Red flags for lipoprotein(a)

Lipoprotein(a), Lp(a), is an important cause for heart disease, heart attack, and coronary atherosclerotic plaque.

How do you know you have it?

Of course, it could be as simple as checking a blood level. But there are also a number of red flags for the presence of Lp(a), tell-tale signs that suggest it is present and contributing to the growth of coronary plaque.

I've seen so much of this pattern over the years that it's gotten so that I can pretty much pick out most of the people with Lp(a) just by either looking at them or by hearing their story. I do this simply by knowing what hints to look for.

Some of the red flags for Lp(a) include:

--High blood pressure in a slender person. Overweight is the overwhelmingly common reason for high blood pressure. However, inappropriate high blood pressure in a slender person can serve to tip you off that Lp(a) is present.

--HIgh LDL cholesterol poorly responsive to statin drugs. For instance, someone's LDL cholesterol of 190 mg/dl will be treated with Lipitor 40 mg, but drops to only 165 mg/dl, a very poor response. This can sometimes point towards Lp(a).

--Family clustering of heart disease in people before age 60. For instance, father with heart attack age 53, uncle with heart attack at age 55, aunt with heart attack age 59, etc. This clustering of risk, more often than not, signals Lp(a).

--Coronary disease or high heart scan score in the presence of relatively bland appearing lipids. For instance, LDL cholesterol 130 mg/dl, HDL 55 mg/dl, triglycerides 70 mg/dl on no medications or other efforts--figures ordinarily not associated with high likelihood of heart disease--yet heart disease is indeed present. This can mean that Lp(a) is the concealed culprit behind coronary atherosclerosis.

These red flags are not perfect. If you lack any of them, it doesn't necessarily rule out the possbility of having Lp(a). They simply serve as signs to suggest that Lp(a) may be lurking.

Once Lp(a) is identified, then the battle begins to gain control over this somewhat troublesome genetic pattern. Resourcesfulness and some ingenuity may be required. However, knowing that you have it shows you where to concentrate your efforts.

Comments (24) -

  • Anonymous

    1/17/2008 1:03:00 AM |

    I wish I knew more about exactly what Lp(a) will do that will cause me problems.  I have high Lp(a)(22 on my VAP test).

    I am 5'2" and weight 110.  I am a fitness professional -  healthy blood pressure level.

    My TC at it's worse was 226 with low Trig, high HDL, and high LDL (144).  My Dr wanted me to get the LDL down with drugs.  I chose the supplement path, and increased my fiber intake.

    My TC is now around 224, but my HDL is 86, and LDL 118.  My real LDL size pattern is A/B.  My HDL 2 & 3, and VLDL 3 are all in the desireable range.

    Oh - I do have a family history of heart disease (mother had strokes in her 60s).

    I had a heart scan - no measurable plaque found.  I'm 55 years old.

    That darn LpInnocent.  Should I be worried it's going to do something I'm not aware of?


  • Dr. Davis

    1/17/2008 1:41:00 AM |

    Yes. You might have a Lp(a) variant that accounts more for carotid disease than coronary disease, judging from your mom's history. Also, you are still young. Some women will not fully express Lp(a) characteristics until their late 50s.

    All the principles we talk about for Lp(a) on the Track Your Plaque website still apply. Also, please see our upcoming report that summarizes unique strategies for Lp(a) treatment to be released in the next two weeks.

  • Anonymous

    1/17/2008 5:32:00 AM |

    If Bonnie thinks her LP(a) at 22 is high, I guess mine is high also at 24, but at least its a whole lot better than it was 18 months ago when it was 52.   I attribute the reduction to DMAE and NAC,thanks to your recomendations, Dr. Davis.

    Your list of possible examples of high LP(a) just doesn't include me.

    My BMI is 21.  I have relatively low blood pressure,95-110 over 70.  My age is 65.   Total Chol=190; LDL=110  HDL>65 and sometimes as high as 100.  Low Trigs < 70.

    No family history (mother still kicking at 95). Father died in hi 70's from pancreatic cancer with a very strong heart and lung system.  And yet I have had a really high LP(a)!!!

