Lp(a) genetics

Lipoprotein(a), often called  Lp(a), is primarily genetically determined and affects both males and females. Approximately 90% of an individual's Lp(a) levels are inherited from their parents. 

While the condition is genetic for both sexes, there are specific differences in how it presents and changes throughout life: 

• Equal Inheritance: The chance of inheriting an elevated Lp(a) gene from a parent is roughly 50%, regardless of whether you are male or female.

• Biological Differences in Women:

  • Higher Average Levels: Women generally have Lp(a) concentrations that are 5% to 10% higher than men.

  • Menopause Impact: Levels are remarkably stable throughout life but often increase in women after menopause due to the loss of estrogen, which acts as a regulator for the gene.

  • Hormonal Influence: Hormone replacement therapy (HRT) and estrogen can lower Lp(a) levels in postmenopausal women.

• Biological Differences in Men:

  • Testosterone Link: Some studies show that men with low testosterone (hypogonadism) may have elevated Lp(a) levels.

• Cardiovascular Risk: High Lp(a) is a major risk factor for heart attack and stroke for both sexes, but some research suggests it may be a stronger predictor of mortality in females, particularly at severely elevated levels. 

For more information, the Family Heart Foundation (USA) provides tools for families to understand their genetic risk, and the CDC (USA) offers guidance on when to get tested based on family history. 

These scientific articles explain the genetic determination of Lipoprotein(a) and its sex-based differences throughout life:

• Genetics and Pathophysiological Mechanisms of Lipoprotein(a)‐Associated Cardiovascular Risk - Journal of the American Heart Association 

• Lipoprotein(a) throughout life in women - ScienceDirect