Most people assume that standard cholesterol testing offers an adequate assessment of heart disease risk. If you, like many, have never heard of a lipoprotein profile test, you may be surprised to learn that this test assesses an important risk factor called Lipoprotein(a) or Lp(a) (“lipoprotein little a”). Influenced by genetics and strongly linked to heart disease and blood clotting problems, this risk factor unfortunately is NOT part of routine cholesterol tests or standard lipid panels. In fact, lipoprotein(a) is so strongly linked to heart disease, that it is one of the four lipid-related risk factors cited by the National Institutes of Health National Cholesterol Education Program (NCEP) as worthy of monitoring. Unfortunately, Lp(a) has been notoriously difficult to treat pharmacologically, as statins have shown little efficacy in lowering Lp(a) levels.
Why is Lp(a) so harmful?
Evidence suggests that Lp(a) may serve as the link between thrombosis and atherosclerosis. Recent clinical studies have implicated Lp(a) as a risk factor for blood clots whether or not atherosclerosis is present. Because Lp(a) is a small, very dense LDL, it can easily penetrate the arterial lining, become oxidized and build plaque, thus contributing to atherosclerosis independent of its thrombotic potential.
How is high Lp(a) treated?
In a recent double-blind, placebo-controlled trial, patients with elevated cholesterol and elevated Lp(a) were divided into two groups, each with 29 people: Group 1 received a statin only and Group 2 received the same statin plus 2 grams/day of L-carnitine, a supplement that plays a key role in fatty acid transport within cells. After 12 weeks, the group receiving only a statin showed about a 7% reduction in Lp(a), but the group receiving the L-carnitine in conjunction with the statin demonstrated over 19% reduction in Lp(a) levels. Authors suggest that co-administration of L-carnitine (whose primary function is fatty acid metabolism), may enhance efforts to lower Lp(a) compared to using a statin alone.
Although heredity plays a large role in the levels of Lp(a), treatment with niacin has also been found to lower levels of Lp(a).
For additional reading refer to the abstract L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study published in the January 2017 issue of Lipids.