By:- Dr. Sreekanth Shetty, Director & HOD - Cardiology, Sakra World Hospital, Bengaluru 

When it comes to heart health, the numbers on a routine cholesterol report may not tell the whole story. You may exercise regularly, follow a proper diet, maintain a healthy weight, and have normal LDL cholesterol levels. A normal LDL cholesterol report does not necessarily mean that all cardiovascular risk factors are normal. Lipoprotein(a), or Lp(a), can reveal such hidden risk factors. Elevated Lp(a) can increase the risk of premature cardiovascular disease.

The cholesterol number you may not know

Lp(a) is a type of lipoprotein that is similar to LDL cholesterol, but has an additional protein called apolipoprotein(a). High levels have been linked to a higher risk of coronary artery disease and stroke, and may also play a role in aortic valve disease.

The catch is that Lp(a) is largely determined by genes. Its levels are usually established early in life and remain relatively stable through adulthood.

That means going to the gym, losing weight, or improving your diet may do little to bring down a genetically elevated Lp(a) level. This, however, does not make a healthy lifestyle any less important. Exercise, a balanced diet, maintaining a healthy weight, and controlling blood pressure, blood sugar, and cholesterol remain central to preventing heart disease.What it does mean is that lifestyle alone may not tell the whole story.

Why it matters in India

The issue is particularly relevant in India, where heart disease often affects people at a younger age. South Asian populations have also been reported to have higher Lp(a) levels on average. This can become especially important when a person develops heart disease despite not having the usual risk factors. A family history of an early heart attack or stroke may be another clue that inherited risk factors deserve a closer look.

For instance, someone whose parent or sibling had a heart attack at a relatively young age may have more reason to discuss Lp(a) testing with a doctor, even if their own cholesterol levels look reassuring.

One test may be enough

Unlike cholesterol, which may be checked repeatedly as part of routine health monitoring, Lp(a) generally does not need frequent testing because its level remains relatively stable.

Increasingly, doctors recommend that adults consider getting their Lp(a) measured at least once in their lifetime, particularly if there is a personal or family history of premature cardiovascular disease.

The test is a simple blood test. But knowing the result does not mean that a person with high Lp(a) is destined to have a heart attack.

“An elevated Lp(a) should not be viewed as a reason for panic. It is better understood as an additional risk factor that can help doctors decide how aggressively other modifiable risks, such as LDL cholesterol and blood pressure, should be managed,” Dr Shetty says.

So, what if the number is high?

There is currently no widely available treatment that specifically eliminates elevated Lp(a). Doctors therefore focus on reducing the other cardiovascular risks that can be modified.

This includes keeping LDL cholesterol under control, managing blood pressure and blood sugar, avoiding tobacco, maintaining a healthy weight and staying physically active. Certain medicines, including PCSK9 inhibitors, can also lower Lp(a) to some extent while reducing LDL cholesterol.

Meanwhile, newer drugs specifically designed to target Lp(a) are being studied in clinical trials. These treatments could potentially provide more options in the future.

Look beyond the cholesterol report

For younger people who feel fit and have healthy habits, the discovery of an inherited risk factor can be unsettling. But the purpose of testing is not to create fear—it is to identify risk early enough to do something about it.

A family history of premature heart disease should not be dismissed simply because a person's current cholesterol report looks normal. In the same way, being physically fit does not necessarily rule out every cardiovascular risk.

Knowing your Lp(a) level at least once could help complete a picture that a routine cholesterol test may leave unfinished.