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Is Lp(a) the Best Kept Secret in Heart Disease?

Most people have had their LDL cholesterol measured. Have you ever had your Lp(a) tested? Did you know that statins may actually raise this key risk factor?
Is Lp(a) the Best Kept Secret in Heart Disease?
Test tube with blood sample for LDL-Cholesterol (LDL-C) test

Ask most people about their risk factors for heart disease and they will likely mention total cholesterol (TC), LDL-C (“bad”) cholesterol and HDL-C (“good”) cholesterol. Chances are very good they have never heard about lipoprotein(a) aka Lp(a). It is also referred to as “Lp little a.” This cholesterol-protein particle is rarely measured, but it is a key player in heart disease.

Lp(a) Is a Serious Risk Factor for Heart Disease!

It has been estimated that one fifth of the population has inherited high levels of lipoprotein a (Scientific American, Nov. 4, 2019).  Elevated levels of this lipoprotein can increase the risk of plaque buildup and blood clots.

This may sound cynical, but the reason we suspect that Lp little a has flown below the radar is because there is no pricey pharmaceutical to lower this risk factor for heart disease. There has been no motivation for drug companies to encourage doctors to measure Lp(a) because there was no money in it.

Eating a very healthy diet doesn’t seem to make much of a difference in controlling levels of lipoprotein(a). Neither does exercise. Both niacin and aspirin do seem to lower Lp(a) levels, but it is not clear if doing so prevents heart attacks or strokes.

Do Statins Raise Lp(a)?

Does this question seem heretical? Shortly after statins were introduced in the U.S. in the late 1980s, a drug company researcher contacted us. He had been involved in statin research and was concerned that these drugs might raise a little-known lipid fraction called lipoprotein(a) or Lp little a.

He was in favor of lowering LDL cholesterol with a statin. But he thought that also raising Lp(a) with a statin might be a little like driving with your foot on the gas and the brake simultaneously.

Here is a question about this issue from a reader of our syndicated newspaper column.

Q. I inherited very high levels of Lp(a), and I have known for years there is little I can do to reduce it. I tried niacin, but I can’t tolerate it.

I grew up in Germany where doctors test for this routinely. In the US, I have had difficulty getting it tested.

My cholesterol is around 220, with HDL over 60. Since my LDL is high (around 140), I am now on Crestor.

My doctor said lowering my LDL is vital, because it will also lower the Lp(a). Is that true? I have read a lot about this problem over the years to educate myself. Everything I read says there are no medications to date that lower lipoprotein(a).

I am 69 years old and worked hard for years following a healthy diet so as NOT to take a statin. (I ate tons of oat bran.) The more I read about high lipoprotein(a), the more scared I got. My mother had a stroke. Can a statin drug like the Crestor I now take really lower Lp(a)?

A. Lipoprotein(a) is a particle in the blood that contains fat, protein and cholesterol. In the US, cardiologists have focused primarily on LDL cholesterol as the bad actor in the development of heart disease. Statins are very effective at lowering LDL.

On the other hand, lipoprotein(a) is also an important risk factor for heart disease. High lipoprotein(a) levels can contribute to calcification of aortic valves (Biomolecules, Dec. 2019). 

Surprisingly, statins may actually raise levels of Lp little a (European Heart Journal, May 20, 2019).  A meta-analysis of statin trials found that even when LDL cholesterol levels are lowered, people run a substantially higher risk of heart disease if statins raise their Lp little a above 50 mg/dl (Lancet, Oct. 13, 2018). 

Don’t give up on exercise and diet just because you are taking rosuvastatin (Crestor). You may also want to ask your doctor about an alternate treatment for lowering LDL cholesterol. Evolocumab (Repatha) reduces both LDL and Lp(a) and in your case may be helpful against heart disease (Circulation, March 19, 2019). 

Get Ready for Lipoprotein(a) and New Drugs

We are reading a lot more in the medical literature about Lp little a. We strongly suspect that pharmaceutical companies are moving aggressively into this lipid-lowering arena. We bet that there are drugs in clinical trial and that soon you will be reading about how important Lp(a) is once those drugs are marketed.

Why do we say this?

Here is a relatively recent article that suggests our crystal ball might be surprisingly clear (Annals of Medicine, May 26, 2020):

“Lipoprotein(a) (Lp(a)) was discovered more than 50 years ago, and a decade later, it was recognized as a risk factor for coronary artery disease. However, it has gained importance only in the past 10 years, with emergence of drugs that can effectively decrease its levels.

“Lipoprotein(a) is an important risk factor in patients with cardiovascular diseases. Lipoprotein(a) has many functions, which include proatherosclerotic, prothrombotic, and pro-inflammatory roles. Treatment options to lower lipoprotein(a) levels are currently scarce, but new drugs are on the horizon.”

We only hope that they will be compared head-to-head with niacin and aspirin to see if the pricey new pills are more effective at reducing heart attacks and strokes compared to the old and inexpensive drugs.

What do you think? Have you ever had your lipoprotein(a) levels measured? Has your doctor ever mentioned that statins might raise levels of this important risk factor? Share your thoughts in the comment section below.

Did you find this information helpful? If so, please share it with friends and family. We suspect that most people have never heard of Lp(a). It might account for many heart attacks in people who have a family history of heart disease. You can send this article by clicking on the email, Twitter or Facebook icon at the top of the page and thank you for helping us keep readers up-to-date on new health information. 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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