High levels of Lp-PLA2 are linked with a higher risk of heart disease & stroke. Read on to learn how to improve your heart health.
Fatty plaque accumulation in the blood vessels can lead to heart disease and stroke. Lp-PLA2 is linked to the amount of plaque in the blood and can act as an early warning sign. Find out if you should test Lp-PLA2. Whether your Lp-PLA2 levels are normal, and what you can do to improve them.
What is Lp-PLA2?
Lp-PLA2, short for lipoprotein-associated phospholipase A2, is an enzyme produced by the inflammatory cells in the blood vessels .
High concentrations of fat and cholesterol in the blood can cause a buildup of fat called plaque, which is the hallmark of the hardening of the arteries (atherosclerosis). This plaque can trigger inflammation and activate white blood cells such as macrophages and mast cells. In the course of their duties, these inflammatory cells produce and release Lp-PLA2 [1, 2].
What does Lp-PLA2 do? The enzyme produces oxidized fatty acids and other pro-inflammatory compounds that promote inflammation and worsen plaque buildup. It also binds to LDL (bad) cholesterol, allowing it to travel through the bloodstream [1, 2].
Because of the link between Lp-PLA2 and plaque concentration in the blood, Lp-PLA2 levels can help predict the risk for heart disease and stroke .
Lp-PLA2 may also be a target for new drugs for the treatment of hardening of the arteries (atherosclerosis) .
Lp-PLA2 is a relatively new test and it’s not commonly used.
Your doctor may order an Lp-PLA2 test (also called a PLAC test) to help determine your risk of developing heart disease or stroke. The test is typically ordered for people who are already at a moderate to high risk for developing heart disease due to risk factors like [1, 3]:
- Metabolic syndrome
- Advanced age (65 and older)
Based on the results of this and other relevant tests, your medical history, and your symptoms, your doctor may start treatment or increase the dose of any current medications to prevent future heart issues .
There are two types of Lp-PLA2 tests:
The Lp-PLA2 test measures the amount of the enzyme in the blood, reported in units of nanograms per mL (ng/mL).
The Lp-PLA2 activity test measures the activity of the enzyme, reported in units of nmol/min/mL. While these units look complex, they simply describe the amount of substance that Lp-PLA2 converts each minute.
There’s some evidence that the Lp-PLA2 activity test is more accurate and it is becoming the more common test of the two [5, 6].
The connection between high Lp-PLA2 and plaque buildup is well-established. In clinical practice, however, it’s not entirely clear how helpful testing is, especially since many other lab markers are also used to evaluate heart disease. Currently, Lp-PLA2 tests are often added to complex panels for people with multiple heart disease risk factors [4, 7].
Normal Lp-PLA2 Levels
For the Lp-PLA2 test, levels below 200 ng/mL are normal. Some health organizations consider levels between 200 and 235 ng/mL as borderline .
For the Lp-PLA2 activity test, levels below 225 nmol/min/ml are normal .
However, these numbers may vary depending on the laboratory performing the test.
If your Lp-PLA2 levels are above the normal range, you may be at an increased risk for heart disease and stroke. In the following section, we’ll dive deeper into the consequences of high Lp-PLA2 .
However, remember that Lp-PLA2 is not diagnostic for heart disease or stroke, it is just an indicator of risk. This means that many with elevated levels will not develop these conditions, while some with normal levels will.
Negative Health Effects of High Lp-PLA2
So what happens if your Lp-PLA2 levels are above normal?
Lp-PLA2 reflects the amount of plaque and inflammation in your blood vessels. Plaque buildup can narrow blood vessels, which puts stress on the heart and increases the risk of blood clots .
Many studies have shown that people with elevated Lp-PLA2 levels are at a significantly greater risk of developing heart disease or experiencing a stroke in the future .
1) Heart Disease
Heart disease is one of the leading causes of death in the world. It often occurs when plaque accumulates in the coronary arteries, the blood vessels that supply oxygen to the muscles of the heart [10, 11].
This plaque buildup, also known as atherosclerosis, hardens and narrows the blood vessels, which reduces the oxygen supply to the heart. A lack of oxygen will damage heart tissues and can lead to a heart attack [11, 12].
One large observational study of over 12.8k healthy adults found that people with Lp-PLA2 levels greater than 422 ng/mL had about double the risk of developing heart disease compared to people with levels below 422 ng/mL .
Based on a large review of 32 studies including over 79k participants, Lp-PLA2 has been linked to the risk of heart disease, stroke, and death from heart-related issues .
A stroke occurs when blood flow to the brain is disrupted either because of a clot or a ruptured blood vessel. Strokes require immediate medical attention and can lead to permanent brain damage and death. Because they pose such extreme danger, stroke prevention is imperative for those with risk factors .
In a large study of over 12.7k healthy middle-aged men and women, those with Lp-PLA2 levels above 422 ng/mL were about twice as likely to experience a stroke compared to those with lower levels .
Strokes are of particular concern in postmenopausal women; the hormone changes associated with menopause can increase the risk of stroke. A study of 1,864 postmenopausal women (who were not on hormone therapy) found that those with Lp-PLA2 levels above 353 ng/mL were 1.6 times more likely to suffer a stroke compared to those with levels below 234 ng/mL .
Causes of High Lp-PLA2
Causes listed below are commonly associated with high Lp-PLA2 levels. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret your levels, taking into account your medical history, symptoms, and other test results.
Diet has a huge effect on your Lp-PLA2 levels and heart health in general. Large amounts of fat and cholesterol in the blood contribute to plaque formation and Lp-PLA2 production .
