What is Lipoprotein (a)?
Have you ever heard of a young, relatively healthy person sudden dropping dead from a heart attack? A major cause of early cardiovascular disease is a genetic type of high cholesterol called Lipoprotein (a), or “L P Little a” for short. This type of cholesterol is particularly sticky to the walls of our arteries and causes disproportionate clogging of our arteries, such as the coronary arteries in the heart. Lp(a) increases risk of coronary heart disease and cardiac death by 20%.1 For people who have levels in the highest 5%, this doubles the risk of having a cardiac event.2
Genetic Prevalence
High Lp(a) affects roughly 25% of the global population and is more common in Black and South Asian individuals, compared to White individuals.3 This type of cholesterol is strongly genetic, with >90% determined by genes, and only a very small percentage determined by lifestyle.4 If a first degree relative of yours, such as a parent or sibling, has high Lp(a), there’s a roughly 2/3rds likelihood that you’re also affected.2
Why to Get Lp(a) Checked
Chances are, even if you’ve had standard cholesterol levels checked with your family doctor, you likely have never had this checked. The Canadian Cardiovascular society recommends that everyone should get their Lp(a) checked once in their lives, with Lp(a) levels reaching a steady state from roughly 5 years old. So, if you check it and it’s high, it’s likely been high from a very young age.
Treatment Options
What can you do if your levels are high? To date, there has not been an effective treatment option available for Lp(a), with standard statin medications having essentially no effect at all on lowering levels. The Canadian Cardiovascular society recommends healthy eating, exercise, and other lifestyle changes, though in truth, while these changes are important, they have minimal effect on lowering levels and focus more on overall cardiovascular risk.5
Thankfully, new therapies are just around the corner: 2 medications in development appear particularly promising for lowering Lp(a). These medications, called pelacarsen and olpasiran, have been shown in early trials to decrease Lp(a) levels by 80 and over 95%, respectively.6,7 Phase 3 trials are underway for both these medications with results for pelacarsen expected later in 2025. If the treatment effect is substantiated without major adverse effects, FDA approval will likely follow.
Ask your physician about getting your Lp(a) checked today – in Ontario it’s covered by OHIP and is a simple blood test that can be done any time of day without fasting.
References
1. Kamstrup PR, Benn M, Tybjærg-Hansen A, Nordestgaard BG. Extreme lipoprotein (a) levels and risk of myocardial infarction in the general population: the Copenhagen City Heart Study. Circulation. 2008 Jan 15;117(2):176-84.
2. Kronenberg F, Mora S, Stroes ES, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky M, Lambert G, Mach F, McNeal CJ. Lipoprotein (a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. European heart journal. 2022 Oct 14;43(39):3925-46.
3. Nissen SE, Wolski K, Cho L, Nicholls SJ, Kastelein J, Leitersdorf E, Landmesser U, Blaha M, Lincoff AM, Morishita R, Tsimikas S. Lipoprotein (a) levels in a global population with established atherosclerotic cardiovascular disease. Open Heart. 2022 Oct 1;9(2):e002060.
4. Langsted A, Kamstrup PR, Nordestgaard BG. Lipoprotein (a): fasting and nonfasting levels, inflammation, and cardiovascular risk. Atherosclerosis. 2014 May 1;234(1):95-101.
5. Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, Francis GA, Genest J, Grégoire J, Grover SA, Gupta M. 2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults. Canadian journal of cardiology. 2021 Aug 1;37(8):1129-50.
6. Tsimikas S, Karwatowska-Prokopczuk E, Gouni-Berthold I, Tardif JC, Baum SJ, Steinhagen-Thiessen E, Shapiro MD, Stroes ES, Moriarty PM, Nordestgaard BG, Xia S. Lipoprotein (a) reduction in persons with cardiovascular disease. New England Journal of Medicine. 2020 Jan 16;382(3):244-55.
7. O’Donoghue ML, Rosenson RS, Gencer B, López JA, Lepor NE, Baum SJ, Stout E, Gaudet D, Knusel B, Kuder JF, Ran X. Small interfering RNA to reduce lipoprotein (a) in cardiovascular disease. New England Journal of Medicine. 2022 Nov 17;387(20):1855-64.