plant protein sources such as pulses, beans, lentils, soya, and nuts, over other proteins.
- Avoid sweets containing added sugars, and take no sweetened palm drinks at all.
- In case you love to consume alcoholic beverages, make sure you do it in moderation.
Conclusion: By controlling other risk factors such as LDL cholesterol and blood pressure and remaining at a healthy weight, in addition to regular check-ups and Lp(a) testing, it is possible to decrease your risk of a heart attack by a significant measure and better your heart health.
FAQ's
Aspirin does reduce the risk of heart attack. However, it increases the bleeding risk. So, you should discuss the risk-benefit with your doctor before taking aspirin.
One in 5 people (20%) worldwide have elevated Lp(a) levels.
It is a specialised procedure similar to dialysis that can filter Lp(a) out of the blood. It is typically used for individuals with very high Lp(a) levels and a history of cardiovascular events.
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