Understanding Lp(a) Levels in nmol/L - A Key Heart Disease Risk Factor

Understanding Lipoprotein(a) Levels in nmol/L

Lipoprotein(a), also known as Lp(a), is a genetic form of LDL cholesterol that can significantly increase heart disease risk when elevated. Many people are unaware they have high Lp(a) as it is not routinely screened by standard cholesterol tests. The preferred unit for measuring Lp(a) is nmol/L, as this allows for standardization across different lab assays.

What is Lipoprotein(a)?

Lipoprotein(a) is a lipoprotein subclass that is composed of an LDL particle bonded to a specific apolipoprotein called apolipoprotein(a). This apolipoprotein(a) distinguishes Lp(a) from regular LDL cholesterol. High levels of Lp(a) promote plaque buildup in the arteries, increasing the chances of blood clots, heart attack, and stroke.

Lp(a) levels are predominantly influenced by genetics rather than lifestyle factors. Having elevated Lp(a) is largely hereditary and outside of a person's control. Medications like niacin can lower Lp(a) to some degree, but levels are difficult to change significantly through diet or exercise alone.

Health Risks of High Lipoprotein(a)

Many scientific studies have found that high Lp(a) levels significantly raise cardiovascular disease risk. People with elevated Lp(a) have a 10-30% increased risk of suffering a heart attack or stroke compared to those with low Lp(a).

The Lp(a) lipoprotein builds up in the walls of blood vessels, causing inflammation and plaque formation. This plaque narrows the vessels, reduces blood flow, and increases the chance of a rupture or blood clot.

In addition to cardiovascular problems, some research indicates that high Lp(a) is linked to fatty liver disease, kidney disease, andcalcified aortic valve disease.

Measuring and Reporting Lipoprotein(a) Levels

Lipoprotein(a) blood tests should be measured in nmol/L, the standard international unit for reporting Lp(a). Using nmol/L allows for accurate comparisons of Lp(a) values between different laboratories and testing methods. Labs may also report Lp(a) levels in mg/dL.

A conversion factor of 2.5 can be used to switch between nmol/L and mg/dL. So 100 nmol/L Lp(a) equals approximately 40 mg/dL. It's important to know which units your Lp(a) level is reported in.

Ideally, Lp(a) testing should be done through a lipid profile or advanced lipoprotein analysis. Routine cholesterol tests do not include Lp(a) screening. Ask your doctor to add on a lipoprotein(a) test if it is not included.

Reference Ranges for Lipoprotein(a)

Reference ranges for lipoprotein(a) are:
- Low: <75 nmol/L (<30 mg/dL)
- Borderline: 75-125 nmol/L (30-50 mg/dL)
- High: >125 nmol/L (>50 mg/dL)

No single cutoff definitively determines high Lp(a). However, the lower your Lp(a) level the better, with optimal levels below 50 nmol/L (20 mg/dL). Anything above 125 nmol/L is considered elevated and concerning.

Lowering High Lipoprotein(a) Levels

The best methods for lowering high lipoprotein(a) include:

• Lipoprotein apheresis - blood filtration treatment that removes Lp(a)
• PCSK9 inhibitor injectable medications
• Niacin in high doses of 2-3 grams per day
• Mipomersen injection for patients with familial hypercholesterolemia
• Antisense oligonucleotide therapies currently in development

Lifestyle approaches like diet, exercise and stress reduction may help modestly reduce Lp(a) levels. But medications or lipoprotein apheresis are needed to significantly decrease elevated Lp(a).

It's also useful to control other cardiac risk factors through a heart healthy lifestyle. Eating well, being active, not smoking and controlling blood pressure and diabetes can help offset high Lp(a) risk.

Screening Recommendations for Lipoprotein(a)

Medical groups recommend people get screened for lipoprotein(a) at least once in their lifetime. Those most likely to have elevated Lp(a) include:

• Individuals with early heart disease
• People with family history of Lp(a)-related conditions
• Individuals with personal or family history of high cholesterol

Screening is recommended to start by age 20, or by age 10 if there is a strong family history of heart problems or high cholesterol. Based on the screening results, your doctor can recommend appropriate treatment and monitoring steps.

The Importance of Knowing Your Lipoprotein(a) Level

Checking your lipoprotein(a) level is key to determining your risk for cardiovascular disease. High Lp(a) is a major inherited risk factor, but one that often goes undetected without testing specifically for it.

Getting your Lp(a) measured, ideally in nmol/L, will help you and your doctor make informed decisions about managing heart disease risk. If your Lp(a) comes back high, treatment options are available to lower levels and prevent heart attacks and strokes.

Raising awareness of lipoprotein(a)'s impacts can motivate people to get screened and treat elevated levels. Know your numbers, know your risk, and work to reduce high Lp(a) for better heart health.

Frequently Asked Questions

Why is lipoprotein(a) reported in nmol/L?

Lipoprotein(a) is reported in nmol/L because this is the standard unit used worldwide for Lp(a) measurement. Using a common unit allows for consistent interpretation of Lp(a) levels between different laboratories and testing methods.

How high is too high for lipoprotein(a)?

Lipoprotein(a) levels above 125-150 nmol/L (50-60 mg/dL) are considered elevated and associated with increased cardiovascular disease risk. The ideal level is below 75 nmol/L (30 mg/dL).

Does lipoprotein(a) respond to lifestyle changes?

Lp(a) levels are largely genetic, so they do not respond significantly to lifestyle measures like diet, exercise or stress management. Medications or lipoprotein apheresis are typically needed to lower elevated lipoprotein(a).

Should everyone get tested for lipoprotein(a)?

Health organizations recommend universal screening for lipoprotein(a) at least once in childhood or adulthood. Those with heart disease or family history of high cholesterol should be prioritized for Lp(a) testing.

Is high lipoprotein(a) hereditary?

Yes, high Lp(a) levels are strongly influenced by genetics. Having a parent with elevated Lp(a) increases your risk of having a high level as well. Discuss family history with your doctor to determine if Lp(a) testing is appropriate.

Does taking niacin lower lipoprotein(a)?

Yes, taking high-dose niacin supplements around 2-3 grams per day has been shown to lower elevated lipoprotein(a) by up to 30%. This makes niacin one of the few lifestyle measures that can reduce high Lp(a).

The Bottom Line

Lipoprotein(a) is a significant genetic risk factor for cardiovascular disease that often goes undetected without specific screening. Getting tested and knowing your Lp(a) level, ideally reported in nmol/L, can inform heart disease prevention efforts. If your Lp(a) is elevated, treatment options like specialized medications and lipoprotein apheresis can lower levels and reduce risk of heart attack and stroke.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.