Lp(a) Risks
It has been established that high levels of Lp(a) can triple one’s risk of stroke and heart attack at an early age. A large Danish study looked at more than 9,000 participants over the course of 10 years and concluded that extremely elevated Lp(a) levels (>120 mg/dL) increased the risk of CAD by 3-4 times.
Interestingly, this inherited marker is pretty common with elevated levels affecting about 20-30% of the global population according to research. Furthermore, about 1 in 5 Americans have elevated Lp(a) and most don’t know it.
While doctors routinely test for HDL, LDL and total cholesterol, there are very few doctors who test for Lp(a) or even know what it is. However, this lipid is a significant cardiovascular risk factor and can cause more than just a little damage.
What exactly is Lp(a)?
Lp(a) is a lipid particle that is rich in cholesterol and is similar to low-density lipoprotein (LDL), except that it promotes MORE inflammation and thrombosis.
It has one apoB-100 molecule along with cholesterol esters, triglycerides, phospholipids and cholesterol. What is unique to it is that Lp(a) has an apo(a) molecule attached to the apoB component (which distinguishes it from LDL). This bond is what determines many of Lp(a)’s effects on cells and its ability to potentiate atherosclerosis.
According to research, apo(a) has a chemical makeup of amino acids that are similar to plasminogen. Apo(a) can compete with plasminogen and inhibit fibrinolysis (which is the breakdown of blood clots). This is why it is such a significant risk factor for blood clots and other cardiovascular conditions due to its ability to prevent the breakdown of clots and to influence platelet aggregation.
The length of the apo(a) unit is what determines the mass of Lp(a) that will circulate in the blood.
The complete mechanisms for how Lp(a) causes atherogenesis and inflammation are still not entirely understood and more research in this realm is needed.
Are there any beneficial functions of Lp(a) in the body?
According to research, Lp(a) plays several key roles such as healing wounds, activating tissue repair, influencing structural changes of blood vessels and healing endothelial injuries. It clearly had several evolutionary advantages (such a preventing bleeding). Relatively new research also suggests that Lp(a) can play anti-cancer and anti-diabetic roles, as well.
How does Lp(a) contribute to atherosclerosis and blockages?
There are essentially three different components of the Lp(a) molecule that contribute to atherosclerosis. The first part is the proinflammatory component, which is the apo(a) unit made up of oxidized phospholipids. The second aspect is the prothrombotic component, which is the apo(a) unit that mimics plasminogen, inhibits plasminogen activation, and prevents the breakdown of fibrous tissue/ blood clots. And the third part is the proatherogenic component, called the apoB unit, which does all the things that LDL does. Therefore, one of the main reasons Lp(a) is so detrimental is that it is a single particle that is proatherogenic, prothrombotic and proinflammatory.
Lp(a) promotes atherosclerosis and inflammation through multiple mechanisms. It can actually bind and transport proinflammatory molecules into the artery wall. Furthermore, Lp(a) is also susceptible to oxidative damage, which leads to additional production of inflammatory cells and atherogenic particles (like oxidized cholesterol).
While all other cholesterol markers are influenced by diet and lifestyle, Lp(a) is pretty much genetically determined.
What are the risks associated with elevated Lp(a) levels?
While there are some evolutionary reasons for why individuals are predisposed to higher Lp(a) levels, there are also significant risks that can result.
Elevated Lp(a)levels are (most notably) associated with increased inflammation, atherosclerosis and clotting in artery walls, which are known risk factors for cardiovascular conditions.
In summary, some established risks of elevated Lp(a) levels include but are not limited to:
- Inflammation
- Atherosclerosis/ advanced atherosclerotic progression
- Aortic stenosis (Lp(a) is linked to development and rate of progression)
- Heart attack (Lp(a) is linked to heart attacks, especially at a younger age)
- Blood clots such as deep vein thrombosis (one should think about Lp(a) if they have unexplained DVT)
- Heart failure
- Cerebral vascular accident
- Peripheral arterial disease
- Abdominal aorta aneurysm (often caused by high Lp(a) and atherosclerosis)
What are the contributing factors to elevated Lp(a)?
