Lipoprotein(a): A big genetic risk for heart disease

lipoprotein(a) gene check your 23andMe

For someone reading this, I’m going to save your life today. Nope – this isn’t a scare tactic or overblown health alert type of article – just statistics and solid genetics research.

It is often tempting to think that people who exercise, are thin, and look healthy are at low risk for heart disease. But beneath all the healthiness can lurk a genetically driven risk factor for a heart attack: elevated lipoprotein(a).

What is Lp(a) ?

Heart disease is the number one cause of death in the US and in most countries around the world. Statistics show that one in four people in the US will die of heart disease.

We often have a picture in our heads of someone at risk for a heart attack: obese, older man who looks unhealthy, probably with a stressful job.

Looking at the statistics, being overweight increases the risk of heart disease by 35% and being obese (BMI >35) can double the risk.[ref]

Compare this to the healthy-looking person who has no signs or symptoms but yet has a 300% increase in the risk of a heart attack due to a genetically elevated lipoprotein(a) — Lp(a) — level.

Lipoprotein(a) or LP(a) — said “L  P  little a” — is a blood particle that carries LDL cholesterol and proteins. Elevated levels of Lp(a) are a strong risk factor for having a heart attack due to atherosclerosis. Read more about Lp(a) on the Lipoprotein(a) Foundation website.

Risk of a sudden heart attack:

The Biggest Loser host and fitness trainer, Bob Harper, has been open about his recovery from a very serious heart attack that he had in 2017. He was the epitome of healthiness – fitness trainer, nutritional guru, athlete, and only in his early fifties. But he also had genetically elevated levels of Lp(a). Here is a Today show interview where he explains some of his recovery and what he is doing to prevent a second heart attack.

Is Lp(a) hereditary?

“Family history” is always mentioned by the doctor as an important indicator of your risk of heart disease, especially if a family member had a heart attack fairly young. One big way that researchers have found that family history plays a role is through the inheritance of a genetic variant that increases lipoprotein(a). Lp(a) levels are estimated to be 90% hereditary. [ref]

There are questions and controversy on the role that cholesterol plays in heart disease, and that may lead some people to dismiss Lp(a) as just the latest number to talk about. I think it would be a big mistake to dismiss the research on Lp(a).  There is abundant research on the increased risk for heart attack, narrowing of the arteries, and stroke  (i.e. cardiovascular disease) being caused by elevated lipoprotein (a).[ref][ref][ref]


Genetic variants that cause elevated Lp(a):

The LPA gene controls the formation of the lipoprotein(a) molecule. Variants in the gene, specifically variable number tandem repeats (VNTR), cause the body to create more Lp(a). About 25% of the population carries one or more risk alleles (listed below) that correlate to the VNTR.

Check your genetic data for rs3798220  (23andMe v4, v5, AncestryDNA):

  • C/C: risk of elevated Lp(a), increased risk for heart disease – 3.7x risk of aortic stenosis [ref][ref]
  • C/T: risk of  elevated Lp(A), increased risk for heart disease, increased risk of aortic stenosis
  • T/T: normal

Check your genetic data for rs10455872 (23andMe v4, v5; AncestryDNA):

  • G/G: likely elevated Lp(a), increased risk for heart disease – 2x risk of aortic stenosis [ref][ref]
  • A/G: likely elevated Lp(A), increased risk for heart disease
  • A/A: normal

Studies also showed that carrying one risk allele for both of the above — compound heterozygous — also doubled the risk of aortic stenosis.[ref]


Lifehacks:

So what do you do if you carry the risk alleles?  Knowledge is power here!

Keep in mind that this is a fairly common genetic risk factor, so it isn’t a reason to stress out or be anxious. It is an excellent reason to make lifestyle changes to lower your risk of a heart attack: stop smoking, don’t drink too much, be active, eat healthily, reduce stress.

You know all of these things… and now you know that this healthy lifestyle advice really does apply to you.

Get educated:

Read more about lipoprotein (a): Lipoprotein(a) Foundation,  European Atherosclerosis Society,

Doctor:

Talk to your doctor about getting an Lp(a) blood test done.

Blood test:

I know that a portion of my readers will ignore that advice about talking to their doctors. You can go and get a test done for Lp(a) in the US without going through your doctor. You can order the test online through Ulta Lab Tests (affiliate link) or through other online lab companies. Ulta Lab Tests is usually the cheapest and the Lp(a) test currently costs $29. (Shop around since other online lab test companies often run specials or may have more convenient locations for the lab draw.)

Seriously, the only way to know your Lp(a) level is to get it tested.

How high is high? 

One study shows a 3x risk of aortic valve stenosis for those with Lp(a) levels greater than 90 mg/dl.[ref]  Another source says normal Lp(a) levels are less than 30 mg/dl (or 75 nmol/L)[ref]  while others put it at less than 50 mg/dl.[ref] Again – this is something to talk to a doctor about and keep up with the research as it comes out.

Therapies to talk with your doctor about:

There are a couple of therapies for high Lp(a) that have been well studied as well as new drugs coming out to target it.[ref]

  • Apheresis, where they run your blood through a machine to remove the LDL particles,  is considered effective, but expensive and inconvenient.[ref]
  • A study of over 20,000 women looked at the effects of aspirin on heart disease.  The study results showed that those women who carried one or two copies of the risk allele cut their heart attack risk with aspirin therapy. (Women without elevated Lp(a) did not have a statistical benefit from aspirin.) The whole study is available here.
  • Niacin (vitamin B3) has been used for decades to lower the risk of heart disease. Studies show that 1 -3 g/day lowers Lp(a) levels by an average of 30-40%.[ref][ref][ref]  Most studies use the type of niacin that causes flushing.
  • Overall, lowering your LDL cholesterol numbers can help lower Lp(a) some since Lp(a) is the carrier for LDL. Here is a good article on it from the Cleveland Clinic.  How do you lower your cholesterol with diet? That seems to be the million-dollar question.  A more whole-food, plant-based diet, in comparison with a higher meat/fat-based diet, works to lower cholesterol for some people.  It may be that you need to try out several diets – Mediterranean, DASH, etc – and test to see what works for your body.
  • One study showed Gingko Biloba reduced Lp(a) levels. The study used 120mg, twice a day and showed a 23% decrease in Lp(a). [ref]

More to read/watch:

Prothrombin and DVT

Factor V Leiden

 

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