When assessing heart disease risk, most physicians measure three things: your cholesterol, blood sugar, and blood pressure levels. But there’s another key biomarker that deserves a place on your CVD risk management plan: Lp(a), or lipoprotein(a).
It’s long been accepted that high Lp(a) increases your risk for heart problems. Some physicians believe it’s “even worse than LDL as a risk marker for cardiovascular disease.”
But maybe, just maybe, the science is more complex.
I’ll show you the research so you can come to your own conclusions.
What is Lp(a)?
Lipoprotein(a) is a liver particle that transports fat, protein, and cholesterol. It’s similar in structure to ‘bad’ cholesterol, or LDL, since it carries the same ApoB-100 protein. But it also has an extra apolipoprotein(a) lipoprotein, which makes it ‘stickier’ than your average LDL particle. It’s therefore more likely to build up in vessels and arteries.
Numerous studies suggest that Lp(a) is an independent risk factor for cardiovascular disease. Some research shows as much as a two-to-three-fold increase for myocardial infarctions, otherwise known as heart attacks.
To make matters more concerning, many physicians believe Lp(a) is genetically determined. Around 20% of the population, or one in five people, live with familial (i.e., inherited) elevated Lp(a).
So, does this mean you’re genetically determined to suffer an early death? Or doomed to a lifetime of fear and medication?
Not necessarily.
Let’s take a closer look.
- Some studies show that elevated Lp(a) may only be predictive of cardiac risk when CRP is elevated as well.
- There are many non-genetic influences for elevated Lp(a), including low-fat diets.
- High Lp(a) may cause (or be exacerbated by) inflammation, which accelerates plaque formation in vessels.
To summarize: high Lp(a) isn’t a death sentence. It’s true high levels may contribute to atherosclerosis, but they’re almost always in the setting of poor metabolic health.
So if you’re willing to address surrounding lifestyle factors, there’s a very good chance you’ll lower your risks.
What causes your Lp(a) to elevate?
Two things in particular:
1. Inflammation
Lp(a) and inflammation are tied at the hip, very much in a chicken-or-the-egg scenario. One researcher writes that “Lp(a) itself promotes inflammatory processes, and vice versa, inflammatory conditions are associated with increased Lp(a) levels.” Similarly, some literature reviews suggest that low levels of inflammation may lessen the risk associated with Lp(a).
One way to avoid high levels of inflammation is to follow a low-carb, high-saturated-fat diet. There are studies showing that low-carb/high saturated fat diets help lower LP-IR and Lp(a). And yes, there was no adverse effect on LDL cholesterol levels.
I personally have seen Lp(a) lowering in patients following low-carb, whole, real food diets.
You can see how Dr. Johannes Scholl managed to bring his Lp(a) down within three weeks simply by following a ketogenic diet.
But I’m getting ahead of myself.
Speaking of diets…
2. Poor diet
I’m specifically talking about diets with poor nutrient density, which means they don’t offer all the micronutrients you need.
Some of the most common culprits include:
- Low-fat, high-carb foods: As this study says, “a low-fat, high-vegetable diet resulted in a significant 9% increase in Lp(a) in 37 healthy women and DASH-type diets increased Lp(a) by 8–19% in 155 men and women.”
- Seed oil: Many processed foods, including plant-based milks, contain linoleic acid. Linoleic acid is an omega-6 polyunsaturated fatty acid that raises your Lp(a) and contributes to oxidation.
- Refined sugar: Sugar triggers inflammation, which may then increase Lp(a). This also includes fake sugars that can sneak into diets and destroy metabolic health.
Interestingly, switching to high-protein, high-fat, animal-based dietary patterns can substantially reduce your Lp(a) numbers.
One study found that cutting dietary saturated fat increased Lp(a) concentrations by 24%.
And another found that “saturated fatty acids not only appear to lower Lp(a) levels, but also do so consistently, regardless of the initial Lp(a) level.”
How to check your Lp(a)
If you haven’t checked your Lp(a) before, or it’s been elevated for some time, now is an excellent time to check. I recommend repeat testing every six months if you’re concerned about other, extraneous risk factors.
Most normal lipid panels don’t test for Lp(a). Fortunately, dedicated tests are relatively quick and inexpensive.
- Order an at-home test or have your physician order labwork. If they’re not willing to help you test, consider firing your doctor and finding another who ‘gets it’.
- Fast for the time recommended by the test. This is typically eight to 12 hours or longer.
- You’ll likely just need a fingerprick for this test, but you may need a larger draw depending on what’s listed on your panel.
- Ship off your test and wait for results. This typically takes around three to five days.
Anything lower than 30 mg/dL is considered normal, 31 to 50 mg/dL suggests a significantly higher risk, and numbers exceeding 51 mg/dL may indicate extreme risk.
But as we’ve discussed, elevated Lp(a) typically contributes to atherosclerosis only in the setting of poor metabolic health. It’s not a telltale sign you will suffer from heart disease — only that you’re more at risk, and therefore should keep a closer eye on your habits.
My summary of advice for people with elevated Lp(a)
High Lp(a) may be genetic to some extent, but it can also be elevated by lifestyle factors.
That means it’s entirely possible to lower your numbers by:
- Avoiding inflammation. This means following a metabolically healthy diet, not smoking, avoiding seed oil, and managing stress.
- Mitigating blood clotting risk. This could be through over-the-counter medications like aspirin, or supplements such as nattokinase. But it’s best to limit your risks of developing blood clots by practicing good hydration, engaging in regular exercise, and eating whole, real food.
Above all else, focus on reclaiming your metabolic health.
You can benchmark where you’re at by taking my free metabolic health quiz.
