Along with watching our low-density lipoprotein (LDL) levels so as to decrease our heart-attack risk, doctors now say we should also be keeping an eye on a substance called lipoprotein a [Lp(a)]. Recent studies have confirmed earlier findings showing that significantly higher than normal levels of Lp(a) are associated with a greater likelihood of heart attack. Lp(a) is similar to LDL but has an additional protein called apo (a) that's attached to the LDL.

What should you do if you're told that your Lp(a) level is high?

• Don't fret too much if you're Lp(a) is elevated (see below).
• Remember that Lp(a) is considered a minor risk factor compared with high blood pressure, cigarette smoking, overweight, diabetes, and high LDL cholesterol itself. Adopting lifestyle measures to reduce these villains is much more important for reducing your chances of a heart attack than worrying overly about Lp(a).
• Although no known lifestyle measure has been found to lower Lp(a), it appears to increase the risk of heart attack particulalry in those whose LDL cholesterol is also elevated. Lower your LDL with statins or other drugs, and your Lp(a) problem should also diminish.
• Some studies have shown that high doses of the vitamin niacin (or nicotinic acid) lower Lp(a), so you might ask your doctor about adding a niacin drug to a statin if your Lp(a) levels are extremely high. (Although drug amounts of niacin are available over the counter, people should only take these products under supervision of their doctor.)
• Levels of both LDL cholesterol and Lp(a) are partly inherited, so if you have high LDL cholesterol or Lp(a) yourself, be sure to encourage your siblings and children to have their LDL cholesterol and Lp(a) measured.

The bottom line, then, is that if you have a high Lp(a), and you also have a high LDL cholesterol, you should begin to manage both with the standard lifestyle measures and medications used for lowering LDL cholesterol.