In domestic hospitals, four types of cholesterol levels are typically measured. The basic items of dyslipidemia (hypercholesterolemia) tests are total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. However, another important particle that carries cholesterol, ‘Lipoprotein (a)’, is excluded from the tests. The medical community refers to it as ‘genetic cholesterol’ or ‘worse cholesterol’. This lipoprotein is sometimes called ‘the silent killer’ or ‘enhanced LDL cholesterol’ due to its risks and characteristics.
This lipoprotein, produced in the liver, has a structure similar to LDL cholesterol (bad cholesterol). It is this lipoprotein that has an additional special protein tail called ‘apolipoprotein (a)’ attached to the surface of LDL cholesterol particles.
This additional protein sticks tightly to the walls of blood vessels. It acts as a kind of ‘sticky hook’. It adheres to the vessel walls much better than regular cholesterol and has a very strong tendency to form blood clots (thrombus) or cause inflammation.
15% of Koreans in the Blind Spot of National Health Screening… “LDL Levels Must Be Strictly Lowered to Offset”
According to recent research from Brigham and Women’s Hospital at Harvard University, the risk of major cardiovascular diseases gradually increases from the point when lipoprotein (a) levels exceed the reference value (30mg/dL). In particular, it was revealed that high-risk groups with levels above 120mg/dL have a 70-74% higher risk of heart disease, such as myocardial infarction, compared to those with lower levels.
The research team tracked 27,748 healthy women from 1993 to January 2023 for 30 years. The results of this study were published in the international journal 《Journal of the American Medical Association Cardiology》. Blood lipoprotein levels are determined by genes inherited from parents in over 90% of cases.
Regular cholesterol levels can change frequently based on food intake or exercise. However, the levels of this lipoprotein are determined within the first two years of life and rarely change throughout a person’s life. In other words, it is a genetic factor that cannot be altered by human effort. For this reason, experts say that one ‘lifetime test’ is sufficient to assess one’s genetic risk.
Currently, this lipoprotein test is not included in the basic items of the national health screening in Korea. However, research results indicate that about 10-15% of Koreans show high lipoprotein levels that put them at risk for cardiovascular diseases. There are also concerns that many citizens are in the blind spot of lipoprotein management.
“All Adults Should Measure Lipoprotein Levels Once in a Lifetime… Can Be Used for Heart Disease Prevention Treatment”
The Korean Society of Lipids and Atherosclerosis recommends that all adults measure their lipoprotein levels at least once in their lifetime. In particular, those with a family history of heart disease at an early age or patients who consistently take cholesterol medication but still experience recurrences of vascular diseases must undergo this test. While the genetic lipoprotein levels themselves cannot be lowered immediately, knowing one’s condition accurately can greatly assist in the prevention and treatment strategies for dyslipidemia.
For high-risk groups with elevated lipoprotein levels, the best approach is to strictly control other risk factors for heart disease. If the genetic hook cannot be artificially removed, LDL cholesterol levels that accumulate in the blood vessels must be lowered significantly below the standard to offset the overall risk of heart disease. Statin medications may not directly lower these lipoprotein levels, but they serve as a powerful defense line to block the environment where vascular disorders occur.
However, one should be cautious of side effects such as muscle pain or increased blood sugar levels due to medication. It is advisable for ultra-high-risk groups with lipoprotein levels above 120mg/dL to consult with specialists to decide on medication use. It is necessary to check for deposits on the vessel walls through carotid ultrasound and maintain all controllable indicators, such as blood pressure and blood sugar, at optimal levels through a customized management strategy.
[Frequently Asked Questions]
Q1. Why should I get a lipoprotein (a) test at least once in my lifetime?
A1. Regular cholesterol levels can change based on the food eaten or the amount of exercise on that day, but this lipoprotein is determined by genetics. The levels set in infancy tend to remain constant throughout life, so a single measurement in adulthood can sufficiently assess and address one’s lifelong genetic risk.
Q2. If my lipoprotein levels are high, do I have to take medication? I’m worried about side effects.
A2. Ultra-high-risk groups with levels exceeding 120mg/dL have a risk of cardiovascular disease that is more than 70% higher than the general population. Medication is not taken to directly lower this genetic level but serves as an ‘indirect defense line’ to eliminate other risk factors and prevent major incidents. If there are concerns about side effects, it is advisable to first check the actual condition of the blood vessels with a specialist before deciding on medication use.
Q3. There is no lipoprotein item in the general health check-up; how can I get tested?
A3. Since it is not included in the basic items of national screening, you need to select a separate option during a comprehensive examination or request to add this item when getting a blood test at a local clinic. The cost is around several tens of thousands of won as a non-covered item, and please check if the value written on the result sheet exceeds 30mg/dL.