    I can't afford a CT scan, as much as I would like to get one, but I did have a lipoprotein breakdown which showed
    VLDL=25; LDL particle number 789 dense LDL IV=101 HDL Total=9066 and Buoyant HDL 2b=2528.  All  measured in (nmol/L).  My density was neither A nor B, but in an intermediate zone near the A border.

    My homocysteine is raised (12.26) probably because of the 750mg of Slo-Niacin I take, but I'm trading niacin's lipid enhancements for it.

    When my LP(a) was at 52, all blood work was similar to now, weight was the same, exercise, diet, everything was the same.   I don't understand why it was so high.   I was hoping your list would give me a clue, but I'm just not on it!!!


  • Anonymous

    1/17/2008 6:44:00 AM |

    Thanks.  My mom unfortunately led an extremely sedentary lifestyle, and didn't eat well or take care of herself.  I always assumed her strokes were a result of that.  I guess it was probably part of it, but not all of it.

    I did not know about Carotid disease - seems all I ever hear about is Heart Disease these days.

    I look forward to finding out more about the new approaches to dealing with Lp(a)!


  • Dr. Davis

    1/17/2008 1:36:00 PM |

    Hi, Noreen-
    I'm curious about the DMAE. I've used it (unsuccessfully) for memory enhancement, but not to reduce Lp(a). What is the basis for this?

  • Anonymous

    1/17/2008 3:45:00 PM |

    Big Goof, Dr. D!!!  I was tired and didn't get up to check my supplements.  I'm taking 50mg of DHEA for lowering the LP(a)!!!

    Sorry, thats what I get for getting into this stuff so late at night!!!

    I'm still at a loss as why mine went so high (52)!!!   Especially with no family history of heart disease.


  • Anonymous

    1/17/2008 4:11:00 PM |

    Noreen - your post reminded me of something that I find curious.

    When I first had my Lp(a) tested it wsa a separate test from my Cholesterol test.  Results came back 59 wih a reference range of  0-29.  

    Next time it was measured it was part of a VAP test, and when I saw it at 22 I thought it had dropped (by some miracle Smile.  Then I noticed the reference range was different, and that the high end of the range was 10.  

    Different tests maybe?


  • Anonymous

    1/17/2008 6:00:00 PM |

    Thanks Bonnie -- Yes, it was different labs, but the reference range was less than 30 on each one.   I did read somewhere that some labs use less than 20 as the normal range, but these two labs used < 30.

    This lab also did a nutrient profile and found that I was deficient in pantothenate, glutamine and glutathione.   I was already taking 500mg NAC, but they recommended 1000mg, so I'm now taking 1200mg of Jarrow Sustain NAC in hopes it will satisfy the glutathione deficiency and lower that LP(a) further.  

    I also started taking pantothenate to satisfy that and read that it can reduce LDL, so I'm hopefull there.   I upped the glutamine that I was already taking and switched to a powder form.


  • Dr. Davis

    1/17/2008 7:41:00 PM |

    Hi, Noreen-
    Somebody, Mom or Dad, had to give you Lp(a), though the expression and consequences of Lp(a) can vary.

  • Anonymous

    1/17/2008 8:25:00 PM |

    Is it a dominant characteristic from just one parent or can it be a recessive one from both with neither having it?   I don't think my mom has ever been tested, but her doctor said her heart is still very strong at 95.    My paternal grandfather died of a massive heart attack at 78.  Before that he was hospitalized several times with fluid in his chest (cardio-myapthy) maybe?

    I was under the impression that if it were genetic that nothing will reduce it.  Is this wrong?   Mine did come down to 24 after taking the NAC and DHEA.   I'm really looking forward to reading that paper on lowering it too.  Thanks so much,

  • Bad_CRC

    1/17/2008 9:09:00 PM |

    Dr. Davis, just to clarify:

    1. Lp(a) is not like IDL, where having any measurable amount is abnormal, right?  Mine was 7 mg/dL, and I took this to mean that I don't "have Lp(a)."

    2. Also unlike IDL, small LDL, etc., it's purely hereditary and not a symptom of metabolic syndrome or similar, correct?  So if I don't have it at 30, I don't need to worry about developing it by 50?


