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Lipoprotein A And Cardiovascular Health

Lipoprotein (a): What is it and how does it impact cardiovascular health

When it comes to cardiovascular health, many of us will be familiar with names like LDL and HDL cholesterol and even perhaps triglycerides, for those with a stronger interest in this subject.

However, there is one very important molecule that very few are talking about, including doctors when presenting you with your annual health check – Lipoprotein(a).

The reason they aren’t talking about this molecule or testing you for elevations in it, is not because it lacks importance, but because there isn’t a drug available to lower it yet.

Unfortunately, this is classic when it comes to allopathic healthcare. If there isn’t a drug to treat it, there is no money to be made and therefore very little attention is given to it.

Lipoprotein(a), also abbreviated as Lp(a) (lp little a), is a lesser-known lipoprotein that plays a significant role in cardiovascular health.

In this article I will be discussing a few areas:

  1. What is lipoprotein (a)?
  2. How does Lp (a) cause heart disease?
  3. What causes high Lp (a)
  4. What could you do to help lower Lp (a) naturally and buffer the side effects?

What is Lipoprotein (a)?

Lipoproteins are lipid carrying vehicles (primarily cholesterol and triglycerides) who’s primary job is to transport them around the body where they are needed.

The two most well-known lipoproteins are low density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDLs are generally regarded as the ‘bad’ type as they carry cholesterol to the peripheries, whereas HDLs are considered more protective as they carry cholesterol away from the peripheries back to the liver to be recycled.

For those who view cholesterol as a primary driver of heart disease, much attention is placed on total cholesterol, LDL, and HDL levels.

Molecularly, Lp(a) is identical to an LDL particle but has a separate protein structure attached to it called apolipoprotein(a) which LDLs do not have.

Elevated levels of Lp(a) have been associated with an increased risk of heart attacks, strokes, and other cardiovascular diseases (CVD).

Studies has suggested a direct causal relationship between Lp(a) and atherosclerotic cardiovascular disease (Lau & Giugliano, 2022).

How does Lp (a) cause heart disease?

There are several reasons why Lp(a) are more atherogenic than your standard LDL;

  1. Lp(a) interferes with the normal breakdown of fibrin, a protein involved in blood clotting, which makes it more likely for dangerous clots to form in the arteries (Farzan & Senthilkumaran, 2022).
  2. Lp(a) has a stronger inflammatory effect resulting in increased damage to the blood vessel wall (Ugovsek & Sebestjen, 2022).

These two factors are arguably much more important to address than levels of LDL and cholesterol levels.

Inflammation and oxidative stress are significant factors when it comes to damaging your vascular lining. The health of your vascular lining is ultimately what then predisposes you to heart disease.

Lp (a) then increases the risk of excessive clotting, leading to a higher likelihood of a cardiac event.

Damage plus an increased risk of clotting = a high risk of a cardiac event.

3. What Causes High Lp (a)?

Elevated Lp(a) levels are largely driven by genetics. Unlike LDL cholesterol, which can be influenced by diet, exercise, and lifestyle, Lp(a) levels are mostly inherited and do not fluctuate significantly with lifestyle changes.

Roughly 20% of the population has elevated Lp(a) levels, and this is often undetected because Lp(a) is not commonly tested during routine cholesterol screening, probably for the reasons mentioned previously.

However, Lp (a) is a marker that we include in our health assessment and consultation packages, which you will find in our testing services section.

Clinical reference ranges for lipoprotein (a)

The clinical reference range for Lp(a) is <75nmol/L. However, above 50 is of interest.

Cardiovascular risk is more than lipoprotein (a)

While elevated Lp(a) levels can certainly increase the risk of having a cardiac event, there’s no single blood test marker that can definitively indicate whether somebody will have one or not. It exists more like a spectrum where individuals will fall under a ‘higher risk’ category or low/moderate risk. What we have to begin to appreciate is that the development of vascular disease is a process, with no one single cause.

Your Lp(a) number will contribute towards your overall risk which determines where you sit on this spectrum and probably has the biggest impact on those who appear otherwise healthy.

In other words, if you have obesity, dyslipidemia (high triglycerides, & low HDL), metabolic diseases like insulin resistance and type 2 diabetes, if you smoke, have issues with stress and your mental health, poor social connections etc, your risk of a cardiac event is already quite high.

