Lipoprotein(a) ∞ Area

Lipoprotein(a)

Meaning

Lipoprotein(a), or Lp(a), is a distinct low-density lipoprotein (LDL) particle featuring an additional glycoprotein, apolipoprotein(a) (apo(a)), covalently bound to apolipoprotein B-100. Its plasma concentration is primarily genetically determined, remaining stable throughout life and minimally influenced by diet or lifestyle. It differs from standard LDL.

Context

Lp(a) circulates in the bloodstream, contributing to lipid transport. Its apo(a) component shares significant homology with plasminogen, a key fibrinolytic system protein. This resemblance suggests involvement in coagulation and fibrinolysis, positioning Lp(a) at the intersection of lipid metabolism and thrombotic processes.

Significance

Elevated Lp(a) levels constitute an independent and causal genetic risk factor for atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction, stroke, and aortic valve stenosis. Its presence significantly contributes to an individual’s cardiovascular risk, even when traditional lipid markers are normal. High Lp(a) levels prompt aggressive management of modifiable risk factors.

Mechanism

The atherogenic properties of Lp(a) stem from its dual nature. The LDL-like component promotes cholesterol deposition in arterial walls, fostering plaque. Concurrently, the apo(a) moiety, resembling plasminogen, interferes with fibrinolysis by competing for binding sites on fibrin, promoting a pro-thrombotic state. Lp(a) also transports oxidized phospholipids, triggering inflammatory responses, exacerbating atherosclerosis.

Application

Lp(a) measurement is integrated into cardiovascular risk assessment, especially for individuals with a family history of premature ASCVD, recurrent events despite optimal lipid management, or unexplained dyslipidemia. While direct pharmacological reduction is evolving, its measurement provides critical information on residual cardiovascular risk and guides other preventive interventions, refining risk stratification.

Metric

Lp(a) levels are quantified via a blood immunoassay, reported in nanomoles per liter (nmol/L) or milligrams per deciliter (mg/dL). Risk thresholds vary, but concentrations exceeding approximately 75-100 nmol/L (or ~30-50 mg/dL) are generally considered elevated and indicative of increased cardiovascular risk. Consistent measurement methods are vital for accurate interpretation.

Risk

The primary clinical risk associated with Lp(a) is its direct contribution to increased atherosclerotic cardiovascular disease burden. High Lp(a) levels heighten the likelihood of developing coronary artery disease, peripheral artery disease, and cerebrovascular events. While Lp(a) itself does not cause symptoms, its presence accelerates pathological processes leading to adverse cardiovascular outcomes, emphasizing its assessment in at-risk populations.

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∞ HPG Axis
∞ CJC-1295

HRTioJuly 19, 2025