Why everyone should take the Lp(a) test at least once in their lifetime

Heart health and cholesterol are a familiar link - we all know about the importance of cholesterol levels, the good HDL and the bad LDL. But there’s another marker that could be just as important, if not more so: lipoprotein(a), or Lp(a).

• Why test for Lp(a)?
• Lp(a) results
• 5 facts on Lp(a)
• Why test at least once in your life?

Why test for Lp(a)?

Testing for Lp(a) is gaining well-deserved attention. This lesser-known cholesterol marker plays a crucial role in heart health. Checking your Lp(a) level at least once in your life could help give you even more clarity into your risk of heart attacks and strokes.

Pronounced L-P-little-a, this molecule transports fats around the body. But, unlike LDL (bad cholesterol), Lp(a) is stickier and more prone to clinging to artery walls. Elevated lipoprotein(a) can form plaques that increase the risk of dangerous blood clots. High lipoprotein(a) levels are now recognised as a significant, independent risk factor for coronary heart disease and stroke.

So, why is it often overlooked in routine health checks? Probably because lifestyle changes only have a small impact on your level. But, that doesn't mean you should stay in the dark about your levels. 

Lp(a) testing on the rise

Over the past year at Medichecks, we’ve seen a steady rise in the number of people testing their Lp(a) levels. This surge is tied to our new Optimal Health Blood Test, which includes Lp(a) as part of its comprehensive panel.

The results from these tests reveal some interesting – and concerning – patterns. While most people’s Lp(a) levels fall within a healthy range, a significant percentage show elevated levels that could indicate increased cardiovascular risk.

What do the results mean?

Here’s what the numbers typically indicate:

• Healthy range: 71.8% of customers had healthy Lp(a) levels, with a result below 90 nmol/L.

• Moderate risk: 21.9% of our customers have levels exceeding 90 nmol/L, putting them at moderate risk of heart disease.

• High risk: 6.6% of individuals have levels over 200 nmol/L, which is considered high risk.

• Very high risk: 0.5% (1 in 200 people) have levels exceeding 400 nmol/L, indicating a very high risk of heart attacks and strokes.

Based on more than 2800 customer results between 01/12/2023 and 30/11/2024. 

Who is most at risk?

Certain groups are more likely to have elevated Lp(a) levels. Post-menopausal women tend to have the highest average levels, with a median result of 34 nmol/L. This increase after menopause is a known phenomenon, even though Lp(a) levels remain relatively stable throughout life for most people.

However, even slim, seemingly healthy, people can have very high levels of Lp(a) – putting them at increased risk of a heart attack. 

What makes Lp(a) different?

Lp(a) stands apart from other cholesterol markers for one key reason: it’s primarily determined by your genetics. Unlike LDL or HDL cholesterol, which can be influenced by diet, exercise, and lifestyle changes, Lp(a) levels remain fairly constant over time, regardless of your habits.

5 facts about Lp(a)

1. Your levels are mostly genetic

Over 90% of your Lp(a) levels are controlled by your genes, specifically the LPA gene. Lifestyle changes like eating healthily or exercising won’t have much impact on this marker, but they are crucial in helping you lower your overall risk.

2. It’s an independent risk factor for heart disease

High Lp(a) levels can increase your risk of heart disease and stroke, even if your LDL cholesterol is normal or well-managed.

3. It’s not included in standard cholesterol tests

Despite its importance, Lp(a) isn’t routinely checked in standard cholesterol panels. To know your levels, you’ll need to request a specific Lp(a) test.

4. Certain groups are more likely to have high levels

Ethnicity plays a role in Lp(a) levels. Black and South Asian populations tend to have higher average levels, while Chinese and Japanese populations generally have lower levels. Additionally, women over 50 are more likely to have elevated Lp(a) compared to men [1].

5. Statins don’t lower Lp(a)

While statins are highly effective for reducing LDL cholesterol, they don’t lower Lp(a) levels – and in some cases, they may even increase them slightly. However, statins are still recommended for those at high risk because they reduce overall cardiovascular risk.

Why testing for Lp(a) matters

Testing your Lp(a) levels can reveal insights into your heart health that other cholesterol tests might miss.

It’s especially crucial for individuals who:

• Have a family history of heart disease or stroke.

• Already have high cholesterol or other cardiovascular risk factors.

• Belong to a group known to have higher average Lp(a) levels, which includes black and South Asian communities.

What can you do if your levels are high?

Lp(a) levels can’t be altered through lifestyle changes or traditional cholesterol-lowering medications like statins. However, the variability in Lp(a) cannot be fully explained by genetic factors alone, emphasising a potential role for non-genetic factors to reduce your overall cardiovascular risk [2]:

• Focus on other risk factors: Keep your LDL cholesterol, blood pressure, and blood sugar levels within a healthy range through lifestyle changes or medications.

• Adopt a heart-healthy lifestyle: While it won’t directly lower Lp(a), eating a balanced diet, staying active, and avoiding smoking can help protect your heart in other ways.

• Consider advanced treatments: Emerging therapies specifically targeting Lp(a) are currently in development and may become available in the future. Heart UK also recommends medications like a statin. Though they don’t lower the amount of Lp(a), they will shrink the size of the lipoproteins and lower non-HDL cholesterol levels. 

Why test at least once in your life?

Since Lp(a) levels are largely determined by genetics and don’t change much throughout life, a single test is often enough to assess your risk. Testing early in your life allows you to take a proactive approach to heart health, especially if your levels are elevated.

Combining Lp(a) with other markers

Lp(a) is just one piece of the puzzle. When combined with other advanced markers like apolipoprotein B (Apo B) and non-HDL cholesterol, it provides a more complete picture of your heart health. These insights can help guide your next steps, whether that’s focusing on prevention, exploring treatments, or making lifestyle adjustments.

Your heart works hard for you every single day. By understanding your Lp(a) levels, you’re taking a vital step toward protecting your long-term health.

References:

1. Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart Journal. 2019;71: 99–112. doi:10.1016/j.ihj.2019.03.004

1. Enkhmaa B, Berglund L. Non-genetic influences on lipoprotein(a) concentrations. Atherosclerosis. 2022;349: 53–62. doi:10.1016/j.atherosclerosis.2022.04.006