COVID-19 and Lipoprotein(a): Time for Widespread Testing

A unique feature of Lp(a) is that, in addition to its pro-atherosclerotic and pro-inflammatory potential, it also promotes blood clotting. Studies have evaluated if persons who inherit Lp(a) are at more risk of blood clots in the legs, lungs and other sites. An increased frequency of Lp(a) in persons suffering these serious conditions has been reported. An elevated level of Lp(a) in stroke patients increased the risk 12 fold for a deep venous thrombosis in one study.

COVID-19 and Hypercoagulability

An unexpected aspect of patient care during the current pandemic with COVID-19 infections is the frequent finding of aggressive blood clotting in arterial and venous circulations. A unique coagulopathy has been identified and recently reviewed.  Some COVID-19 patients become seriously ill and die due to rampant clotting in vital organs. The gripping fight for survival by Broadway star Nick Cordero, and his need to have a leg amputated apparently due in part to vascular compromise and clotting, has captured many hearts and minds in the media.

Lipoprotein(a) and COVID-19

To date, there are no published reports examining whether levels of Lp(a) are elevated in patients fighting COVID-19 who experience clotting complications. However, two organizations have provided comments on the possibility that this possible connection should be considered. The FH Foundation has added a section on their website indicating that many patients with Familial Hyperlipidemia (FH) also have an elevated Lp(a) and may be at risk for clotting disorders if infected. In addition, the Lipoprotein(a) Foundation has added comments on their website. This included a letter by S. Tsimikas, MD, of the University of California San Diego and noted researcher on Lp(a). He indicates in the letter that an inflammatory mediator, IL-6, is increased in the cytokine storm that can develop during a COVID-19 infection. IL-6 can also increase levels of Lp(a) raising the possibility that elevated and rising levels of Lp(a) could lead to cardiovascular complications and a poorer prognosis.

What to Do?

If you know you have an elevated level of Lp(a), it would seem prudent to take even greater precautions with hand washing, physical distancing, masks, and overall healthy lifestyles including nutrient rich diets. If you do not know if you have an elevated level, it would be wise to have yours checked on a simple blood test run by every major laboratory. There is even a ICD-10 code for elevated Lp(a) which is E78.41. If you have cardiovascular disease, taking precautions as to exposure and lifestyle are recommended along with maintaining your prescription medications. It is unknown if added a low dose adult aspirin (81 mg) in the absence of an allergy, or using natural anticoagulants like garlic and nattokinase, are of any protection