What is lipoprotein A/Lp(a)? Why could it put me at high risk for heart attack and stroke?

Lipoprotein A or Lp(a) is a subtype of LDL cholesterol. The BaleDoneen Method calls Lp(a) the "mass murderer" because elevated levels of Lp(a) triples your risk of heart attack and stroke. At the CureCenter, we call it the “worst” or “really bad” cholesterol. Think of it as “highly flammable” lipid.

Elevated Lp(a) affects around 30% of the population, yet it is not included in standard lipid testing. Why?

In the past, the test for Lp(a) was expensive. Today, it only costs about $10 and is becoming more common, yet still not routine. Change in practice tends to be slow, particularly in bureaucratic systems designed to keep revenue flowing through interventions. New drugs and associated revenue are on the horizon, potentially explaining a resurgence in interest.

What causes elevated Lp(a)?

Elevated Lp(a) is a genetically determined root cause with little impact from lifestyle or medications.

Genetics determines Lp(a) levels. You are much more likely to have elevated Lp(a) if you have a family history of high Lp(a).

Why does elevated Lp(a) increase risk for heart attack and stroke?

Lp(a) is made of cholesterol, protein, and fat. Elevated levels (>75 mg/dl) increase the likelihood of development of atherosclerosis, leading to heart attack and stroke. Elevated Lp(a) also increases the risk of calcific aortic stenosis, a valve disease that can lead to heart failure. Finally, it accelerates blood clotting. When atherosclerotic plaque ruptures, a blood clot forms more rapidly to occlude blood flow leading to a stroke or heart attack.

When combined with high levels of inflammation, elevated Lp(a) fuels that inflammation in the artery wall and leads to the formation of plaque.

Lp(a) is not included in standard lipid panels ordered by most doctors. It should be.

While its effect is often lost in the statistics of large population studies, Lipoprotein (a) can be dangerous for the minority with significantly elevated levels. For this reason, everyone should have it measured once, especially if you have:

• Family members who have had a heart attack or stroke at an early age

• Premature vascular disease in the absence of other usual risk factors

• Familial hypercholesterolemia

• Family history of elevated Lp(a)

If your Lp(a) is tested and at a normal level, you will not need a repeat test. Your levels will not rise. However, if it is very high, you and your relatives should know, as they could be at high risk as well. 

How are elevated levels of Lp(a) treated?

Niacin is the most effective supplement/drug to reduce levels of Lp(a). We have also witnessed response to Bergamot BPF, an effect we have not seen reported in the literature but have observed incidentally. In our experience Bergamot BPF has had a favorable effect that rivals or exceeds niacin in some cases, and it reduces insulin resistance,a highly prevalent root cause of atherosclerosis.

Lifestyle and statins tend to have very little effect on reducing high levels of Lp(a). They can, however reduce inflammation contribution to disease and cardiac events. Therefore, knowing about the increased risk from Lp(a) can motivate more proactive measures to control these other root causes more optimally.

Knowing about the presence of this "mass murderer" in your body will make healthy diet, exercise, and other risk reductions more imperative. Information is empowering. Become aware of Lp(a) - the “worst” or “really bad” cholesterol.

For further reading on Lipoprotein A, we recommend the BaleDoneen website.