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  • Lp(a)

    I had my Lp(a) tested by Lapcorp and it came back 62.1 nmol/L. The reference range is <75 nmol. Most information I have found, including Dr. Brewer's videos, on Lp(a) is based on figures reported in mg/dL with normal value stated as <30 mg/dL. Where can I find information on a what level risk increases for Lp(a) as measured in nmol/L. There doesn't seem to be a direct conversion from mg/dL to nmol/L.

    My understanding is that Lp(a) can pose a risk independent of other factors.

  • #2
    30mg/dL is equivalent to 75nmol/L, and it scales linearly. For what it's worth, the general consensus in Cardiology is that Lp(a) is genetically determined, so it only needs to be tested once. I've tested mine twice and gotten 76 and 122 nmol/L, which makes me doubt that consensus.


    • #3
      Lp(a) varies a lot by time with individuals. Yes, it is genetic, but the level varies depending on the inflammation & other metabolic determinants. In fact, we track those levels in our Lp(a) patients to make sure that they're responding to niacin, lifestyle & other factors.


      • #4
        Lp(a) mass is measured in mg/dL and Lp(a) particle number is measured with nmol/L. I believe that Lp(a) mass measurement came before Lp(a) particle number measurement, and there was over time a switch to Lp(a) particle number measurements as those provide a better risk evaluation. The Lp(a) mass measures the mass of the entire LDL-like Lp(a) particles of which the Lp(a) portion is relatively very small. Two random people with the same Lp(a) mass measurement might have substantially different risks. However if Lp(a) mass is high enough, then it does indicate that there is likely a problem. Measuring the Lp(a) particle numbers provides a better resolution for risk, but even it has issues because it is really both the Lp(a) particle number along with the structure of the kringle-IV section of the Lp(a) that determines the real risk. I am not aware of any commercial Lp(a) test for the kringle-IV structure. Sam Tsimikas is an expert on Lp(a), and he is working for a company (I know I know big bad pharma) doing the phase-III trials for a new drug that seems to lower Lp(a) particle number by something like 80%. As to your question on the risk of 62 nmol/L, well Labcorp says worry about it once it is over 75 nmol/L. In reality lower is better, but there may not be sufficient data that indicates some sort of gradient of risk as it goes lower.

        Here is Sam Tsimikas's twitter account in case you are interested.
        Last edited by Tom; 11-05-2019, 09:53 AM.


        • Sapien
          Sapien commented
          Editing a comment
          Thanks for the tip regarding Sam Tsimikas. After reading through his feed I also did a quick search on Twitter and found that Thomas Dayspring says that a normal Lp(a)-P is <50 nmol/L. Looks like my level tested within reference range but is not "normal". Interesting will be how much it varies if I have it tested again.

      • #5
        On my last two tests mine dropped somewhat from 450 to 373.


        • #6
          Joe Reilly, mine was 306 nmol/L over a year ago, and two years prior, 189. Clearly I have a problem. But, during the same test last year my inflammation markers were all good: hs-CRP 0.4, Lp-PLA2 143, homocysteine 7.9, myeloperoxidase 135...Very good blood pressure, not a smoker, normal weight. Two years prior the numbers were even better. My current doctor didn't do such thorough testing recently which is frustrating, don't know where I'm at, but I've started niacin and am going to take nattokinase. I'm really not thrilled about another drug being made specifically to tinker with these things because I just don't believe it's good to rob Peter to pay Paul. What else will be messed with to change this one thing? My question is, is it possible for Lp-a to not pose a problem if inflammation is under control?


          • #7
            I think it is possible. We see inflammation markers decline even with moderate declines in Lp(a) with Niacin routinely.


            • #8
              My last inflammation level was 0.5%. If it was low before my lifestyle changes I don’t know. But plenty of damage had been done. Hence, various angioplasties, and value job I referenced in another of youur posts.
              Last edited by Joe Reilly; 08-05-2020, 08:10 AM.