Lp(a) Cholesterol Guidelines

Lp(a) cholesterol has been of great interest to many of you, and we’ve had many comments posted on the topic. I’d like to take the opportunity to answer a sound question from a concerned mom, because it is exemplary of what folks often ask us in the office that all of you can benefit from it.

Like many of you looking at the results of your cholesterol profiles, she reports that she is not sure what constitutes an alarming abnormal Lp(a) value. In her 50-year-old daughter’s case, the blood work read as follows:

• Total Cholesterol:  173
• HDL:   74
• LDL:   87
• LDL cholesterol-C:  90
• Lp(a) : 12

In this particular case, there is no family history of cardiovascular disease, and the lipid panel results were within normal limits.

As with other blood level parameters, there may be some variation in normal ranges for Lp(a) as reported by different labs. I have seen some labs where up to 30 was within the normal range for the equipment and reagents they use. Our concerned mom reports that, for her daughter’s lab, anything over 10 is out of the normal range; hence her concern.

Her question is a good one. In the absence of any family history of cardiovascular problems and good cholesterol levels, how much should one be concerned about slightly elevated Lp(a)?

In this particular case, Dr. Sinatra and I would like to reassure her not worry about this finding. First of all, her daughter’s Lp(a) is only elevated two points (or  20 percent above the limit). Secondly, her high HDL “good” cholesterol levels of 74  (HDL > 60 for a woman,  and > 45 for men is considered desirable) is a very protective component. And, thirdly, there is no family or personal history of heart disease.
 
When do we get concerned? Dr. Sinatra takes action when he sees Lp(a) levels that are twice the normal limit (he sees some that are even four times higher or more!). In those cases, he recommends fish oil (a total of 2 grams/day in divided doses) and nattokinase (50 mg twice daily).

Even if your Lp(a) levels are normal, borderline, or even slightly elevated and you want to be more aggressive in your preventive medicine efforts, then just be sure that omega 3s are part of your daily vitamin and mineral plan. About one to two grams of a high quality fish oil—or squid oil—should do the trick.

Lp(a) may still be a new blood component to know about for many of you. Be sure to watch for an upcoming newsletter article on the seriousness of this risk factor. For other tips on healthy cholesterol levels, visit Dr. Sinatra's Web site. While there, don't forget to sign up for his FREE eLetters!