Clinical Information

Lipoprotein (a) (Lp[a]) consists of an LDL particle that is covalently bound to an additional protein, apolipoprotein (a) (Apo[a]). Apo(a) has high-sequence homology with the coagulation factor plasminogen and, like LDL, Lp(a) contains apolipoprotein B100 (ApoB). Thus, Lp(a) is both proatherogenic and prothrombotic. Lp(a) is an independent risk factor for coronary heart disease (CHD), ischemic stroke, and aortic valve stenosis. Lp(a) has been referred to as "the most atherogenic lipoprotein." The mechanism of increased risk is unclear but most likely involves progression of atherosclerotic stenosis via intimal deposition of cholesterol and promotion of thrombosis via homology to plasminogen.

Concentrations of Lp(a) particles in the blood can be expressed readily by 2 methods: as concentrations of Lp(a) protein or as Lp(a) cholesterol. Mayo’s Cardiovascular Laboratory Medicine measures and reports Lp(a) cholesterol individually (LPAWS / Lipoprotein [a] Cholesterol, Serum) and as a part of the lipoprotein profile (LMPP / Lipoprotein Metabolism Profile). The cholesterol content of Lp(a) particles varies little, and Lp(a) can contain significant proportions of the serum cholesterol.

Unlike Lp(a) cholesterol, accurate immunochemical measurement of Lp(a)-specific protein, is complicated by the heterogeneity of Lp(a) molecular size. Due to the large number of polymorphisms in the population any given individual can have an Apo(a) protein between 240 to 800 kDa. This heterogeneity leads to inaccuracies when results are expressed in terms of mg/dL of protein. In addition, the degree of atherogenicity of the Lp(a) particle may depend on the molecular size of the Lp(a)-specific protein.

Serum concentrations of Lp(a) are related to genetic factors, and are largely unaffected by diet, exercise and lipid-lowering pharmaceuticals. However, in a patient with additional modifiable CHD risk factors, more aggressive therapy to normalize these factors may be indicated if the Lp(a) value is also increased.