Did you know that around 1 in every 5 people might have an important genetic factor that affects their heart health?

Here's what we discovered: 18% of people who get tested with us find out they have elevated levels of something called lipoprotein(a). The American College of Cardiology says this affects 20-25% of people worldwide.

So what exactly is this lipoprotein (a) (we call it "Lp(a)" for short)?

Here's what you need to know:

• Whether your Lp(a) is high or low, it’s caused by genetics
• If yours is high, it means you are at a higher risk for heart attacks or strokes
• Most people should get tested at least once, and again if you are sick, have been through menopause, or had high inflammation at the time of testing
• Most people will not be tested for this 

Here's why Lp(a) matters: if you know your levels, you can make better choices about your heart health.

What is lipoprotein (a)?

Think of it this way: you know how there's "good" and "bad" cholesterol? Well, Lp(a) is like bad cholesterol's troublemaker cousin. It carries cholesterol around your body just like regular LDL cholesterol does, but it's stickier and more likely to cause problems.

Here's what makes Lp(a) different: it's almost entirely controlled by your genes. There's a specific gene (called LPA) that determines how much you make. Unlike regular cholesterol that goes up and down based on what you eat and how much you exercise, your Lp(a) level is pretty much set.

Here's a helpful way to think about it: imagine regular LDL cholesterol particles are like cars driving down the highway. Lp(a) particles are like those same cars, but with extra sticky bumpers. They're more likely to get stuck to your artery walls and cause traffic jams (blockages).

Want to know your Lp(a) level? At NiaHealth, we include this often-overlooked test as part of our comprehensive heart health assessment.

Why is Lp(a) important?

Clinical studies have shown that individuals with high Lp(a) levels have a 2-4 times higher risk of heart disease compared to those with lower levels. Heart disease consists of heart attacks, strokes and a range of other cardiovascular conditions such as heart valve disease, aortic stenosis, and limited lower-body circulation. This makes Lp(a) testing crucial for cardiovascular risk assessment, especially for those with a family history of early heart disease. 

‍

‍

‍What does elevated lipoprotein (a) mean?

First, don't panic. Having elevated Lp(a) doesn't mean you're guaranteed to have heart problems. What it does mean is that your heart may need a bit more attention than someone with normal levels.

Research shows that people with elevated Lp(a) have about 2-4 times higher likelihood of heart problems like heart attacks, strokes, and heart valve issues. While that sounds concerning, remember: this is just one piece of your health puzzle.

Different organizations use different reference ranges, but many–including NiaHealth–use 100nmol/L (50mg/dL) as the threshold for elevated levels. Many healthcare providers consider anything above 75nmol/L (30 mg/dL) worth addressing proactively. The important thing to understand is that the higher your Lp(a), the more beneficial it becomes to take excellent care of your heart in other ways.

The key point: If your Lp(a) is elevated, it means you have valuable information your healthcare provider can work with to create the best heart health plan for your situation. Always discuss your results with your healthcare provider to understand what they mean for your specific circumstances.

How to optimize your health with elevated lipoprotein (a)

Right now, there's no medication specifically approved in Canada to lower Lp(a). But there are still many effective ways to protect your heart.

Current treatment developments:

• PCSK9 inhibitors (like evolocumab and alirocumab) can lower Lp(a) by 20-30% - these are already available for high cholesterol.
• Newer treatments in clinical trials (like pelacarsen and olpasiran) are showing impressive results - lowering Lp(a) by 70-90%.
• For severe cases, there's a procedure called lipoprotein apheresis that filters Lp(a) from your blood. More information about this procedure can be found here.

Why lifestyle choices still matter (even though they won't change your Lp(a)):

Here's something important to understand: you can't exercise or diet your Lp(a) away because it's genetically determined.

However, you can still make a significant impact on your overall heart health. While lifestyle modifications won't signficantly change your Lp(a) levels, they remain crucial for optimizing your cardiovascular health when working with your healthcare provider.

