Cholesterol tests and blood pressure checks are a routine part of preventive care to help doctors figure out a person’s risk for heart disease. But there’s another, less well-known screening that can identify a key risk factor for a heart attack.
Most people don’t know this risk exists, but they should “absolutely” be aware of it, says Dr. Michael Miller, a cardiologist at Penn Medicine and professor at the Hospital of the University of Pennsylvania.
It’s genetically determined and doesn’t fluctuate so most people just need to check it once to know if their levels are normal or high.
Cardiologist Tip of the Day: Ask Your Doctor To Have Your Lipoprotein(a) Measured
“Lipoprotein(a) is a first cousin, if you will, of LDL, the bad cholesterol, except it has another protein attached to it, and many believe that high levels of lipoprotein(a) will really raise the risk of a heart attack and a stroke,” Miller tells TODAY.com.
“Because it does two bad things. One, just like LDL, it can help to form cholesterol plaques. But on top of it, it also makes your blood thicker, so you're more likely to clot. And it's the combination of blood clot plus cholesterol plaque that causes heart attacks.”
Lipoprotein(a) is also known as Lp(a).
Why It Matters
A person might be healthy and have normal cholesterol levels and blood pressure readings, but still have this hidden risk for a heart attack and a stroke, Miller says.
In a recent study of more than 27,000 healthy women, having a very high lipoprotein(a) level was associated with an increased risk of cardiovascular disease over 30 years — even in people who would otherwise be considered unlikely to have heart problems.
Screening for elevated lipoprotein(a) in the general population “may be warranted,” the authors wrote.
How to Get Started
Ask your doctor whether you should have your lipoprotein(a) measured. It’s done via a blood test.
Miller says it may be especially important if you have a family history of early heart disease — for example, a relative who had a heart attack under the age of 60.
Lp(a) levels are "genetically determined and remain remarkably stable" over a person's lifetime, the American College of Cardiology notes.
Almost everybody should have their Lp(a) measured in their 20s to know if they're at risk for atherosclerotic cardiovascular disease, experts told the ACC.
One dilemma is what to do if your levels are high.
“Other lipids can be affected with diet and exercise, (but) Lp(a) really doesn't budge,” Miller says. Statins don’t lower it either.
A trial is underway to see whether other drugs can help.
Lowering LDL cholesterol levels may be most effective.
“The major strategy now is to drive your LDL cholesterol down even lower. If you drive the LDL low enough, the risk from Lp(a) may drop out,” Dr. Karol Watson, a co-director of the UCLA Program in Preventive Cardiology, told UCLA Health.
“We also have to lower your blood pressure, check that your glucose levels aren’t high and make sure you have optimal body weight. That's how we treat it.”
TODAY’s Expert Tip of the Day series is all about simple strategies to make life a little easier. Every Monday through Friday, different qualified experts share their best advice on diet, fitness, heart health, mental wellness and more.