  • Dr. Davis

    1/17/2008 10:26:00 PM |

    Lp(a) is genetic but blood levels are manipulable. But Mom or Dad HAD to give it to you, they just may not have fully expressed its consequences (which does happen occassionally, for not entirely clear reasons).

  • Dr. Davis

    1/17/2008 10:28:00 PM |

    Hi, Bad--
    Yes, correct on both counts.

  • Anonymous

    1/17/2008 10:33:00 PM |

    But Mom or Dad HAD to give it to you, they just may not have fully expressed its consequences (which does happen occassionally, for not entirely clear reasons).

    So Dr. Davis, are you saying that if you have this genetic marker, that it is inevitable that at some point down the line it will do bad things - no matter how good all of the rest of your risk factors are? (assuming there continues to be no reliable way to reduce it).


  • Dr. Davis

    1/17/2008 10:54:00 PM |

    No, not inevitable, but darn close. It could be expressed as hearet disease, carotid disease, aneurysms, or just hypertension.

  • Anonymous

    1/18/2008 2:29:00 AM |

    Are there any major differences between  Lp(a) testing via a VAP test as compared to NMR?

    VAP seems to use a lower test range (over 10 being considered high). Does this mean their test is different than others, or simply they use a lower marker to differentiate between high and low? And would a Lp(a) test via VAP be as accurate as one from NMR, etc,?

    My VAP numbers for Lp(a) was pretty low, around 4-5, if I remember right. I just want to make sure this was an accurate test.

  • Dr. Davis

    1/18/2008 1:19:00 PM |

    There are several methodological differences among the various Lp(a) measures. For this reason, I advise everyone to always stick with the same laboratory. There may also be differences in the validity or accuracy. This is detailed in a full Special Report on the Track Your Plaque website.

  • Joan

    1/18/2008 8:54:00 PM |

    My Lp(a) score came back at 160--that's right--160!  I have a stent in one artery, obviously I have CAD.  I presently take Zocor 20 mg. and an Ace Inhibitor drug.  I can not take Niacin---what can I do?


  • Anonymous

    1/19/2008 2:35:00 AM |

    Dr Davis,
    My Cardiologist has me on 1500mg Niacin which reduces LP(a)to around 30 and that seems to be about the lowest I can get it, as more Niacin gives me a rash. So He says we need to reduce LDL as low as possible by diet,exercise and possibly a low Statin dose. Reducing the amount of carriers, He says, will negate to a large degree, the risk of my high LP(a). Does this sound like sound treatment?   Thanks.....

  • Dr. Davis

    1/19/2008 5:06:00 AM |

    That sounds like a very solid approach to Lp(a). Congratulations to your doctor for being up to date in his thinking about Lp(a).

    Also, watch for an upcoming report on our Track Your Plaque website for a review of unique therapies for Lp(a).

  • Dr. Davis

    1/19/2008 5:13:00 AM |

    I'm afraid that's a bit too much to handle in a blog post.

    You are invited to read our Track Your Plaque Special Reports on Lp(a), including an upcoming review of unique therapies to be posted within the next two weeks.

  • Anonymous

    1/19/2008 5:40:00 AM |

    Also, watch for an upcoming report on our Track Your Plaque website for a review of unique therapies for Lp(a)

    Can you see me tapping my foot..... impatiently.....  

    (Just kidding)

    I hesitate to take Niacin because I have a tendency toward slightly high liver enzymes for some reason (possibly mild NAFLD since all other tests came back negative), and I've read Niacin can raise liver enzymes.  I look forward to hearing about other possibilities.


  • Anonymous

    2/20/2008 6:50:00 PM |

    SO after all is said and done should a LP(a) redaing of 12 be of any concern? It is noted as "high" on my VAP test but it certainly is close to normal. All of my other readings on the VAP are normal.


  • buy jeans

    11/3/2010 2:26:48 PM |

    These red flags are not perfect. If you lack any of them, it doesn't necessarily rule out the possbility of having Lp(a). They simply serve as signs to suggest that Lp(a) may be lurking.