Your heart health toolkit:

Nutrition strategies:

• Fish, nuts, and olive oil (healthy fats)
• Whole grains instead of refined carbohydrates
• Plenty of fruits and vegetables
• Limited saturated fats and moderate sodium intake

Physical activity recommendations:

• 150 minutes of moderate exercise like walking or swimming each week
• Strength training twice weekly (bodyweight exercises count)
• Regular daily movement

Lifestyle factors:

• 7-9 hours of quality sleep (your heart repairs itself during sleep)
• Stress management through meditation, relaxation, or activities you enjoy
• No smoking, and moderate alcohol consumption if you drink
• Strong social connections and meaningful relationships

Medical partnerships:

• Regular check-ups with healthcare providers
• Taking prescribed medications as directed
• Monitoring blood pressure and blood sugar levels

The goal is making everything else about your heart health as strong as possible, maximizing all the factors within your control.

What is the life expectancy with elevated lipoprotein (a)?

Elevated Lp(a) doesn't necessarily shorten your life, especially when you know about it and take proactive steps.

Many people with elevated Lp(a) live long, healthy lives. The key is knowing about it so you can be more proactive about heart health. It's similar to having a family history of heart disease: you need to pay closer attention, but it doesn't determine your fate.

Why don't doctors test lipoprotein (a)?

Why don't doctors test lipoprotein (a)? This is an excellent question! Even though the Canadian Cardiovascular Society recommends that everyone get tested at least once, most primary care providers don't order this test routinely.

Here's a look at the stats:

• Only 0.3% of people received Lp(a) screening between 2012-2019
• Most tests were ordered by just a small number of healthcare providers
• Testing is now covered by most insurers in most regions, for certain people
• In Europe they're beginning to test everyone routinely, but North America is slower to adopt this practice

Some healthcare providers don't test for several reasons. Many focus on treatable factors like LDL cholesterol that respond well to medications, and there's limited awareness about Lp(a) among some providers. Until recently, there weren't effective treatments specifically for Lp(a), and healthcare resources are limited, so providers prioritize well-established tests.

‍Don't want to be part of that 99.7% who haven't been tested? We'd love to help you understand your complete cardiovascular picture - Lp(a) testing is included in all our comprehensive health assessments.

When to get Lp(a) testing done

While it's not tested for regularly, there are times when you should certainly test your Lp(a)—especially to help manage overall cardiovascular risk. Here's when:

Family history of early heart disease

If you have family members who experienced heart disease at a young age (men under 55, women under 65), Lp(a) testing can help identify whether you've inherited this genetic risk factor.

Personal cardiovascular health optimization

For individuals committed to understanding and optimizing their complete cardiovascular health profile, Lp(a) testing provides an important piece of the puzzle that standard lipid panels don't capture.

Parent experienced heart disease

Understanding your genetic factors, including Lp(a) levels, helps inform your health approach and allows you to take proactive steps based on your inherited risk profile.

Comprehensive wellness assessment

As part of a thorough health evaluation, Lp(a) testing contributes to a complete picture of your cardiovascular health status alongside other important markers.

Unexplained cardiovascular events

If you've experienced heart problems despite having normal cholesterol levels, elevated Lp(a) might explain the underlying cause and guide future prevention strategies.

High LDL cholesterol that's difficult to control

When LDL cholesterol remains elevated despite lifestyle changes and medications, Lp(a) testing can help determine if this genetic factor is contributing to your overall risk profile.

What to know before your Lp(a) test

Once you've decided you need the test, here's what you should know:

• One-time test: Since Lp(a) is genetic, levels generally remain stable throughout life (there are some exceptions to this rule)
• No fasting required: Unlike other cholesterol tests
• Family testing recommended: If you have high levels, encourage family members to get tested
• Medical interpretation required: Always discuss results with a qualified healthcare provider

Understanding your lipoprotein (a)test results

Different laboratories and healthcare providers may use varying reference ranges, so it's essential to discuss your specific results with your healthcare provider. The ranges below represent NiaHealth's interpretation for optimal health.

