Lipoprotein (a) Lp(a)

Lipoprotein (a), or Lp(a) is a special type of low-density lipoprotein ("bad" cholesterol), which is a powerful and independent genetic marker of cardiovascular disease.

Unlike regular low-density lipoprotein ($LDL$), the level of Lp(a) in the blood at 70–90% is determined by inheritance and practically does not change throughout life under the influence of diet, exercise, or most standard medications (e.g., conventional statins).

1. Why is this analysis important?

The structure of Lp(a) is unique: it consists of a regular LDL particle to which a special protein is attached — apolipoprotein (a). This combination makes Lp(a) much more dangerous than regular cholesterol for two reasons:

• Atherogenicity (plaque formation): It penetrates the walls of blood vessels more easily and oxidizes, accelerating the growth of atherosclerotic plaques.

• Thrombogenicity (blood clot formation): Structurally, the apo(a) protein is similar to plasminogen (a protein that dissolves blood clots). Lp(a) blocks the work of plasminogen, preventing the body from naturally breaking down microthrombi, which dramatically increases the risk of heart attack and stroke.

2. Indications for use

Lp(a) testing is not part of the standard annual checkup for everyone, but is critically important in the following cases:

• Early development of cardiovascular diseases in the patient or his/her closest relatives (in men under 55 years of age, in women under 65 years of age).

• Having a heart attack or stroke in the absence of obvious risk factors (normal cholesterol levels, healthy lifestyle, normal pressure).

• High levels of "bad" cholesterol (LDL), which is poorly responsive to treatment with standard doses of statins.

• Familial hypercholesterolemia (hereditary high cholesterol).

• Cardiovascular risk assessment in patients with intermediate or high risk for a more accurate prognosis.

3. Reference values (norms)

In most laboratories, results are measured in milligrams per deciliter (mg/dL) or moles per liter (nmol/l).

⚠️ Importantly: Since the level of Lp(a) is genetically determined, this test is usually sufficient. once in a lifetime, to determine your baseline risk.

4. Interpretation of results

What does elevated level mean?

A high level of Lp(a) indicates an increased susceptibility to:

• Coronary heart disease (CHD) and myocardial infarction.

• Ischemic stroke.

• Atherosclerosis of peripheral arteries (damage to the vessels of the legs).

• Stenosis (narrowing) of the aortic valve.

What does a reduced level mean?

Low values have no clinical significance and are considered normal (the lower the Lp(a) in the blood, the better for the vessels).

5. What to do if Lp(a) level is high?

Since it is almost impossible to lower it with diet or standard statins, the strategy to protect the patient is to the strictest control of all other risk factors:

1. Aggressive reduction of LDL cholesterol: If Lp(a) cannot be lowered, it is necessary to lower the usual "bad" cholesterol to the lowest possible values (often using a combination of statins and ezetimibe).

2. Blood pressure and sugar control: Maintaining blood pressure within normal limits and monitoring blood glucose.

3. Lifestyle: Complete cessation of smoking (smoking with high Lp(a) increases the risk of heart attack many times over), regular physical activity, maintaining a healthy weight.

4. Modern therapy (as prescribed by a doctor): Innovative drugs (PCSK9 inhibitors) can reduce Lp(a) by 20-30%, and the latest genetic drugs (siRNA), which are currently undergoing clinical trials, can reduce its level by more than 80%.

Preparation for analysis

• Blood is donated strictly on an empty stomach (8–12 hours of fasting).

• Avoid fatty foods, alcohol, and heavy physical exertion for a day.

• Do not smoke 1–2 hours before blood collection.