For the most part, Lp(a) is considered to be pre-determined by genetics. However, there are some established factors for high Lp(a). These include the following:
- Acute inflammation or tissue damageAccording to research, Lp(a) levels can be transiently increased with inflammatory processes or damage to tissues (such as during an acute heart attack).
- AgeThere is research that has shown that individuals over the age of 75 years will show a mild increase in Lp(a) plasma levels.
- Reduced estrogenStudies have shown that estrogen depletion in women is linked in increased Lp(a) levels.
- DHEA levelsResearch has shown that Lp(a) concentrations can be affected by DHEA, the hormone produced by the adrenal glands.
- Weight lossA 2001 study showed that weight loss in individuals (who had high Lp(a) levels before treatment) was linked to a reduction in serum Lp(a) levels at the end of the weight reduction treatment.
- Low-fat dietNew research has revealed that low total fat/ low saturated fat and high carbohydrate diets significantly increase Lp(a) levels. Furthermore, the low-fat diet was shown to increase the presence of very small LDL particles, a comorbid risk factor for high Lp(a).
- Chronic inflammatory diseases and medical conditionsDiverse conditions can elevate the levels of Lp(a). These include uncontrolled diabetes, familial hypercholesterolemia, severe hypothyroidism, nephrotic syndrome, chronic renal insufficiency, and obliterative thromboangiitis.Studies have also shown that patients with anti-phospholipid syndrome (APS) have reduced fibrinolysis and increased levels of Lp(a).
Earlier research studies have also revealed elevated Lp(a) levels in autoimmune conditions like lupus and rheumatoid arthritis. Lp(a) is one of the mechanisms that links the increased incidence of cardiovascular conditions in autoimmune patients and why heart disease can be an “autoimmune” process.
- Gut healthIt has been established that the gut microbiome has significant effects on lipid profiles and therefore could have an effect of Lp(a) expression (however, more research is needed for this area). There’s a delicate interplay of leaky gut syndrome, inflammation, oxidative stress, autoimmune conditions and Lp(a) in which more research is warranted.
What can I do to help lower my Lp(a)?
While it can be tricky to lower Lp(a) it can be done. Furthermore, when it comes to lowering one’s risk associated with elevated Lp(a) levels is also best to lower other cardiac risks too.
- Take supplements. Lowering Lp(a) requires a potent arsenal of supplements to target it from all different angles.
- Take high-dose fish oil. Take 3-4 caps of our Omega DHA A study showed that combination therapy (defined as Niacin AND omega 3 fats) was linked to significantly lower Lp(a) levels.
- Vitamin C has also been shown to lower Lp(a). Try 1 tab 3x a day of Super C.
- Take 1 capsule 3 times per day of our Acetyl- L-Carnitine. It has been suggested by recent research that L-Carnitine could lower Lp(a) levels with researchers speculating that this is due to its ability to reduce the production of Lp(a) by the liver.
- Eat healthy fats and go low carb with the Paleo diet. Increase dietary intake of both saturated and monounsaturated fats.
- Manage your hormones. Hormones such as estrogen, DHEA and testosterone all play an influential role. If those are out balance, then they can affect your Lp(a) levels.
- Get plenty of sunshine. Sunshine normalizes cholesterol levels and helps fend off CAD.
- Lower your Lp(a) risk by reducing oxidative stress through detoxification strategies. Try to detox daily.
- Manage your stress. Stress is inflammatory and can exacerbate any cardiac condition.
- Increase nitric oxide levels to ensure proper circulation, blood flow and a fully functioning heart. Check out our nitric oxide combo here.
It should be noted here that statins do not lower Lp(a) levels and in fact, they significantly raise them!