Optimal levels (Less than 30 mg/dL or 75 nmol/L)

If your Lp(a) levels fall in this range, there's minimal genetic contribution to your cardiovascular risk from this particular factor.

Worth monitoring (30-50 mg/dL or 75-100 nmol/L)

Results in this range suggest you should work closely with your healthcare provider to develop a comprehensive wellness plan. While not critically elevated, these levels warrant attention as part of your overall cardiovascular health strategy.

Elevated (Above 50 mg/dL or 100 nmol/L)

Elevated Lp(a) levels provide valuable information for creating a personalized cardiovascular health approach. This genetic factor increases your risk, making it important to optimize all other modifiable risk factors and work with your healthcare team on prevention strategies.

Significantly elevated (Above 100 mg/dL or 200 nmol/L)

Significantly elevated levels require medical supervision and a comprehensive prevention strategy. Your healthcare provider will likely recommend aggressive management of other cardiovascular risk factors and may consider specialized treatments as they become available.

Understanding significantly elevated lipoprotein (a)

When Lp(a) levels are above 100 mg/dL (200 nmol/L), this represents an opportunity for comprehensive cardiovascular health optimization with medical supervision.

Here's when to prioritize immediate medical consultation:

1. Lp(a) above 100 mg/dL combined with other cardiovascular factors
2. Family history of early heart disease (under age 45)
3. Multiple cardiovascular health factors to address
4. Any symptoms of cardiovascular concerns like chest discomfort or shortness of breath
5. Difficulty controlling other cholesterol levels despite medications

Important: This information empowers you to take proactive steps toward optimal cardiovascular health, but always in partnership with qualified healthcare providers who can assess your complete health picture.

Where to get lipoprotein (a)testing in Canada

Getting your Lp(a) levels tested in Canada is becoming more accessible, with several options available depending on your preferences and healthcare needs.

NiaHealth comprehensive testing options

NiaHealth offers Lp(a) measurement with optimal reference ranges as part of our comprehensive health assessments. It includes:

• Lp(a) measurement with optimal reference ranges
• ApoA1 and ApoB testing for complete lipid particle analysis
• Comprehensive cardiovascular panel including inflammation markers
• Personalized health insights showing how all markers work together
• 100+ key biomarkers for deep health understanding

A NiaHealth membership is best for individuals who want to understand Lp(a) alongside many other biomarkers that will help them take ownership of their health journeys.

Other Canadian testing options

You can request Lp(a) testing from your family doctor or nurse practitioner, though coverage may vary by province and demographic. Private lab testing is available through major Canadian laboratories like Dynacare or LifeLabs. If you have existing cardiovascular risk factors, a cardiologist referral may also provide access to this testing.

The bottom line on lipoprotein (a)

Lipoprotein (a) represents a perfect example of why one-size-fits-all healthcare doesn't work. While 80% of people have normal levels and don't need to worry, the 20% with elevated levels need to know so they can take control of their cardiovascular health.

Key takeaways:

• Get tested once to understand your genetic risk
• Don't panic if your levels are high—it's manageable
• Focus on what you can control through lifestyle and medical management
• Work with healthcare providers who understand Lp(a) and its implications
• Stay informed about emerging treatments and research

Knowledge is power when it comes to your health. Don't let lipoprotein (a) remain a hidden threat—understand your risk and take action to protect your cardiovascular future.

‍

Frequently Asked Questions

Is Lp(a) genetic?

Unlike other heart disease risk factors such as age, diet, or inflammation, Lp(a) is largely controlled by a specific gene, called LPA on chromosome 6. Although genes normally fail to account for the full story in biology, Lp(a) levels have a very direct link to your genetic code. 

‍

If one of my parents has high Lp(a), does that mean I will as well?