However, if you are not a “high risker”, lipoprotein (a) may still be of significant relevance as high levels may still significantly increase your risk of vascular disease. The excessive clotting, inflammation and oxidative damage are often silent killers. These are the issues that have a major impact on that person you thought was healthy but dropped down dead from a heart attack or stroke.

So, my advice to you, get your Lp (a) assessed and know whether you are one of the 1.4 billion people on this planet that have high Lp (a) levels!

What Could You Do to Help Lower It Naturally?

Using lifestyle changes to manage Lp (a) risk

While our genes may set the baseline, lifestyle plays a significant role in influencing cardiovascular risk.

Knowing that your Lp (a) levels are high means you need to get on top of your other risk factors and lifestyle habits that might contribute to vascular disease pronto!

That means being a non-smoker for sure and minimising your exposure to other things that produce smoke, toxins or heavy metals.

Adopting a dietary approach that prioritises cardiovascular health, reducing inflammation and supporting you with plentiful antioxidants.

Managing stress and getting support with any chronic mental health issues.

The list can go on and as part of our ‘Beat The Cardiovascular Clock’ Program we cover all areas of lifestyle to optimise your cardiovascular health.

Using supplements to manage Lp (a) risk

I would also consider adding in natural supplement support that helps to reduce the side effects of having high Lp (a). Examples below:

Vitamin C – To support the health and regeneration of collagen that repairs and makes up the lining of the vascular wall.

CoQ10 – General support for the health and functional of the endothelial lining of your blood vessels and helps to reduce oxidative stress.

Omega 3 fish oil with vitamin E – Has broad anti-thrombotic effects, anti-inflammatory effects and will help to support the health of the vascular lining.

Then you have a couple of potential things to experiment with for influencing Lp (a) levels directly.

Niacin – Niacin (vitamin B3) shows promise in lowering Lp (a) by 20%, with some case studies suggesting as much as 60-80%. One challenge is it can cause flushing (a warm, tingling sensation on the skin), which makes it difficult for some people to tolerate.

Lysine – This is based more on theory and early small-scale studies rather than solid robust evidence. However, there is some suggestions that Lysine may help to block the binding sites for Lp (a).

Conclusion

One of the most dangerous aspects of elevated Lp(a) is its ability to promote clot formation. As mentioned, Lp(a) interferes with plasminogen, a precursor to plasmin, which is responsible for breaking down clots.

When Lp(a) levels are high, the body’s ability to dissolve clots is compromised, increasing the risk of thrombosis.

Additionally, Lp(a)-induced endothelial damage can lead to plaque formation, which may rupture and trigger clot formation. This makes it critically important to manage atherosclerosis and maintain healthy blood vessels. Reducing endothelial damage through diet, exercise, and potentially anti-inflammatory supplements is essential for those with high Lp(a) levels.

I would also look out for medications and supplements that might increase clotting issues. Common prescribed and over the counter meds used chronically such as PPIs and NSAIDs have been linked with increased clotting risk.

