5 min readMar 24, 2026 07:35 AM IST
In the realm of fitness, a 48-year-old man stood out. He was dedicated to his health, standing 174 cm tall and weighing 67 kg. As an active swimmer with a remarkable resting heart rate of 48 beats per minute, his cardiovascular health appeared to be in excellent shape. He abstained from smoking, maintained a diet composed largely of whole foods, and had no apparent health worries. However, he decided to take a proactive step by signing up for routine heart function tests. While he passed tests such as the electrocardiogram (ECG) and echocardiogram (Echo), one particular test revealed troubling results.
The calcium score test, a non-invasive CT scan that assesses the amount of calcified plaque in the arteries, returned a concerning score of 30, significantly higher than the safe range of 1-10. Although his lipid profile indicated a low level of low-density lipoprotein (LDL) cholesterol at below 60 mg/dL, further tests showed elevated levels of lipoprotein(a) or Lp(a) at 70 mg/dL, well above the normal threshold of 30 mg/dL. Lp(a) is a type of cholesterol that can cling to artery walls, increasing the risk of heart disease and stroke, particularly among individuals of Indian and South Asian descent, where about 25% present elevated levels.
Understanding Lp(a)
Lp(a) is a lipoprotein that transports cholesterol in your bloodstream, and its levels are largely determined by genetics. It features an additional protein known as apolipoprotein(a), which alters the behavior of the particle, making it more harmful than standard LDL cholesterol. Unlike traditional cholesterol, which can be influenced by dietary changes and exercise, Lp(a) levels remain relatively stable and may stay high due to inherited genetic factors, even in a physically fit individual.
How Lp(a) Impacts Heart Health
Lp(a) contributes to heart disease in several ways. Like LDL, it carries cholesterol into arterial walls, where it accumulates over time, forming plaques that can narrow arteries, restrict blood flow, and elevate the risk of chest pain and heart attacks. Furthermore, the apolipoprotein(a) component endows Lp(a) with a heightened stickiness, which can irritate blood vessel linings and speed up plaque formation. These Lp(a)-affected plaques tend to be less stable, increasing the likelihood of rupture and triggering acute cardiovascular events.
Moreover, Lp(a) disrupts the body’s natural clot-dissolving mechanisms, leading to a heightened risk of blood clots. This can ultimately increase the likelihood of heart attacks and strokes, even in individuals who might otherwise appear to be in excellent health.
Who Should Consider Lp(a) Testing?
A simple blood test can measure Lp(a) levels, which typically remain constant over time, minimizing the need for frequent testing. This test is especially important for individuals with a family history of heart disease, those who experience heart issues despite having normal cholesterol levels, or those with very high LDL cholesterol. If there are recurring heart problems despite treatment, Lp(a) testing is also advisable.
Can Standard Cholesterol Medications Lower Lp(a)?
While statins are effective in lowering LDL cholesterol levels and are vital for reducing heart disease risk, studies indicate they may inadvertently raise Lp(a) levels by about 10-20%. However, this increase does not negate the protective effects of statins, and doctors typically continue prescribing them. When Lp(a) reaches concerning levels, management strategies shift towards lowering LDL to less than 30 mg/dL. Low-dose statins combined with PCSK9 inhibitors—effective drugs for lowering both LDL and Lp(a)—may be prescribed. These injectable options can decrease LDL by up to 70% and reduce Lp(a) by approximately 20-30%.
Excitingly, an oral medication aimed at reducing Lp(a) is currently in trials and has shown promising results, potentially lowering Lp(a) levels by 65-85%. It is expected to become available by late 2026 or early 2027. Until then, an emphasis should be placed on managing other modifiable risks, including achieving strict LDL targets, controlling blood pressure, preventing diabetes, avoiding smoking, and maintaining a robust exercise routine.
(Dr. Shetty is the lead cardiologist and medical director at Sparsh Hospital, Bengaluru)
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### Conclusion
Navigating heart health can be perplexing, especially for those who lead active, healthy lives yet may carry genetic risk factors like elevated Lp(a). Regular check-ups and understanding your body’s nuances are crucial for effective long-term health management. Remember, physical fitness is a multifaceted endeavor; stay informed, proactive, and always prioritize a comprehensive approach to your wellness.