As Lp(a) is primarily genetic if one of your parents has high Lp(a), you're more likely to have elevated levels too. However, a blood test is the only way to know for sure.

‍

My dad died of a heart attack, could it have been from Lp(a)?

A heart attack can be triggered by a wide range of causes, it’s impossible to know if the exact cause was from high Lp(a). With that being said, if one of your parents has experienced heart disease in the past, it is advisable that you get your Lp(a) levels tested as early as possible so you can better understand the risks posed to your health going forward.

‍

What Lp(a) level is too high?

Canadian guidelines have placed an upper limit of 50mg/dL (100nmol/L) as healthy. What’s important to note here about Lp(a) is that there is no clear ‘safe zone’. There is a linear trend that the greater the Lp(a) levels the greater the heart disease risk. For this reason, certain healthcare providers including ourselves, consider anything above 30mg/dL (75 nmol/L) at increased risk 

‍

Can you lower your Lp(a)?

At the moment there is not a clear drug available in Canada that has been approved to specifically lower Lp(a). However, many pharmaceutical companies are working towards exploring new drugs and therapies to target Lp(a). A specific class of molecules called PCSK9 inhibitors, have been discovered to reduce levels to the tune of 30%; however, robust trials are still missing to confirm clinical benefit for cardiovascular disease. Another possible method that has been shown to decrease Lp(a) levels is a blood procedure called Lipoprotein apheresis. More information about this procedure can be found here.

‍

I exercise every day, why is my Lp(a) so high?

Exercise, while beneficial for overall heart health, doesn't significantly affect Lp(a) levels. Your high Lp(a) is likely due to your genetic makeup rather than lifestyle factors.

‍

Does diet affect your Lp(a)?

Like with exercising, there is little evidence that diet affects your Lp(a) levels. However, healthy lifestyle habits such as exercising and a strong diet can benefit other cardiovascular components, which can in turn reduce your risk of heart disease.

‍

What other biomarkers function similarly to Lp(a)?

Although Lp(a) may seem like an unavoidable precursor to heart disease, optimizing other biomarkers that function similarly such as LDL cholesterol, HDL cholesterol, and ApoB can be beneficial. Additionally, managing inflammation markers like C-reactive protein (CRP) can help reduce overall cardiovascular risk.

‍

What can people with high Lp(a) do to avoid their risk of heart disease?

While you can't easily lower your Lp(a) levels, there are many steps you can take to reduce your overall risk of heart disease:

1. Maintain a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.
2. Exercise regularly, aiming for at least 150 minutes of moderate-intensity weekly activity.
3. Quit smoking and limit alcohol consumption.
4. Manage stress through relaxation techniques or mindfulness practices.
5. Control other risk factors like high blood pressure, diabetes, and obesity.
6. Discuss the use of statins or other preventive medications with your healthcare provider.

‍

Why doesn’t Canadian healthcare test for Lp(a)?

Lp(a) is not routinely measured in traditional primary care practices despite current Canadian guidelines. For instance, The Canadian Cardiovascular Society recommends that Lp(a) levels be checked at least once in your lifetime. 

The typical Canadian healthcare provider will recommend getting only the standard lipid profile test, which often doesn’t include an Lp(a) measure. 

Since intervening to lower Lp(a) has yet to be proven to diminish heart disease risk, the financial costs of offering Lp(a) tests to people below the age of 50 could outweigh the potential benefits for a national healthcare system. Although discovering high Lp(a) might not lead to immediate ways to lower it, the awareness from uncovering the risk earlier on could proactively motivate undergoing measures that could decrease overall heart risk.

‍

NiaHealth stands out as a leading Canadian provider of comprehensive health insights. We analyze 100+ key biomarkers to give you a deep understanding of your body's current state. Based on these results, we create a personalized dashboard with tailored lifestyle recommendations. Our goal? To help you optimize your health, extend your health-span, and achieve your wellness objectives with precision and clarity.