Your doctor may request Lp(a) measurement if you have a family history of premature cardiovascular disease or elevated Lp(a) or if you develop cardiovascular disease at a young age, particularly in the absence of conventional risk factors
A blood sample taken from a vein in your arm
No test preparation is needed.
Lp(a) is a risk factor for heart disease especially when LDL cholesterol is also raised. Lp(a) is a lipoprotein comprising a lipid rich core surrounded by two proteins, apolipoprotein B100 and apolipoprotein (a).
Lp(a) may accelerate atherosclerotic damage (atheroma) by increasing the size of plaque/atheroma in artery walls. It is retained in the artery wall more than LDL cholesterol as it binds to the artery lining through apolipoprotein (a). Lp(a) is also thought to increase risk of heart attacks by interfering with clotting mechanisms and therefore promoting clot development on the inner surface of blood vessels.
This dual action may explain the role of Lp(a) in the promotion of cardiovascular disease (CVD).
Lp(a) concentrations within the blood are genetically determined and will remain fairly constant in an individual over a lifetime. Concentration is not affected by diet, exercise, and other lifestyle modifications used to lower lipids within the blood. Lp(a) concentrations are slightly lower in men than in women and increase slightly in women after the menopause. The concentration of Lp(a) also varies with ethnicity: patients of African American descent can have concentrations up to 4 times higher than Caucasians, but they may not have a higher risk for CAD.
How is it used?
Lp(a) may be requested with other lipid tests in patients who have developed cardiovascular disease at a young age or who have a family history of premature heart disease. Its measurement will tell the doctor whether the concentration of Lp(a) is contributing to the patient’s risk of cardiovascular disease. Since the concentration of Lp(a) is largely genetically determined, lifestyle changes or treatment with statins or fibrates will usually be ineffective in lowering the concentration.
Current advice for the treatment of those known to have a high Lp(a) level is to treat other modifiable risk factors maximally, particularly LDL cholesterol. Aspirin may be added if there are no contra-indications, in order to reduce the risk of thrombosis. Once levels of Lp(a) have been determined, they do not usually need to be checked again, but it is important to continually monitor the other risk factors. There are several new medications currently in development, which may have an effect on Lp(a) levels.
When is it requested?
Lp(a) may be requested, with other lipid tests, when you have a family history of premature coronary artery disease or of raised Lp(a), or you have developed symptoms of cardiovascular disease at a young age which are not explained by conventional risk factors (e.g. high total cholesterol or LDL-cholesterol).
What does the test result mean?
Lp(a) concentrations within the blood are genetically determined and remain relatively constant over an individual’s lifetime. They are not affected by lifestyle changes or by most drugs.High Lp(a) concentrations increase a person’s risk for developing coronary artery disease and cerebral vascular disease, especially in patients with hypercholesterolaemia.
Is there anything else I should know?
The European Atherosclerosis Society currently recommends patients with an intermediate, moderate or high risk of cardiovascular disease should have their Lp (a) levels measured. This should include those with premature cardiovascular disease, familial hypercholesterolaemia (FH), family history of premature cardiovascular disease, family history of elevated Lp(a) and those with recurrent cardiovascular disease despite optimum medical treatment.