Lp(a) – a hidden reason behind so many heart attacks and cardiovascular events.

I have been measuring Lp(a) and targeting cholesterol for decades.  A recent study released last week is going to throw some confusing light on this topic and before tiktok and Instagram skew your opinion I want you to really understand what this is and why this marker is so important.

Lp(a) is lipoprotein (a) and you will hear people call it L..P little a.  This is measured in regular labs and if elevated indicates you have a genetic predisposition for cardiovascular events that are independent from your lifestyle.  Once you have Lp(a) elevated, it will always be elevated regardless of how much you change your diet or how much you exercise.  Only now are we starting to see some new age medications lowering this marker but as with anything there is controversy regarding what should happen when this marker turns up.

READ ON to get some facts about Lp(a), why everyone needs to measure this at least once and what you need to do about it….

Lp(a) is a type of lipid that is similar to the so called “bad” LDL but it is more complex and has some extra harmful features.  When this is elevated, there is an increased risk of clotting and plaque formation leading to increased risk of heart attacks, strokes, rhythm issues, heart valve disease (particularly aortic stenosis) and decreased circulation.  Elevated Lp(a) is associated with

  • 85% increased risk of heart attacks
  • 60% increased risk of peripheral arterial disease
  • 60% increased risk of ischemic stroke
  • 50% increased risk of cardiovascular mortality
  • 100% increased risk of calcific aortic valve stenosis

This is present in about 1 in 5 people and you may have this and not even know it!  It is more heritable that high blood pressure and diabetes. You CANNOT lower this marker just by diet, exercise and lifestyle although those factors are very important especially if you have this elevated marker.  I have tried for decades different supplement combinations as well as some medications without much consistent progress.  The only supplement that has some value is niacin but only in high doses which can create a lot of side-effects as well as affect the liver.  Medications like ezetimibe (zetia) don’t lower this as well as most statins.  In fact, some of the statins can actually raise this level.  When I see the Lp(a) high, I always get wary of “normal” cholesterol levels because I have seen people have heart attacks and strokes with “normal” and even “optimal” cholesterol levels for reasons we are still learning.  Bottom line is if you have an elevated Lp(a) then you have a wild card and need to take this seriously.

Recent Newsletters:  Growing MMJ - It's a Science!

Here are a few suggestions when this is elevated:

  1. Measure more than your regular cholesterol levels. Be sure and check ApoB and aim for low levels of all of these. There are a few other markers but the apoB is easily obtained thru regular labs.  If you have plaque already seen somewhere then you will want an apoB less than 50.
  2. Additive factors that increase your risk of plaque. The more you have of these the higher the risk.
    1. Elevated triglycerides – this is an independent risk factor of plaque formation
    2. Elevated LDL – the so called “bad cholesterol”
    3. Low HDL – this is the good cholesterol. Exercise and even lower doses of niacin will help raise this
    4. Elevated blood sugars – even mild elevations contribute (check your A1C and aim for 5.3 or below)
    5. Elevated C reactive protein – this is an inflammation marker
    6. Obesity – increased fat cells are inflammatory
    7. Poor diet especially with ultraprocessed foods
    8. Sedentary lifestyle – exercise really does make a difference
    9. High blood pressure
  3. Right now, the most well known medications on the market that actually lowers the Lp(a) are the PSCK9 inhibitors like Repatha.  This medication is showing decreased cardiovascular events.  There are newer medications in trials now actually targeting lowering LP(a) alone.

The Horizon study evaluated a new drug targeting lowering the lp(a) alone.  They released their data recently and they didn’t see any cardiovascular benefit with lowering Lp(a).  The drug lowered Lp(a) but did not change the risk of cardiovascular events.  There are some questions this study has raised that go way beyond this newsletter but here is the take home message regarding Lp(a):

  • You need to have your Lp(a) measured at least once in your lifetime. If you have a borderline number, you may want to remeasure when you are going thru hormone changes like menopause or andropause as this is the one time you might see this increase.
  • If you have an elevated Lp(a), you have a significant risk of cardiovascular events. Take this seriously and go through all of the additive factors I listed above and tighten things up.  Don’t be afraid to take medications to get those factors in line because the alternative is really not what you want…stroke or heart attack, etc.

To your health,

Laura