Lipoprotein (A) [Lp(a)]

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Elevated Lp(a) is a strong, independent risk factor for cardiovascular disease (CVD), stroke, and calcific aortic valve stenosis

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Lipoprotein (A) [Lp(a)] - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Overview: The Lipoprotein (A) test measures the level of Lp(a), a lipoprotein particle composed of apolipoprotein B-100 and apolipoprotein(a), in the blood. Lp(a) is an independent risk factor for cardiovascular disease and is genetically determined.
- Primary Indications: Assessment of cardiovascular risk in patients with personal or family history of premature coronary artery disease; evaluation of patients with recurrent cardiovascular events despite adequate lipid-lowering therapy; stratification of patients with borderline cardiovascular risk; screening in families with familial hypercholesterolemia.
- Timing and Circumstances: Should be measured at least once in adulthood for risk assessment; performed during initial cardiovascular risk evaluation; ordered when there is a family history of early myocardial infarction or stroke; useful when standard lipid profiles do not adequately explain cardiovascular risk.
Section 2: Normal Range
- Reference Values: Normal Lp(a) level: less than 50 mg/dL or less than 125 nmol/L (may vary by laboratory); Borderline elevated: 50-100 mg/dL (125-250 nmol/L); Elevated: greater than 100 mg/dL or greater than 250 nmol/L
- Units of Measurement: mg/dL (milligrams per deciliter) or nmol/L (nanomoles per liter); conversion factor: 1 mg/dL = 2.5 nmol/L
- Interpretation Guidelines: Normal (less than 50 mg/dL): Low to neutral risk factor for cardiovascular disease; Elevated (greater than or equal to 50 mg/dL): Increased independent risk for coronary artery disease, myocardial infarction, and stroke; considered modifiable risk factor in some populations
Section 3: Interpretation
- Low Lp(a) Levels (Less than 50 mg/dL): Associated with lower cardiovascular risk; generally favorable for cardiovascular health; does not negate the need to control other risk factors such as LDL cholesterol, hypertension, and smoking
- Elevated Lp(a) Levels (50-100 mg/dL): Modestly increased cardiovascular risk; warrants additional assessment of other lipid parameters and risk factors; may benefit from aggressive management of modifiable risk factors
- Very Elevated Lp(a) Levels (Greater than 100 mg/dL): Significantly increased independent risk for premature atherosclerotic cardiovascular disease; suggests genetic predisposition; requires intensive management of other cardiovascular risk factors; may warrant consideration of emerging Lp(a)-lowering therapies
- Factors Affecting Results: Lp(a) levels are genetically determined and remain stable over time; minimal variation with diet or lifestyle changes; slight elevation during acute inflammation or illness; estrogen-containing medications may lower levels; statins have minimal effect on Lp(a); ethnic variations exist with higher levels in African descent populations
- Clinical Significance: Elevated Lp(a) is associated with thrombotic potential and inflammatory properties; acts synergistically with other risk factors to increase cardiovascular disease risk; particularly important in patients with premature coronary artery disease; part of comprehensive cardiovascular risk assessment alongside traditional lipid panel
Section 4: Associated Organs
- Primary Organ Systems Involved: Cardiovascular system (heart and blood vessels); hepatic system (liver produces apolipoprotein components); kidneys (involved in metabolism of lipoprotein particles)
- Associated Medical Conditions: Coronary artery disease; myocardial infarction; ischemic stroke; peripheral arterial disease; aortic valve stenosis; familial hypercholesterolemia; metabolic syndrome; type 2 diabetes mellitus; chronic kidney disease
- Diseases This Test Helps Diagnose or Monitor: Premature atherosclerotic cardiovascular disease; genetic predisposition to early coronary events; familial Lp(a) hyperlipoproteinemia; cardiovascular risk stratification in asymptomatic individuals; recurrent cardiovascular events despite optimal lipid therapy
- Potential Complications from Elevated Levels: Increased risk of atherosclerotic plaque formation; increased thrombotic risk with potential for acute coronary syndrome; elevated risk of recurrent myocardial infarction; increased stroke risk; potential for sudden cardiac death; accelerated coronary atherosclerosis; valvular heart disease progression
Section 5: Follow-up Tests
- Recommended Follow-up Testing: Comprehensive lipid panel (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides); apolipoprotein B measurement; high-sensitivity C-reactive protein; lipoprotein-associated phospholipase A2; homocysteine level; kidney function tests (creatinine, eGFR)
- Cardiovascular Imaging Studies: Coronary artery calcium scoring; carotid intima-media thickness measurement; stress testing or exercise electrocardiogram; coronary computed tomography angiography; invasive coronary angiography if indicated by clinical presentation
- Genetic and Family Testing: Genetic testing for familial hypercholesterolemia-associated mutations; family screening if elevated Lp(a) identified; apolipoprotein(a) gene testing if considering novel Lp(a)-lowering therapies
- Monitoring Frequency: Lp(a) typically measured once as it is genetically stable; does not require repeated measurement unless baseline uncertain; regular monitoring of other lipid parameters recommended annually or as clinically indicated; follow-up imaging based on Lp(a) level and presence of other risk factors
- Complementary Diagnostic Tests: Oxidized phospholipid to apolipoprotein B ratio; Framingham Risk Score assessment; SCORE risk calculator; ATP III risk stratification; additional inflammatory biomarkers; thyroid function tests if dyslipidemia present
Section 6: Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for Lipoprotein (A) measurement; Lp(a) levels are not significantly affected by fed or fasted state; blood sample can be collected at any time of day
- General Lipid Panel Consideration: If Lp(a) is ordered with a complete lipid panel (including triglycerides, LDL, HDL cholesterol), fasting may be recommended for optimal accuracy of the triglyceride and LDL measurements; typically 9-12 hours of fasting preferred when combined with full lipid panel
- Patient Preparation Instructions: No special preparation needed for Lp(a) alone; if combined with lipid panel, fast for 9-12 hours prior to blood draw; avoid excessive alcohol for 24 hours before testing; maintain normal medication regimen unless otherwise instructed; collect sample in morning if possible for consistency
- Medications and Supplements: Continue all regular medications including statins, beta-blockers, and antihypertensives; no medications need to be discontinued for Lp(a) testing; hormone replacement therapy and oral contraceptives should be noted as they may affect Lp(a) levels; inform healthcare provider of all supplements being taken
- Other Preparation Requirements: Avoid acute stress or strenuous exercise immediately before testing; wear comfortable clothing for easy blood draw access; inform phlebotomist of any recent acute illness or inflammatory conditions; bring insurance card and identification; notify laboratory if sample is delayed or if patient recently experienced acute coronary event

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