The “Triple Threat” Cholesterol You Might Be Missing

February is Heart Month, the perfect time to look beyond the basics of cardiovascular health. While many of us are familiar with LDL (“bad”) and HDL (“good”) cholesterol, there is a third, lesser-known player that affects approximately 20% of the population: Lipoprotein(a), or Lp(a). Unlike standard cholesterol markers, which are heavily influenced by diet and exercise, Lp(a) levels are determined almost entirely by genetics at birth. This means that even people with pristine lifestyles and “normal” lipid panels can carry high levels of this particle, unknowingly harboring a significant risk factor for heart disease and stroke [1, 5].

Lipoprotein(a) is often described by cardiologists as a “triple threat” to your arteries. First, it is pro-atherogenic, meaning it contributes to the buildup of fatty plaque in artery walls much like LDL. Second, it is pro-inflammatory, carrying oxidized phospholipids that irritate blood vessels and accelerate disease progression. Third, and perhaps most distinctly, it is pro-thrombotic. The structure of Lp(a) mimics a protein called plasminogen, which helps dissolve blood clots. By competing with plasminogen, Lp(a) prevents the body from breaking down clots effectively, simultaneously increasing the risk of blockage while plaque is accumulating [2, 3]. Because standard lipid panels only measure the total mass of cholesterol types and not the specific Lp(a) particles, this dangerous combination often goes undetected in routine physicals [4].

The good news is that because Lp(a) levels are genetically fixed and remain stable throughout your life, you only need to check them once. Major medical guidelines, including those from the National Lipid Association and the European Atherosclerosis Society, now recommend universal screening—testing every adult at least once to identify those at risk. Knowing your status allows you and your doctor to be more aggressive in managing other risk factors, such as lowering LDL levels further or monitoring blood pressure more closely. At your next physical, ask your doctor specifically for an Lp(a) blood test; it is a simple, one-time check that could redefine your heart health strategy [3, 4].

References

1. Prevalence and Genetics: Lipoprotein(a). Family Heart Foundation. Link
2. Mechanisms of Risk: Schmidt, K., et al. (2016). “Lipoprotein(a)–The thicker the blood, the harder the heart?” Atherosclerosis, 252, 1-2.
3. Screening Guidelines: Wilson, D. P., et al. (2022). “Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association.” Journal of Clinical Lipidology.
4. Testing Stability: Tsimikas, S. (2017). “A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies.” Journal of the American College of Cardiology, 69(6), 692-711.
5. General Overview: Lipoprotein (a). American Heart Association. Link