AUTHOR – Constance Bos
March 24 is Lipoprotein(a) Awareness Day! Lipoprotein(a), or Lp(a) (pronounced L-P-little-a), is a common, genetic, and independent risk factor for heart disease and stroke. Despite affecting nearly 1 in 5 people worldwide, 6 to 8 million people in Canada, Lp(a) remains under-recognized, and many have never been tested for it.
Why Lp(a) Matters
Lp(a) is similar to LDL (“bad” cholesterol) but has an added component called apolipoprotein(a), which makes it particularly dangerous. High Lp(a) contributes to plaque buildup in arteries, increased inflammation, and blood clot formation, raising the risk of:
✔ Heart attacks
✔ Stroke
✔ Aortic valve stenosis, a condition that narrows the heart’s aortic valve
Unlike LDL cholesterol, Lp(a) is mostly determined by genetics, meaning diet and lifestyle changes have little effect on its levels. On a per-particle basis, Lp(a) is estimated to be six times more atherogenic than LDL, meaning it promotes artery blockages at a much higher rate.
Certain populations, such as people of African or South Asian descent, tend to have higher Lp(a) levels, although the increased cardiovascular risk applies across all ethnic groups.
Lp(a)] is similar to LDL (“bad” cholesterol) but has a unique structure. It has a core made up of fats (lipids) and cholesterol, like LDL, and contains a protein called apolipoprotein B100 (apoB), which contributes to artery blockages. However, what sets Lp(a) apart is its outer layer, which includes a special protein called apolipoprotein(a) [apo(a)], made up of repeating, looped protein structures known as kringles (KIV subtypes).
Testing and Awareness
Despite its clinical importance, Lp(a) is not part of routine cholesterol testing, leaving many unaware of their risk. Recognizing this gap, national and international guidelines, including the Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines, recommend measuring Lp(a) at least once in a lifetime. Testing is particularly crucial for:
🔹 Individuals with a family history of premature heart disease
🔹 Those with early or unexplained cardiovascular events
🔹 People with persistently high LDL cholesterol despite treatment
Molar-based measurements are increasingly recommended for standardized cardiovascular risk assessment, with the Canadian Cardiovascular Society considering ≥100 nmol/L a significant threshold, while mass-based measurements use ≥50 mg/dL as a treatment threshold.
At the Canadian Cardiovascular Congress 2024, the Canadian Cardiovascular Society hosted an expert panel titled “Lp(a): A Small Particle with a Large Impact – 10 Things You Need to Know”, which focused on testing strategies, risk assessment, and the latest evidence-based management approaches.
Future Treatment
Exciting new therapies are in development. Drugs like pelacarsen and olpasiran, which block Lp(a) production at the genetic level, have shown 70-95% reductions in clinical trials. Researchers eagerly await results from phase 3 trials to determine whether lowering Lp(a) will reduce heart attacks and strokes.
Key Takeaway
Lp(a) is a silent but powerful risk factor for heart disease and stroke. Since it is genetic and unaffected by lifestyle, everyone should get tested at least once. Greater awareness and early detection can lead to better prevention strategies. In the near future, targeted treatments may help reduce risk.