What Is Lipoprotein, and Should You Have Your Levels Checked?

Even with optimal diet, exercise, and stress management, some cardiovascular risks may be hardwired into your DNA. It’s possible to carry a genetic variant that makes you more susceptible to higher levels of lipoprotein(a) (Lp(a)), a specific LDL particle that carries unique risks for heart health.

Lp(a) includes an added protein that makes it extra sticky, inflammatory, and clot-promoting. It can silently increase the risk for heart disease, even if other lipid levels look normal. Levels below 50 nanomoles per liter are generally considered within the optimal range, while levels above 125 nano­moles per liter are associated with a higher risk of cardio­vascular disease.

Unlike traditional LDL, Lp(a) is not directly affected by diet or exercise, making it frustratingly resistant to the usual heart-health strategies. Statin drugs do not lower Lp(a) levels and can sometimes even increase them, though statins’ overall LDL-lowering effects may still provide a net benefit for those with elevated Lp(a).

Currently, there’s no proven treatment for lowering Lp(a) that alters CVD outcomes. “We don’t have clear evidence yet that manipulating or reducing Lp(a) changes risk, but the pharmaceutical industry has developed drugs that lower Lp(a), and large-scale clinical trials are being done right now,” says Joseph Marine, MD, FACC, a clinical cardiac electrophysiologist at Johns Hopkins Hospital.

In the meantime, there’s increasing consensus among experts that it’s worth having your levels tested. “Everyone should have Lp(a) measured at least once in their life,” says integrative cardiologist Mimi Guarneri, MD, FACC.

Because elevated levels are usually genetically determined and not subject to much fluctuation, a one-time test can offer valuable insight into your baseline cardiovascular risk. The European Society of Cardiology already includes it in its guidelines; U.S. guidelines may soon follow suit.

While pharmaceutical interventions are in development, some functional-medicine practitioners have used supplements to address elevated Lp(a), including niacin, CoQ10, estrogen (in women), and aronia berry. Responses to these supplements are highly individual and not always clinically significant, notes Guarneri.

What is clear is that elevated Lp(a) acts as a force multiplier, compound­ing the risks of high LDL, inflammation, and insulin resistance. The presence of elevated Lp(a) is a good reason to double down on anti-inflammatory habits and take a comprehensive approach to managing all other risk factors for heart health, including using a statin to lower overall LDL if your provider recommends it.