Lp(a) Levels Predict 30-Year Cardiovascular Disease Risk in Healthy Women: What You Need to Know
Key Points:
Elevated lipoprotein(a) [Lp(a)] is linked to a significantly higher risk of cardiovascular disease (CVD) over 30 years in healthy women.
Risk increases progressively with higher Lp(a) levels, starting at 30 mg/dL and above.
Early screening for Lp(a) is recommended due to its genetic determination, ease, and low cost of measurement.
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Introduction
Lipoprotein(a), or Lp(a), is emerging as a vital marker for long-term cardiovascular disease risk, especially in women who otherwise appear healthy. Recent research from the Women’s Health Study reveals that elevated Lp(a) levels substantially increase the risk of major cardiovascular events, coronary heart disease, ischemic stroke, and cardiovascular death over a 30-year period. Understanding these risks, the thresholds involved, and the benefits of early screening can empower women and healthcare providers alike to take proactive steps in cardiovascular health management.
Understanding Lp(a) and Its Role in Cardiovascular Disease
Lp(a) is a type of lipoprotein in the blood that carries cholesterol. Unlike LDL cholesterol, Lp(a) levels are largely determined by genetics and remain relatively stable throughout life. Elevated Lp(a) has long been associated with increased cardiovascular risk, but until recently, it has been difficult to target with treatment. Now, promising new drugs are in development to lower Lp(a), potentially changing future prevention strategies.
Stepwise Increase in Cardiovascular Risk Across Lp(a) Levels
The Women’s Health Study analyzed nearly 28,000 women over almost 28 years, focusing on baseline Lp(a) levels and subsequent cardiovascular outcomes. The findings showed a clear, stepwise increase in risk with higher Lp(a) levels:
| Lp(a) Level (mg/dL) | Adjusted Hazard Ratio (HR) for Major CV Events (95% CI) |
|---|---|
| < 10 (Reference) | 1.00 |
| 10 to < 30 | 0.99 (0.92-1.08) |
| 30 to < 60 | 1.16 (1.05-1.28) |
| 60 to < 90 | 1.28 (1.15-1.43) |
| 90 to < 120 | 1.41 (1.17-1.71) |
Women with Lp(a) levels of 30 to less than 60 mg/dL had a 16% higher risk of cardiovascular events than those below 10 mg/dL. The risk rose sharply to 41% higher in women with levels between 90 and 120 mg/dL. Notably, women with extremely high Lp(a) (above the 99th percentile, ~131 mg/dL) faced an 85% higher risk of ischemic stroke and an 86% increased risk of cardiovascular death compared to those with lower levels.
Implications for Cardiovascular Prevention and Screening
Ask Tybjærg Nordestgaard, MD, PhD, lead investigator and expert at Brigham and Women’s Hospital, emphasized the importance of these findings:
“It’s relatively easy and cheap to measure, and I do think we should consider screening for this and doing it at a young age.”
Given that Lp(a) is genetically determined and stable over a lifetime, measuring it once could provide critical information about future cardiovascular risk. Even without currently approved treatments specifically targeting Lp(a), identifying those with high levels allows healthcare providers to more aggressively manage traditional risk factors like LDL cholesterol and hypertension.
New Therapies on the Horizon
Historically, Lp(a) was viewed as untreatable. However, several promising therapies—such as lepodisiran, zerlasiran, and pelacarsen—are in late-stage clinical trials. Large cardiovascular outcome studies like Lp(a)HORIZON and OCEAN(a) are expected to provide crucial data this year on whether lowering Lp(a) can reduce cardiovascular events.
Conclusion: Empowering Women Through Knowledge and Action
The link between elevated Lp(a) and long-term cardiovascular risk in healthy women highlights a critical, often overlooked factor in heart disease prevention. The gradual but significant increase in risk underscores the need for early identification and personalized care strategies. While we await definitive treatments, proactive screening and management of other cardiovascular risk factors remain essential.
Understanding your Lp(a) level offers a window into your cardiovascular future—a chance to act early, reduce risk, and potentially save lives. As the research evolves, embracing this knowledge empowers women to take control of their heart health with informed decisions and timely interventions.
Key Points Summary
Elevated Lp(a) increases long-term cardiovascular event risk in healthy women.
Risk rises progressively from 30 mg/dL upwards.
Very high Lp(a) correlates with increased stroke and cardiovascular death.
Lp(a) measurement is easy, cheap, and recommended once in a lifetime.
New therapies to lower Lp(a) are in clinical trials.
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Frequently Asked Question (FAQ)
Q: What is Lp(a)?
A: Lipoprotein(a) is a genetic form of cholesterol linked to higher cardiovascular risk.
Q: Who should get tested for Lp(a)?
A: Experts recommend at least one lifetime screening, ideally at a young age, especially for those with family history of heart disease.
Q: Can high Lp(a) be treated?
A: While treatments are emerging, current management focuses on controlling other risk factors like LDL cholesterol and blood pressure.
Q: How does Lp(a) affect cardiovascular risk?
A: Higher Lp(a) levels are associated with increased risk of heart attacks, strokes, and cardiovascular death.
Q: Is Lp(a) testing expensive or complicated?
A: No, it’s relatively easy and inexpensive to measure once.
Sources:
TCTMD – Article on Lp(a) linked to 30-year CVD risk in healthy women
https://www.tctmd.com/news/lpa-linked-30-year-cvd-risk-healthy-women
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