Testing for elevated Lp(a)
Testing for elevated Lp(a)
Most people with elevated levels of Lp(a) experience no symptoms and have no idea they are affected. Therefore, if a blood-related family member is found to have elevated Lp(a), other family members should be tested, including children.
People with known risk factors for cardiovascular disease or who have a family member with cardiovascular disease should also discuss the possibility of being tested with their doctor.
Lp(a) levels can be measured by a simple blood test. However, most standard cholesterol tests do not include screening for Lp(a) and so it must be specifically requested. Lp(a) levels are considered elevated if they are above 50mg/dl (500mg/L) or 120nmol/L.
Who should be tested for elevated Lp(a)?
Elevated Lp(a) is a genetic condition so when one person in a family is diagnosed, other family members (parents, siblings and children) should also be tested.
The European Atherosclerosis Society and European Society of Cardiology recommend that screening for Lp(a) is offered to people who are at intermediate, moderate or high risk of developing cardiovascular disease. This includes the following groups of people:
- Those closely related to somebody who has a high level of Lp(a) (sibling, parent or child).
- Those with a family history of cardiovascular disease, particularly if this occurs at a young age (younger than 55 years for men and younger than 65 years for women).
- People who have had a heart attack or stroke with no other known risk factors (smoking, high cholesterol, diabetes or obesity).
- Those with familial hypercholesterolemia (an inherited form of very high LDL cholesterol levels).
- People who have high LDL cholesterol levels even when they take statins or other LDL lowering medications.
Anyone who believes they fall into any of these categories should talk to their doctor about being tested for elevated Lp(a).
+ How is Lp(a) treated?
Current medicines that are used to lower lipid (fat) levels in the blood do not have a meaningful effect on Lp(a), and are less effective overall in people with high levels of Lp(a).
In people with elevated Lp(a), the emphasis is on treating other modifiable risk factors, such as high LDL cholesterol in general, high blood pressure, raised blood sugar and obesity. The aim is to reduce the overall risk of cardiovascular disease. Lifestyle factors such as poor diet, smoking and lack of physical activity should also be addressed. The earlier elevated Lp(a) levels are diagnosed (e.g. in childhood, for children of diagnosed adults), the earlier positive lifestyle choices can be taken.
A number of new treatment approaches are currently being investigated. One of these, gene ‘silencing’ therapy, has the potential to reduce levels of Lp(a) and thereby reduce the risk of cardiovascular disease.
+ Key treatment options
- Medications such as statins are sometimes used in the management of raised Lp(a) but they usually have little effect on Lp(a).
- A number of other medications are used to reduce risk of cardiovascular disease. These include: niacin (vitamin B3), calcium channel blockers, ACE inhibitors and PCSK9 inhibitors.
- A low dose of aspirin may be recommended for some people to reduce the risk of heart attack or stroke.
- The emphasis is on treating other modifiable risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, diabetes or raised blood sugar and obesity. People with or at risk of cardiovascular disease may be prescribed specific medication to manage these.
- Lifestyle measures such as stopping smoking, taking regular physical exercise and eating a balanced diet, also play an important role in reducing the overall risk of cardiovascular disease. Particular in children with elevated Lp(a) for whom other medication would not be appropriate. See ‘further reading’ for advice on a healthy lifestyle.
- Specialist treatments such as apheresis may be considered for specific groups of patients. [Heart UK] This is a blood filtering process, similar to dialysis, that temporarily removes particles of Lp(a). This treatment is only suitable for a small group of high-risk patients as it needs to be repeated every one or two weeks and carries certain risks.
- Treatment for elevated Lp(a) is progressing all the time. A number of new treatment approaches are currently being investigated. These include a gene ‘silencing’ therapy that is designed to temporarily block a specific gene’s message that would otherwise trigger an unwanted effect. In this case, it aims to ‘silence’ LPA, a gene that tells the body to make a specific protein that is only found in Lp(a). It is hoped that silencing LPA will lower levels of Lp(a) and this has the potential to reduce the risk of heart disease, heart attacks and strokes at any age.