Genetics Northern California

Familial hyperlipoprotein(a)

Familial hyperlipoprotein(a) is an inherited condition that leads to higher levels of a substance called lipoprotein(a) or Lp(a). Lipoproteins are important for moving fats and cholesterol around the body. Changes in the normal levels of certain lipoproteins, such as low density lipoprotein (LDL) and high density lipoprotein (HDL), can be risk factors for heart disease. The role of Lp(a) as a risk factor is less certain, particularly when LDL and HDL levels are normal.

How does Lp(a) increase the risk for cardiovascular disease?
Lp(a) is thought to increase risk for cardiovascular disease by increasing the formation of blood clots and causing damage to blood vessels.  Lp(a) gets into the cells found in the wall of the blood vessels. Over time this can lead to build up of the plaque that causes “hardening of the arteries”.

What is considered a normal level of Lp(a)?
In adults, levels of Lp(a) below 30 mg/dl is considered the normal range, however, normal Lp(a) levels may vary by race. Average Lp(a) levels seem to be higher in African Americans, without increasing the risk for cardiovascular disease.

How common is high Lp(a)?
Approximately 25% of the US population have levels above 30mg/dl. Lp(a) levels are mostly determined by genes and stay fairly consistent throughout life. Levels  can increase slightly with age. Levels can also be higher in people with kidney disease and diabetes.

Who should be tested?
If your family history indicates premature cardiovascular disease, your health care provider might consider testing your Lp(a) level. Not everyone needs to have Lp(a) testing. 

What does the research say?
There have been mixed results about how useful it is to know a person’s Lp(a) level.  Some studies show that high Lp(a) levels increase the risk for cardiovascular disease, regardless of other cholesterol values. However, other research found an increased risk mainly when other testing is also abnormal, such as elevated LDL or low HDL. One study found the risk from high Lp(a) levels was reduced just by lowering LDL levels. For now, the risk for heart disease due to high Lp(a) levels remains unclear. More research may help us understand this better over time.

Is there a treatment for high Lp(a)?
Lipoprotein (a) levels do not change in response to changes in lifestyle.  Changes, such as improving one’s diet or increasing physical activity, will not lower Lp(a) directly, but could help reduce your overall risk for heart disease. You can also lower the risk for cardiovascular disease by quitting smoking or reducing weight.

Medications used to improve cholesterol levels, such as statins, do not lower Lp(a). Sometimes Niacin in high doses (3 – 4 grams/day) will help lower Lp(a), although it is not successful in all people. It is sometimes advisable for females with high Lp(a) and on estrogen therapy take a low dose (81mg) aspirin.  

Created by:  Suzanne Kordesh, MPH, RD
Reviewed by:  Suzanne Kordesh, MPH, RD
Kimberly Barr, MS, CGC

Last Updated: 5/27/10