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References

  1. Duarte Lau F, Giugliano RP. Lipoprotein(a) and its Significance in Cardiovascular Disease: A Review. JAMA Cardiol. 2022 Jul 1;7(7):760-769. doi: 10.1001/jamacardio.2022.0987. Erratum in: JAMA Cardiol. 2022 Jul 1;7(7):776. PMID: 35583875.
  2. Enkhmaa B, Petersen KS, Kris-Etherton PM, Berglund L. Diet and Lp(a): Does Dietary Change Modify Residual Cardiovascular Risk Conferred by Lp(a)? Nutrients. 2020 Jul 7;12(7):2024. doi: 10.3390/nu12072024. PMID: 32646066; PMCID: PMC7400957.
  3. Farzam K, Senthilkumaran S. Lipoprotein A. [Updated 2022 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570621/
  4. Melita H, Manolis AA, Manolis TA, Manolis AS. Lipoprotein(a) and Cardiovascular Disease: A Missing Link for Premature Atherosclerotic Heart Disease and/or Residual Risk. J Cardiovasc Pharmacol. 2022 Jan 1;79(1):e18-e35. doi: 10.1097/FJC.0000000000001160. PMID: 34694242.
  5. Ugovšek S, Šebeštjen M. Lipoprotein(a)-The Crossroads of Atherosclerosis, Atherothrombosis and Inflammation. Biomolecules. 2021 Dec 24;12(1):26. doi: 10.3390/biom12010026. PMID: 35053174; PMCID: PMC8773759.
  6. Wilson DP, Jacobson TA, Jones PH, Koschinsky ML, McNeal CJ, Nordestgaard BG, Orringer CE. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019 May-Jun;13(3):374-392. doi: 10.1016/j.jacl.2019.04.010. Epub 2019 May 17. Erratum in: J Clin Lipidol. 2022 Sep-Oct;16(5):e77-e95. PMID: 31147269.
  7. https://www.jacc.org/doi/10.1016/S0735-1097%2823%2903757-9#
  8. Lp(a)’s interference with plasminogen: Reference: Boffa, M. B., Marcovina, S. M., & Koschinsky, M. L. (2004). Lipoprotein (a) as a risk factor for atherosclerosis and thrombosis: mechanistic insights from animal models. Clinical Biochemistry, 37(5), 333–343.
  9. Role of Lp(a) in plaque formation and rupture: Reference: Caplice, N. M., & Panetta, C. (2003). Lipoprotein(a) and vascular disease. Atherosclerosis, 170(1), 1–8.
  10. Vitamin C’s role in vascular health and endothelial support: Reference: Frei, B., & Lawson, S. (2008). Vitamin C and atherosclerosis. Proceedings of the Society for Experimental Biology and Medicine, 222(3), 196–204.
  11. CoQ10 and endothelial function: Reference: Rosenfeldt, F., Hilton, D., Pepe, S., & Krum, H. (2003). Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure. BioFactors, 18(1–4), 91–100.
  12. Omega-3 fatty acids’ cardiovascular benefits: Reference: Calder, P. C. (2012). Mechanisms of action of (n-3) fatty acids. Journal of Nutrition, 142(3), 592S–599S.
  13. Niacin and its impact on Lp(a) levels: Reference: Albers, J. J., Slee, A., O’Brien, K. D., Robinson, J. G., Kashyap, M. L., Kwiterovich, P. O., & Davidson, M. H. (2010). Effects of extended-release niacin on lipoprotein (a): the AIM-HIGH trial. Atherosclerosis, 219(2), 557–562.
  14. Lysine and Lp(a) binding theory (Dr. Linus Pauling’s work): Reference: Pauling, L., & Rath, M. (1992). Solution to the puzzle of human cardiovascular disease: its primary cause is ascorbate deficiency leading to the deposition of lipoprotein(a) and fibrinogen/fibrin in the vascular wall. Journal of Orthomolecular Medicine, 6(3), 125–134.
  15. Genetic factors behind high Lp(a): Reference: Clarke, R., Peden, J. F., Hopewell, J. C., Kyriakou, T., Goel, A., Heath, S. C., & Farrall, M. (2009). Genetic variants associated with Lp(a) lipoprotein level and coronary disease. New England Journal of Medicine, 361(26), 2518–2528.
  16. Lp(a) and fibrin breakdown/clot formation: Reference: Boffa, M. B., & Koschinsky, M. L. (2016). Oxidized phospholipids as a unifying theory for lipoprotein(a) and cardiovascular disease. Nature Reviews Cardiology, 13(12), 731–739.
  17. Inflammatory effect of Lp(a): Reference: Tsimikas, S. (2017). The re-emergence of lipoprotein(a) in a broader clinical arena. Progress in Cardiovascular Diseases, 60(1), 27–35.
  18. Lp(a) and vascular damage/clot formation: Reference: Feric, N. T., & Boffa, M. B. (2021). The role of lipoprotein(a) in cardiovascular disease. Journal of Internal Medicine, 289(4), 501–507.
  19. Study on the link between Lp(a) and cardiovascular risk: Reference: Tsimikas, S., & Hall, J. L. (2012). Lipoprotein(a) as a potential causal genetic risk factor for cardiovascular disease: a clinical chemistry perspective. Clinical Chemistry, 58(3), 497–500.