The Other Bad Cholesterol

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Lipoprotein(a), or Lp(a), is the bad cholesterol you’ve probably heard little about. But under new guidelines, your doctor may start measuring it.

In May 2019, the National Lipid Association released recommendations regarding when doctors should consider testing patients’ Lp(a). Elevated levels of this type of low-density lipoprotein (LDL) particle are linked to a heightened risk of atherosclerosis, heart attack, and other cardiovascular complications. The guidelines suggest that a level of greater than 50 mg/dL is associated with a higher risk of cardiovascular disease.

Testing might be useful for people at moderate or moderately high risk of having a heart attack in the next 10 years, when the decision over whether to start statin therapy is being considered. It is usually recommended for people with a family history of premature heart disease, to help clarify their own risk, or for those at very high risk of a heart attack to help determine whether to escalate cholesterol-lowering treatment.

There is, however, no specific treatment for high Lp(a). Levels are largely genetically determined, and do not budge in response to diet and exercise. There’s some evidence that the non-statin PCSK9 inhibitors can lower Lp(a) by about 20 percent, but more research is needed. At this point, high-dose statin treatment might be recommended—along with medication and lifestyle measures to control blood pressure and other well-established cardiovascular risk factors.