Lipoprotein Checklist: Lipoprotein(a)
Lipoprotein(a)
Lipoprotein (a), or Lp (a) (read “L–P little a”) is a
powerful and underappreciated cause of heart disease. Up to 20% of
people with heart disease will have increased Lp(a). It can trigger
heart attacks early in life, as early as 40s or 50s. Lp (a) also
magnifies dangers of other abnormalities.
Several studies have shown that LDL cholesterol assumes greater
importance when Lp(a) is present. In the Track Your Plaque approach, we
aim for an LDL of 60 mg/dl or an LDL particle number (NMR) of 600–700
nmol/l or apoprotein B of 50–60 mg/dl. LDL values in these ranges seem
to provide greater protection than conventional targets (e.g., LDL 100
mg/dl).
Small LDL particles hugely magnify risk when Lp(a) is present. We
therefore aim to eliminate small LDL particles in order to effectively
treat this pattern. A useful goal is to reduce small LDL to <10% of
total LDL. Another interesting aspect of the small LDL question is that
LDL particle size and Lp(a) particle size seem to be connected to each
other. In other words, when small LDL is present, Lp(a) is also small
and may pose greater risk. This may provide another reason to eliminate
small LDL, since eliminating small LDL may make Lp(a) less harmful.
Treatment of Lp(a) therefore requires attention to other abnormalities,
as well, particularly LDL cholesterol and small LDL.
Lipoprotein(a) is reduced by:
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Copyright 2006, Track Your Plaque.