The heart disease risk factor you probably haven’t heard of: Lipoprotein (a)

Heart Health

by Bethany Zachariah   and Anandita Kulkarni, MD

Oct 21, 2021

True or false? If you’ve eaten “heart-healthy” your whole life and exercise daily, you’re not at any risk for a heart attack. The answer: False.  

A few years ago, Bob Harper, a trainer from reality TV show “The Biggest Loser,” had a heart attack at 52 years old. But how? Wasn’t he healthy and active? Turns out, right under his nose—and the noses of many others—another powerful factor has been lurking and wreaking havoc on hearts. It’s called Lipoprotein(a).  

What exactly is lipoprotein(a) or Lp(a)?

Lipoprotein(a) is a genetically inherited emerging risk factor for heart disease that is often undiagnosed or under diagnosed until people develop heart disease. Lipoprotein(a) is similar in structure to low-density lipoprotein (LDL) cholesterol, aka the “bad cholesterol” that causes heart disease.  

Having elevated lipoprotein(a) can put you at high risk for heart disease. High levels of lipoprotein(a) cause different types of heart disease, including blockages in the coronary arteries and disease of the heart valves, namely aortic stenosis (narrowing of the aortic valve).  

Studies show that, even without other risk factors for heart disease, people can develop heart disease simply because of elevated lipoprotein(a). 

Here’s the really scary part. Approximately 20% of the world’s population has high lipoprotein(a) levels, meaning that 1 in 5 individuals are at a higher risk for heart disease.

How do you know if you have elevated levels of Lp(a)? 

Ask your doctor to measure your lipoprotein(a) level through blood work. Unlike other types of cholesterol, lipoprotein(a) levels typically remain constant over your lifetime. So, you really only need to have it checked once in your lifetime to evaluate your risk for heart disease.  

Let’s say your Lipoprotein(a) is elevated. Now what? 

Again, lipoprotein(a) levels generally stay the same over your lifetime. Unlike other forms of cholesterol, you cannot lower your lipoprotein(a) by eating better or exercising more. It is also not something that can be reduced with current standard medications such as statins often used to lower cholesterol.  

Currently, medications and other therapies for reducing lipoprotein(a) are still being tested in clinical trials. So, it may be a while before we have something that can help us fight this other factor in causing heart disease. 

However, this is not to say that having elevated lipoprotein(a) makes you powerless. In fact, there are lots of ways to protect yourself and your family from heart disease: 

  • Know your numbers. Have your cholesterol and lipoprotein(a) measured with blood work (aka “get tested”).
  • Consult an expert. If your lipoprotein(a) is elevated, consult with a preventive cardiologist or lipid specialist to see how you can lower your risk for heart disease.
  • Talk to family. Ask your family members, particularly your first-degree relatives, to get screened for high lipoprotein(a).
  • Lead a healthy and active lifestyle. Eat a balanced diet and get regular exercise. Even though this will not directly lower your lipoprotein(a) level, these healthy lifestyle habits protect against heart disease overall (in addition to most other chronic medical conditions).

Next steps

You shouldn’t wait to develop heart problems to see a cardiologist. Seeing a preventive cardiologist is an excellent way to be proactive about your health and take the necessary steps today to avoid future heart problems. Whether you’re 20 or 80 years old, it is never too early or late to start improving your heart health.

About the Author

Bethany Zachariah, BS in Healthcare Management, is a medical assistant and aspiring medical student. Bethany is active in community advocacy and clinical research. She feels strongly about educating and empowering those around her to learn about heart disease and its risk factors.

Anandita Kulkarni, MD, is a preventive cardiologist and women's heart specialist on the medical staff at Baylor Scott & White The Heart Hospital – Plano's Center for Cardiovascular Disease Prevention. Dr. Kulkarni is a national leader in the field of preventive cardiology and lipidology. Her clinical expertise lies in the management of complex lipid disorders, women’s cardiovascular health, South Asian cardiovascular health, and cardiac imaging. Schedule an appointment with Dr. Kulkarni today.

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