New Delhi: Heart disease is often linked to factors like cholesterol, blood pressure and lifestyle, but experts say genetics can play an equally significant role. A lesser-known contributor, lipoprotein(a) or Lp(a), is emerging as a key inherited risk factor that may silently increase the chances of cardiovascular problems.
According to Dr Jeremy London, a cardiothoracic surgeon with over 25 years of experience, Lp(a) is a type of cholesterol particle that behaves differently and more aggressively than commonly discussed forms.
What is Lp(a)?
Lp(a), or lipoprotein(a), is a variant of LDL cholesterol, often referred to as “bad cholesterol”. However, it has an additional protein component that makes it more harmful.
This structural difference increases its ability to:
- Promote inflammation in blood vessels
- Accelerate plaque buildup in arteries
- Contribute to blood clot formation
Over time, these effects can significantly raise the risk of conditions such as heart disease, even in individuals who may otherwise appear healthy.
A largely genetic risk factor
One of the most important aspects of Lp(a) is that it is primarily inherited. Experts estimate that nearly 80–90 per cent of Lp(a) levels are determined by genetics.
This means:
- Diet and exercise have minimal impact on Lp(a) levels
- Around 1 in 5 people may have elevated Lp(a)
- Many individuals remain unaware of their risk
Unlike other cholesterol markers, routine health check-ups may not always include Lp(a) testing, making it an often overlooked factor.
Why it matters
Elevated Lp(a) can amplify overall cardiovascular risk, especially when combined with other factors such as high LDL cholesterol, high blood pressure or diabetes.
Doctors emphasise that risk is cumulative. In simple terms, having multiple risk factors including high Lp(a) can significantly increase the likelihood of heart-related complications.
How to manage the risk
While Lp(a) itself cannot be easily reduced through lifestyle changes, experts stress that overall heart health can still be effectively managed.
Key strategies include:
- Control other cholesterol markers: Keep LDL and ApoB levels as low as possible
- Maintain healthy blood pressure: Regular monitoring and treatment if needed
- Manage blood sugar: Especially important for those with diabetes or prediabetes
- Adopt a healthy lifestyle: Balanced diet, regular exercise and adequate sleep
- Avoid smoking: A major contributor to cardiovascular disease
- Focus on mental and social well-being: Stress management and social connections also play a role
Emerging treatments
Medical research is currently exploring new therapies specifically aimed at lowering Lp(a) levels. While early results are promising, experts note that more evidence is needed to confirm whether reducing Lp(a) directly lowers the risk of heart attacks.
When should you get tested?
Doctors recommend Lp(a) testing especially if:
- There is a family history of early heart disease
- You have unexplained high cholesterol
- You’ve experienced cardiovascular issues at a younger age
A single test is usually sufficient, as Lp(a) levels remain relatively stable throughout life.
Conclusion
Lp(a) highlights an important reality: heart disease risk is not just about lifestyle it can also be inherited. While you may not be able to change your genetic makeup, understanding your risk and managing other controllable factors can make a significant difference. Early awareness, combined with proactive care, remains the best defence against long-term cardiovascular disease.