LIPOPROTEIN A (LPA) - An Important Cardiovascular Risk Marker

The lipoprotein (a) particle has a structure similar to that of LDL (bad cholesterol), differing by the presence of apolipoprotein (a) linked by a disulfide bond to apolipoprotein B. Its synthesis occurs in the liver, and its plasma concentration varies from < 1 mg to > 1,000 mg/dL. It can be routinely measured in a clinical laboratory using an antibody-based method.

Above 20 to 30 mg/dL, the risk of developing cardiovascular disease increases by approximately TWO TIMES. This does not apply to individuals of African descent, who generally have higher levels of this lipoprotein than Caucasians and Asians. However, the risk for Black individuals should also be considered.

Gender and age have little influence on lipoprotein (a) concentration.

The homology with plasminogen (an enzyme important for degrading blood clots), which interferes with the fibrinolytic cascade, may be a mechanism for the atherogenicity of lipoprotein (a). However, direct deposition in the arterial wall is also a possible mechanism, with lipoprotein (a) being more oxidizable than LDL.

In general, prospective studies confirm lipoprotein (a) as a predisposing factor for atherosclerosis. The use of statins does not interfere with lipoprotein (a) levels, unlike several supplements such as NIACIN (VITAMIN B3), Coenzyme Q10, and the medication ezetimibe, which promote its decrease, although the latter requires confirmation. It has not been demonstrated that reducing lipoprotein (a) results in a decreased risk of coronary artery disease. Given higher concentrations of lipoprotein (a) and in the absence of more effective and well-tolerated medications, one should at least strive to more rigorously control other risk factors for coronary artery disease.

In addition to sharing the atherogenic risk of LDL, the fact that Lp(a) also contains apo(a) confers even greater pathogenic potential. Its main properties contributing to this potential are:

As previously mentioned, there is significant variability among individuals for this specific marker. Values below 30 mg/dL (or 75 nmol/L if particle number is measured instead of concentration) are considered normal. One in five individuals has Lp(a) concentrations above 50 mg/dL (80th percentile), and one in four has levels above 30 mg/dL (75th percentile). Ideally, due to the inherent risks, we should aim for the 25th percentile, meaning the lowest possible level.

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