β€οΈ Doctor Eno Says: What You Need to Know About Lipoprotein(a)
Aug 29, 2025Most people are familiar with cholesterol and the importance of monitoring LDL, HDL, and triglycerides. These are the components of what is commonly referred to as the "Lipid profile", which your primary care physician typically orders. But there’s another type of cholesterol that doesn’t always get the attention it deserves: lipoprotein(a), or Lp(a) for short. This “stealth” particle is genetically determined and can quietly raise the risk of heart attack and stroke—even in people who seem otherwise healthy. Let’s break down what it is, why it matters, and what to do if your levels are high.
π¬ What Is Lipoprotein(a)?
Lipoprotein(a), or Lp(a), looks a lot like LDL (the “bad” cholesterol), but with a twist. It has an additional protein, called apolipoprotein(a), attached to it. That protein makes Lp(a) especially concerning because it can trigger inflammation in blood vessels, it promotes plaque buildup in the arteries, and it interferes with the body’s natural ability to dissolve clots. Unlike LDL, which we can lower with diet, exercise, and medications, Lp(a) is almost entirely genetic. That means if you have high levels, you were likely born with it.
β οΈ Why Lp(a) Matters
Research shows that about 1 in 5 people worldwide have elevated Lp(a). High levels are linked to coronary artery disease, heart attack, stroke, peripheral artery disease, and aortic valve stenosis. The problem? Lp(a) doesn’t usually show up on a standard lipid panel. Without checking specifically, people can have elevated Lp(a) and not know it until a significant event happens.
π° A Real-Life Example
A widely shared example comes from Bob Harper, the celebrity trainer from The Biggest Loser. At age 52, he suffered a massive heart attack despite looking fit and healthy. Later, he revealed that high Lp(a) levels were a big part of the cause. Stories like Bob’s remind us that traditional cholesterol checks may not tell the whole story.
π§ͺ Why Lp(a) Testing Should Be Added to Your Lipid Profile
A simple blood test can measure your Lp(a) level—and it only needs to be done once in a lifetime, since levels don't change much. Adding this test to a lipid profile can catch hidden risk factors earlier, guide more aggressive prevention if levels are high, and potentially prevent heart attacks, strokes, and other complications.
Experts are increasingly recommending that all adults get tested at least once, especially if there’s a family history of heart disease.
π‘οΈ What To Do If Your Lp(a) Is Elevated
Here’s the important part: even though lifestyle changes don’t lower Lp(a) itself, they do reduce overall heart risk. Steps to take if your Lp(a) is high:
- β Keep your LDL (“bad” cholesterol) as low as possible
- β Control blood pressure, blood sugar, and weight
- β Quit smoking (if you do)
- β Prioritize regular exercise and a heart-healthy diet (Mediterranean style is great)
- β Get enough sleep and manage stress.
Medications and therapies: The key thing to recognize is that the medication used to treat a high cholesterol level called Statins don’t lower Lp(a) directly, but they reduce other risks. There is another class of medications called PCSK9 inhibitors that can lower Lp(a) by 20–25%. Niacin and LDL apheresis are used in select, more severe cases. There are new treatments are on the horizon: drugs like pelacarsen and lepodisiran are in advanced trials and may dramatically lower Lp(a) in the near future.
β¨ Takeaway
Lipoprotein(a) is a genetically inherited cholesterol particle that can increase heart risk—even when your regular cholesterol looks “fine.” Testing for Lp(a) is simple and can be done once in a lifetime. If levels are high, the best approach right now is to double down on heart-healthy habits and work closely with your healthcare provider on managing overall risk.
π If you’ve never had your Lp(a) checked, ask your doctor about adding it to your next lipid profile. One small test could give you big peace of mind.
If you’re wondering how to bring up Lp(a) testing with your primary care physician, or if you’ve recently learned your levels are elevated, let’s connect. Together, we can review your results, explore your options, and create a personalized plan that helps you feel confident about your health.
π Schedule a Free 30-minute Session with me today — and let’s see if we can turn knowledge into action for your heart and your future.
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