Cardiology Terminology: Lp(a)

Lately, Dr. Sinatra has been getting a lot of questions about the very small, dense, and highly inflammatory cholesterol particle known as lipoprotein(a)—or Lp(a) for short.

Good questions! Dr. Sinatra is one cardiologist who just doesn’t think that total cholesterol levels are the evil culprits behind cardiovascular problems that they have been made out to be. In fact, he believes that it is high time we switch the heart disease prevention paradigm from total cholesterol to Lp(a). There are too many folks with normal cholesterol levels having heart attacks not to believe that something is amiss.

But before we discuss ways to lower or prevent high Lp(a) levels, you must first know what you are up against.

Lp(a) is small, dense, highly inflammatory sub-fraction of a cholesterol particle and is made in the liver. Dr. Sinatra believes that it is so dangerous, it should be listed as a specific risk factor for heart disease—instead of total cholesterol.

While we know a lot about what it does in terms of how it affects the body, we are still in the theoretical stages in terms of how Lp(a) is metabolized and all of its physiological functions. So, here is what we’ve got on it to date:

• Because of its small dense properties, Lp(a) has been shown to contribute to atherosclerosis;
• Your Lp(a) level is often hereditary, with DNA determinants;
• Lp(a) is thought to have something to do with coagulation and clot formation;
• It can help with wound healing because of its ability to turn on inflammatory reactions; and
• At high levels, it can promote excessive inflammation.

In short, Lp(a)’s  characteristics include:

• small—it can easily sneak in and permeate the cell wall and wreak havoc;
• dense— like a stone that sinks to the bottom, it can pile up on the walls of your blood vessels; and
• highly inflammatory—it is a provocative little monster.

Everyone should know what their Lp(a) level is, especially anyone with known heart disease. Anyone with a family history of heart disease should also know, since Lp(a) blood levels are inheritable, and its production is controlled by a specific gene (an apolipoprotein(a) gene on chromosome 6q26-27 to be specific). That’s why we see elevated Lp(a) levels run in families. Also, if you are of African-American or some European heritages, you may be more at risk.

Lp(a) levels can range from 0.2 to 200, and because folks with very low Lp(a)s appear to be quite healthy, whatever its functions, they are not thought to be critical. Dr. Sinatra likes to see levels less than 35 nmol/l, according to the Quest Diagnostics standards he usually sees.

Here are the usual parameters, depending on how your lab expresses this level:

Desirable: < 14 mg/dL (< 35 nmol/l)
Borderline risk: 14 - 30 mg/dL (35 - 75 nmol/l)
High risk: 31 - 50 mg/dL (75 - 125 nmol/l)
Very high risk: > 50 mg/dL (> 125 nmol/l)           

Should you find your Lp(a) elevated, then you need take action. Later this week, I’ll tell you the most effective natural ways to reduce or even prevent Lp(a) cholesterol.

For more information on cholesterol guidelines and other cardiovascular problems, visit www.drsinatra.com.