Lipoprotein(a) and Heart Health: Understanding Risks and Strategies

You may be familiar with the terms “bad cholesterol” (LDL) and “good cholesterol” (HDL). Doctors are beginning to understand that the story is even more complicated than this. We now understand that specific types of cholesterol-carrying particles (lipoproteins) affect the risk of stroke and heart attack. One of these particles is called lipoprotein(a). This article summarizes what we know about lipoprotein(a) and cardiovascular risk, when to test for it, and what we should do about high levels.


What are Lipoproteins

Cholesterol and triglycerides are lipids (fats). Unlike proteins, they are not water-soluble. The body packages lipids with proteins to make them soluble in the blood to transport them into the bloodstream. These microscopic transport particles are called lipoproteins. Cholesterol enters the body from the diet via the intestine and is also manufactured in the liver.

The body needs cholesterol to make cell membranes and certain hormones. Different lipoproteins transport lipids from the small intestine (i.e. from dietary intake) to the liver, from the liver to the peripheral tissues to be utilized, and from the peripheral tissues back to the liver to be degraded.

Lipoprotein(a) and Heart Health: Understanding Risks and Strategies Heart Matters

The primary types of lipoproteins of clinical relevance are:

Low-Density Lipoprotein (LDL): Often referred to as “bad” cholesterol, high levels of LDL can lead to cholesterol buildup in arteries, increasing the risk of heart disease.

High-Density Lipoprotein (HDL): Termed “good” cholesterol, HDL helps remove excess cholesterol from the bloodstream, reducing the risk of arterial plaque formation.

Very Low-Density Lipoprotein (VLDL): VLDL carries triglycerides and cholesterol from the liver to cells throughout the body. As VLDL particles release triglycerides, they become LDL particles, contributing to artery plaque formation if present in excess.

Lipoprotein(a) – The Lesser-Known Player: Lp(a) is a unique lipoprotein that consists of an LDL-like particle linked to a protein called apolipoprotein(a). While its exact function is still being studied, elevated Lp(a) levels have been associated with an increased risk of atherosclerosis, heart attacks, and strokes.


Emerging Evidence of Cardiovascular Risk 


Recent research has underscored the significance of Lp(a) in cardiovascular health. High levels of Lp(a) appear to contribute to the narrowing of arteries, thrombosis (blood clot formation), and inflammation, all of which are key factors in cardiovascular disease.

High levels of Lp(a) in the blood have been associated with an increased risk of heart disease, stroke, and peripheral artery disease. Lp(a) can contribute to the development of atherosclerosis, which is the buildup of plaque in the arteries. This can lead to blockages and reduce blood flow to the heart and other organs, increasing the risk of heart attack and stroke.

Lp(a) levels are primarily determined by genetics, meaning some people are likelier to have higher Lp(a) levels than others. However, lifestyle factors like diet, exercise, and smoking can influence Lp(a) levels.


How can Lp(a) levels be measured?

Lp(a) levels can be measured with a blood test. However, it is important to note that Lp(a) levels can vary widely depending on the laboratory that performs the test. In addition, Lp(a) levels do not respond to lifestyle changes or medications like other types of cholesterol do.


When to Consider Lp(a) Testing

Lp(a) testing may be considered under the following circumstances:

Family History:

Individuals with a family history of premature cardiovascular disease may have a genetic predisposition to elevated Lp(a) levels.

Unexplained Heart Disease:

If someone experiences heart disease at a young age or without traditional risk factors, Lp(a) testing could offer insights.

Recurrent Cardiovascular Events:

For those who continue to experience cardiovascular events despite standard treatments, Lp(a) levels could provide additional diagnostic information.


Treatment Strategies

No medication is specifically approved to lower Lp(a) levels. However, some medications that lower LDL cholesterol may also moderately affect Lp(a) levels. These include statins, niacin, and PCSK9 inhibitors. In addition, lifestyle changes such as eating a healthy diet, exercising regularly, maintaining a healthy weight, and quitting smoking may help lower Lp(a) levels to some extent. However, these lifestyle changes may have a smaller effect on Lp(a) levels than other cholesterol types.

Lifestyle modifications:

There is a strong genetic predisposition to high lipoprotein levels (a). Lifestyle changes have only a minimal effect on lipoprotein(a) levels. However, the risk of heart attack and stroke is multifactorial, and instituting a healthy lifestyle (maintaining a heart-healthy diet, regular exercise, and avoiding smoking) will reduce overall cardiovascular risk significantly.


Niacin and certain medications like PCSK9 inhibitors and novel RNA-targeted therapies are being investigated for their potential to lower Lp(a) levels.

Awareness and management of other risk factors:

Identifying high Lp(a) levels allows for proactive management of other risk factors, such as blood pressure and diabetes.



Lipoprotein(a) might not be as widely recognized as LDL and HDL cholesterol, but emerging evidence suggests it plays a significant role in cardiovascular health. Understanding the nuances of cholesterol carriers in the blood and the potential risks associated with elevated levels can empower individuals and healthcare professionals to make informed decisions. As research continues to unfold, targeted testing and treatment strategies could contribute to more personalized approaches to reducing cardiovascular risk. Always consult a healthcare provider for personalized guidance on testing and management strategies.

Search articles


Subscribe for exclusive heart health resources, valuable tips, and the latest research updates.

Editor's Picks

Empowering heart health

Subscribe to our newsletter and be the first to receive valuable insights, tips, and resources on heart health.

other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.