A new long-term study by researchers at Brigham and Women’s Hospital has found that women with very high levels of lipoprotein(a)—a type of cholesterol that is mostly controlled by genetics—face a much higher risk of serious heart problems over the course of 30 years.
The study was published in JAMA Cardiology and followed healthy women from the Women’s Health Study for three decades.
Lipoprotein(a), also called Lp(a), is a type of cholesterol that doesn’t change much over time and is usually determined by your genes early in life.
While one blood test is often enough to measure Lp(a) levels, the problem is that lifestyle changes and common cholesterol-lowering drugs don’t do much to reduce it. That makes it hard to know what to do when someone has very high levels.
Previous studies have linked high Lp(a) to heart disease, stroke, and death from heart-related causes. But doctors still don’t agree on how high is too high or whether everyone should be tested. This study aimed to find out how Lp(a) levels measured once could predict heart health over 30 years.
Researchers studied 27,748 healthy women who joined the study in 1993. These women had no history of heart disease, cancer, or other major illnesses at the start.
Their blood was tested for Lp(a), and they were placed into groups based on how high their levels were. About 23,179 of the participants were also genetically tested for a gene variant known to increase Lp(a) levels.
Over the next 30 years, the study tracked major heart problems like heart attacks, strokes, and heart-related deaths. Women with very high Lp(a)—especially levels above 120 mg/dL—were 54% to 74% more likely to experience these events than those with low levels.
That’s an extra 10% absolute risk over time. The risks started to rise at levels above 30 mg/dL and got worse as levels climbed higher.
The link between high Lp(a) and heart disease was especially strong for coronary heart disease (like heart attacks), and somewhat weaker—but still present—for strokes and heart-related deaths. For example, women with Lp(a) levels above 131 mg/dL had significantly more strokes than those with levels below 11 mg/dL.
Genetics also mattered. Women with a certain version of the LPA gene, known as rs3798220, had higher Lp(a) levels and a 27% greater risk of heart problems over 30 years. That number was based on women who carried one copy of the gene variant. Too few participants had two copies to provide an estimate for that group.
So what does this mean for prevention? Since diet and exercise don’t do much to lower Lp(a), and standard treatments don’t work well either, doctors may want to screen for very high levels to identify women at the highest risk. These individuals might be good candidates for future drugs aimed specifically at lowering Lp(a).
In conclusion, the study shows that very high lipoprotein(a) levels are a strong and long-lasting signal of heart risk in otherwise healthy women. While there are still no clear guidelines on how to treat high Lp(a), this study helps identify the group of women who might benefit the most from new treatments in the future.
If you care about heart disease, please read studies that herbal supplements could harm your heart rhythm, and how eating eggs can help reduce heart disease risk.
For more health information, please see recent studies that apple juice could benefit your heart health, and results showing yogurt may help lower the death risks in heart disease.
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