Lipoprotein(a), or Lp(a), is one of the least known cardiovascular risk factors – and one of the most important. Of genetic origin, it can increase the risk of heart attack and stroke even in people with apparently normal cholesterol
Cardiovascular prevention has evolved a lot, but there are still risk factors that go unnoticed in routine exams. Lp(a) is one of them.
It is estimated that around 20% of the population has high levels of this lipoprotein, often without knowing it. Unlike traditional cholesterol, it is not usually included in basic check-ups, which contributes to its underdiagnosis.
A risk that does not appear in the basics
Lp(a) is a particle similar to LDL, the so-called “bad cholesterol”, but with an additional characteristic: it has a protein that increases its ability to promote inflammation and the formation of plaque in the arteries.
The most important point is that your levels are determined almost exclusively by genetics. In other words, they do not respond significantly to diet, exercise or weight loss.
This means that a person can have healthy habits and controlled cholesterol and still have an increased cardiovascular risk due to Lp(a).
Why almost no one measures
Despite already being included in more recent international guidelines as a relevant risk factor, the test is still rarely requested in clinical practice.
Part of this is explained by the tradition of focusing on classic factors, such as total cholesterol, LDL, hypertension and diabetes. Another reason is that, until recently, there were few specific treatment options targeting Lp(a), which reduced the perceived usefulness of the test.
This scenario, however, is changing. It is now recognized that measuring Lp(a) at least once in a lifetime can help identify people at hidden risk, especially those with a family history of early heart attack or cardiovascular disease with no apparent explanation.
What to do when you discover high levels
Receiving a high Lp(a) result does not mean that a cardiovascular event will occur, but it does indicate the need for greater attention.
As there are currently no widely available interventions capable of significantly reducing this lipoprotein, the main strategy is to strictly control other risk factors.
This includes keeping LDL cholesterol at lower levels, controlling blood pressure, avoiding smoking, practicing physical activity and taking care of metabolic health.
Furthermore, new specific therapies are under development and have shown promising results in clinical studies, with the potential to significantly reduce Lp(a) levels in the future.
Lp(a) represents a clear example of how genetics can silently influence cardiovascular risk.
Identifying this factor is an opportunity to act earlier and more precisely – before the problem manifests itself.
Dr. Ana Paula Andrade Garcia – CRM-SP 151.840
Cardiology
Membro Brazil Health
