Why Young Adults With 'Normal' Cholesterol May Still Face Heart Attack Risk: Lipoprotein(a) Explained

There has been an increase in heart attacks and heart-related events. While most reports suggest that such cardiac events are sudden, this is not entirely true. A majority of people only focus on their HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglycerides. However, there's another blood marker that plays a role in your heart health. This is Lipoprotein(a) or Lp(a). When most people get their annual blood tests done, they only get their HDL, LDL, and triglycerides checked. However, it is also crucial that you get your Lp(a) levels checked.

Speaking to NDTV, Dr. Saurabh Yatish Bansal, Additional Director, Neurology at Fortis Gurgaon and Anu Kundra, Senior Vice President, Lab Operations, Agilus Diagnostics, North, explained this lipoprotein. Read on to know what is lipoprotein(a), why is it important, and more.

What Is Lipoprotein(a)?

It is a genetically inherited cholesterol particle that significantly increases the risk of premature cardiovascular disease. Unlike regular LDL cholesterol, Lp(a) levels are determined at birth, remain stable throughout life, and are not influenced by diet, exercise, or lifestyle. This makes them an important but often overlooked risk marker.

Why Should You Check Lipoprotein(a) Levels?

High Lp(a) promotes faster plaque buildup, increases inflammation, and enhances blood clot formation, creating a strong foundation for early heart attacks and strokes. Many individuals with normal or borderline cholesterol levels may still have high cardiovascular risk purely due to elevated Lp(a), which is why testing becomes essential.

Kundra said, "The Lipid Association of India (LAI) 2024 guidelines classify Lp(a) as a key cardiac risk marker, especially for the Indian population, which is genetically predisposed to earlier and more aggressive cardiovascular disease. Since Indians are at inherently higher risk due to genetics, central obesity, and lifestyle patterns, early detection of Lp(a) helps identify individuals who may require more intensive preventive strategies."

Dr. Bansal added, "Checking it helps in early risk detection and prevention."

When Should You Get Lipoprotein(a) Levels Checked?

Since, Lp(a) is completely genetic and remains stable lifelong, testing once in early adulthood is recommended. According to the LAI 2024 guidelines, all individuals should get their Lp(a) measured by the age of 18, with earlier testing advised if they have:

• A family history of premature heart disease or unexplained sudden cardiac events
• High cholesterol at a young age
• Strong family history of stroke or early myocardial infarction

Lp(a) does not change significantly with age, hence, a one time test is usually sufficient, unless a doctor recommends repeat testing based on clinical risk. The guidelines also emphasise that individuals with elevated Lp(a) may need aggressive LDL cholesterol lowering to below 70 mg/dL, and for very high risk individuals, below 55 mg/dL, to counter the elevated risk of premature heart disease.

How Does Lipoprotein(a) Impact Risk Of Heart-Related Events?

High Lp(a) increases cardiovascular risk through multiple mechanisms:

• Accelerated Atherosclerosis: Lp(a) drives rapid plaque formation, narrowing arteries at an earlier age.
• High Risk Of Clot Formation: Due to its similarity to clotting proteins, Lp(a) raises the tendency for clot development, increasing the risk of sudden blockages.
• Inflammatory Effects: It promotes inflammation within blood vessels, worsening plaque instability.

Together, these effects significantly increase the risk of premature heart attacks, strokes, and aortic valve disease.

Why Is High Lp(a) Concerning For Indians?

This is especially concerning for Indians, who already face a higher burden of lifestyle linked conditions such as obesity, diabetes, and metabolic syndrome, further amplifying the impact of elevated Lp(a). Even individuals with optimal cholesterol, healthy habits, or no symptoms may be at high risk if their Lp(a) level is elevated. This makes it a crucial marker in preventive cardiology, said Kundra.

For the Indian population, who already have a high cardiovascular risk, Lp(a) testing is an essential. One-time screening that can help identify hidden genetic risk early and guide timely lifestyle changes and medical intervention.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.