High Cholesterol and Lipoprotein(a) or Lp(a) AKA Lp little a

What is a lipoprotein?

Lipoproteins are the proteins that transport cholesterol molecules around in the blood stream.  They are the Trailers that carry the Cars along the highway, so to speak.  Most people are familiar with cholesterol levels like LDL (bad cholesterol) and HDL (good cholesterol).  If you are not familiar, please refer to our High Cholesterol page.  These cholesterol levels are important, and the lipoproteins that your body produces to carry the cholesterols around are equally important.  There are many different types of lipoproteins and each lipoprotein has its own unique characteristics.  Lipoproteins can be good or bad.  Your healthcare provider will review your lipoprotein levels with you, and they can explain which lipoproteins you want higher or lower.  Lipoproteins can be sticky which means they like to get “stuck” in the blood vessel walls.  This causes plaque build-up over time.  They can also be healthy by removing cholesterol from circulation, fat stores, and blood vessel walls.  The lipoproteins that are helpful are the ones that carry around the HDL cholesterol (good cholesterol).

What is Lipoprotein(a), Lp(a)?  Also known as Lp little a.

Lipoprotein(a), or Lp(a), is a lipoprotein that is rich in cholesterol.  It is still fairly new to the scientific community.  It is assumed that Lp(a) is produced by liver cells.  How this lipoprotein is cleared from the blood is still poorly understood.

What are the levels of Lp(a)?

Lp(a) levels rise right after birth, and then it remains consistent throughout life.  The levels can range from 0.2 to 250 mg/dL.  About 1 in 5 individuals have blood levels higher than 50 mg/dL.  Normal levels are considered less than 30 mg/dL.

How does Lp(a) cause heart disease and strokes?

Thus far, Lp(a) has been associated with risk of cardiovascular disease (heart attacks and strokes) more than any of the other Lipoprotein markers.  Patients with a level of Lp(a) > 50mg/dL had a 3 fold increase in heart attacks.  Some studies have shown that Lp(a) levels are not a risk if LDL levels (bad cholesterol) are low, but other studies have contradicted this stating that high Lp(a) levels matter regardless of LDL cholesterol levels (bad cholesterol).

Lp(a) and LDL cholesterols (bad cholesterol) penetrate into the artery walls, and they accumulate at sites.  These accumulations are first called fatty streaks; as they progressively get larger, they are then called plaque which is thicker and harder.  These stiff arteries are now called atherosclerotic.  Athero- means blood vessel and –sclerotic means stiff.  As blood vessels become atherosclerotic, they are more likely to rupture which causes a life-threatening blood clot wherever the rupture occurs.  If it occurs in the heart, it is called a heart attack.  If it occurs in the brain, it is called a stroke.  Studies show that Lp(a) has the strongest attraction to the interior of blood vessel walls compared to LDL cholesterol(bad cholesterol).  Lp(a) also has pro-inflammatory characteristics.  This means that it also contributes to inflammation which speeds up this entire process of atherosclerosis.  By being pro-inflammatory, it recruits infection-fighting cells to the plaque which makes the plaque even more likely to rupture.

Why do I have elevated Lp(a)?

Lp(a) levels are genetically determined.  This means that one or both of your parents probably have elevated Lp(a) levels, and you likely have early cardiovascular disease (heart attacks or strokes) running in  your family.  Elevated Lp(a) levels are not caused by being overweight, eating too much, or being sedentary (not exercising).

How can I lower Lp(a)?

Elevated Lp(a) levels are difficult to treat.  They typically do not respond to increasing exercise or improving your diet.  Since Lp(a) is difficult to treat, and it puts you at higher risk for heart disease:  This means that exercise and a healthy diet is even more important for you than people without elevated Lp(a).  Unfortunately, there are not many medications that improve Lp(a) levels, and the data on efficacy is still rather controversial based on scientific studies.  Niacin is the best medicine at lowering Lp(a) levels.  It is not guaranteed to lower levels, so we recommend a 4-6 month trial period of 500mg or more of Niacin daily.  After 4-6 months, you should have your levels redrawn.  If your Lp(a) levels have not changed, then you are considered a “Niacin failure,” and you should stop taking Niacin as it is not helping.

Note:  Niacin can be difficult to take.  Please see the end of this document for tips on taking Niacin.

Another way to attack Lp(a) is to reduce the LDL cholesterols (bad cholesterols) as much as possible.  This works for 2 different reasons:

1) Lp(a) is a lipoprotein that is utilized when LDL cholesterol is high.  Therefore, when LDL Cholesterol levels are lowered with statins (Crestor, Lipitor, Zocor), there is less Lp(a) needed to carry LDL Cholesterols through your blood stream.  This is controversial since some studies show that Lp(a) levels rise  in combination with statin drugs.

2) Next, LDL Cholesterol is a bad cholesterol that creates plaque in addition to Lp(a).  Therefore, if you cannot reduce Lp(a) levels, then it is imperative to be more aggressive and lower LDL levels.  Let your healthcare provider choose the right level for you.

At this time, there are clinical trials being conducted to assess different medications and treatments for elevated Lp(a) levels.  You should get regular physicals and consistently check your lipoprotein levels.  As more is discovered, your healthcare provider will keep you up to date on current treatment guidelines and changes.  Until then, maintain a healthy lifestyle, including eating a proper diet, exercise regularly, avoid smoking, and limit alcohol consumption.

Tips for Taking Niacin:

Niacin keeps causing me to flush.  How do I prevent Niacin from making me flush?  Many people have flushing when taking Niacin.  It is comparative to a hot flash.  It happens when blood vessels throughout the skin dilate.  This gives the patient a sensation that their skin is “burning up.”  The sensation resolves on its own in minutes to hours.  In order to limit the flushing, many people reach for the “flush-free niacin” over the counter. DO NOT TAKE FLUSH-FREE NIACIN PRODUCTS FOR CHOLESTEROL PROBLEMS.   Flush-free niacin is NOT active against cholesterol problems, and it is especially ineffective against Lp(a) levels.  In order to reduce the flushing, follow these tips:

1) Take your niacin dose before you go to sleep.  You may sleep through the flushing.

2) Try a smaller dose of Niacin for 1 week to see if your body gets used to the medication.  Most people’s bodies get acclimated to the niacin over time.

3) If it is safe for you to take aspirin, you can take a 325mg aspirin tablet 30 minutes before your niacin dose .  You should ask your healthcare provider if this is safe for you.
Note:  If you take a baby aspirin (81mg aspirin) for cardiovascular risk prevention, then you do not need to take it when taking the 325mg dose.

4) Buy the Niacin supplement at our office from PURE.  It is specifically formulated to slow the absorption from the stomach in order to curb the flushing.  It is still active niacin, and it is not “flush free,” but it is a reduced flush formulation.  It is much cheaper than the prescription niacin.  For prices, please ask our office staff for cost, or you can visit our website (https://ausfamp.wpengine.com/holistic-nutrition-consultations/online-supplements/).

5) Ask your healthcare provider about the prescription extended-release Niacin called Niaspan.  This product is designed to reduce flushing by slowly releasing Niacin into your bloodstream.  It is the most costly of all the options.