Lipoprotein (a) and high cholesterol link!

What is lipoprotein (a) and how is it related to high cholesterol? DR PETER TING from The Harley Street Heart & Vascular Centre shares his thoughts on these tiny fat-and-protein particles and why they matter for your heart health.

Mr L, a 37-year-old patient of mine, came in with recurrent exertional chest pain that had been getting progressively worse. He subsequently had a heart attack due to a severely blocked (95 percent stenosis) left anterior descending coronary artery. For it, he underwent urgent coronary ballooning and stenting to restore blood flow.

At first glance, Mr L appeared to be a young, healthy individual who did not smoke and was not overweight. He did not have hypertension, diabetes or high cholesterol levels. There was, however, a family history of heart disease. His mother had undergone coronary artery bypass grafting in her early sixties. Overall, Mr L would not be considered at high risk for premature heart disease. So, how could we have avoided his heart attack? If you think normal or low cholesterol means you won’t have heart disease, think again! Mr L was found to have elevated lipoprotein (a) levels, or Lp (a) for short.

What is lipoprotein (a) and why does this matter to our heart health?

Lipoprotein (a) is a cholesterol-carrying particle in the blood that is similar to LDL (“bad”) cholesterol, but it is even more likely to cause heart attacks and strokes. Elevated lipoprotein (a) levels can increase this risk even in individuals with normal or low LDL cholesterol levels. This is because, in addition to entering the blood vessel wall more easily to cause blockages, it also promotes inflammation and blood clotting.

High levels of lipoprotein (a) are genetically determined and occur more commonly than we think. They affect around one in five people. At present, testing is not routinely performed. Nonetheless, there are increasing calls to include it during routine cholesterol screening, especially in individuals with artery blockages at a young age or those with a family history of early heart disease or stroke. It’s also important for high cholesterol that doesn’t respond to treatment.

What can we do if we have elevated lipoprotein (a) levels?

Currently, there is no drug treatment yet, but there are several promising candidates undergoing research. Although healthy changes to diet and exercise don’t significantly lower lipoprotein (a) levels, these measures are still important because they can lower one’s overall cardiovascular risk.

Beneficial measures include quitting smoking, regular exercise and eating a heart-healthy diet such as DASH or Mediterranean. Maintaining a healthy weight (BMI under 25), managing stress and ensuring quality sleep are also crucial. Traditional risk factors – hypertension, diabetes, high cholesterol – must be strictly controlled. Additionally, the threshold for medications should be lowered. Blood thinners may be recommended in some patients. In more severe cases, even apheresis, which acts like dialysis to extract Lp (a) from the blood, thereby reducing its level.

Getting screened for elevated lipoprotein (a) levels

Presently, many people are unaware of their lipoprotein (a) levels, as it doesn’t typically cause noticeable symptoms. Knowing your level can help you and your doctor make more informed decisions on how to better manage your risk of heart attack and stroke. If Mr L had known of his raised Lp (a) sooner, he would likely have had earlier screening for heart disease. This would then have resulted in it being detected and treated before he could have a heart attack. Check with your doctor if you should screen for elevated Lp (a) today.

About the doctor

Dr Ting is a general cardiologist with interests in heart valve disorders, noninvasive treatment of coronary artery disease, preventive cardiology and cardiac rehabilitation. He’s a strong proponent of lifestyle medicine. It uses therapeutic lifestyle modifications to reverse or slow the progression of coronary artery disease.

The Harley Street Heart and Vascular Centre (Gleneagles Hospital)
#02-38/41 Annexe Block, 6A Napier Road 6472 3703 | WhatsApp 8031 2388
harleystreet.sg/heart

This article on what is lipoprotein (a), high cholesterol and The Harley Street Heart & Vascular Centre first appeared in the September 2025 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!

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