Multiple studies have confirmed that dietary factors linked to high Lp-PLA2 levels include [4, 18, 19].
- High saturated fats
- High carbohydrates
- Low proteins
2) Physical Inactivity
Physical inactivity and body weight also play an important role in heart health and the amount of Lp-PLA2 in the blood .
A study found that physical inactivity was strongly associated with higher Lp-PLA2 levels. The study defined inactivity as less than 20 METS (metabolic equivalent of task) per week, which is equivalent to roughly 7 hours of walking or 2 hours of running per week [18, 20].
In other words, if you get less exercise than that, you are more likely to have higher Lp-PLA2 levels.
Another study found that those who were overweight (BMI greater than 25 kg/m2), were likely to have high Lp-PLA2 [19, 18].
A study of 186 people found that average Lp-PLA2 levels in smokers were 75 ng/mL higher than in non-smokers. The study also found that people who were chronically exposed to second-hand smoke also experienced elevations in Lp-PLA2 .
4) Gum Disease
There is increasing evidence that poor dental hygiene can have a negative effect on the rest of the body, especially the heart.
One study found that people with a history of gum disease (also known as periodontal disease) were almost twice as likely to have Lp-PLA2 levels above 215 ng/mL compared to those who have never had gum disease .
5) Testosterone Deficiency
Hypogonadism is a condition whereby defects in the testes lead to reduced testosterone production. This lack of testosterone can increase cholesterol and fat levels in the blood, potentially leading to more Lp-PLA2 .
A study of 70 adult men found that those with hypogonadism had an average Lp-PLA2 level of 243 ng/mL, well above the normal range .
6) HIV Infection
People with HIV often have elevated Lp-PLA2 levels. This is because HIV treatments can interfere with the balance of cholesterol and fats in the blood, leading to increases in total cholesterol, LDL, and triglycerides [17, 24].
One study found that the average Lp-PLA2 level of 107 HIV patients was 389 ng/mL .
Ways To Improve Heart Health and Lp-PLA2
The most important thing is to work with your doctor to find out what’s causing your high Lp-PLA2.
Discuss the lifestyle changes listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!
A healthy diet is essential for a healthy heart. Eating the right foods can improve heart function and lower Lp-PLA2 .
Research shows that certain dietary changes can reduce Lp-PLA2 levels. Smart choices include [19, 18, 17]:
- Eating less carbs and more protein
- Choosing monounsaturated fats instead of saturated fats
The American Heart Association also has several dietary recommendations to improve heart health in general. Although it’s not clear if these recommendations lower Lp-PLA2 specifically, they’re a good idea for anyone at risk for heart disease. These recommendations include :
- Eating a diet rich in vegetables and fruits
- Eating whole-grain, high-fiber foods
- Eating fish (especially oily fish) at least twice a week
- Limiting saturated fats to <7% and trans-fats to <1% of total energy consumption
- Limiting cholesterol to <300 mg/day
- Minimizing the consumption of beverages and foods with added sugars
- Choosing and preparing foods with little or no salt
A little physical activity each week can go a long way in preventing or reducing risk factors for heart disease .
One study investigated the effects of diet and exercise on Lp-PLA2. The exercise consisted of aerobic and resistance training for 75-90 minute sessions 3 times a week. They found that Lp-PLA2 levels dropped an average of 65 ng/mL after 24 weeks of the program. However, it’s important to note that the study focused solely on patients with HIV .
How much should you exercise? The American Heart Association recommends :
- At least 30 minutes of moderate aerobic activity at least 5 days per week
- OR 25 minutes of vigorous aerobic activity at least 3 days per week
- PLUS moderate- to high-intensity muscle-strengthening activity at least 2 days per week
3) Quit Smoking
Besides diet and exercise, quitting smoking is one of the best things you can do for your heart and your health in general .
As mentioned earlier, smokers have significantly higher (about 75 ng/mL more on average) Lp-PLA2 levels compared to non-smokers .
Even if you don’t smoke, you may still want to avoid environments where smoking is present. A study suggests that second-hand smoke can increase Lp-PLA2 as well .
4) Good Dental Hygiene
People who have a history of gum disease have significantly higher Lp-PLA2 levels, suggesting that good oral hygiene can reduce your risk of high Lp-PLA2 and heart disease .
What can you do to avoid gum disease? Most people know that daily brushing and flossing are important to good oral health along with regular professional teeth cleaning. However, some other, less obvious factors may also contribute to gum disease, such as :
- Medications (birth control, phenytoin, cyclosporine)
- Poor nutrition
If possible, avoid these factors – or, if you can’t avoid them, take extra steps to protect your gums from their influence.
It is important to remember that supplements have not been proven to be effective in treating heart disease. The FDA has not approved any of these supplements for medical purposes and they should not be used in place of medications and recommendations prescribed by your doctor .
Discuss the following foods and supplements with your doctor. Studies show they may help bring down Lp-PLA2 levels, including:
- Omega-3 fatty acids, which are the only supplements recommended by the American Heart Association [29, 30]
- Probiotics 
- Vitamin D 
- A blend of red yeast rice and olive extract 
Remember, always speak to your doctor before taking any supplements, because they may interfere with your health condition or your treatment/medications!
Lp-PLA2 is linked to plaque buildup in the blood vessels. High levels have been associated with heart disease and stroke. The test is not diagnostic of heart disease or stroke; it’s a risk indicator. Many people with increased concentrations will not develop these conditions, and some with normal levels will.
Luckily, there are steps you can take to lower your Lp-PLA2 levels and improve your heart and blood vessel health, including a healthy, balanced diet, exercise, quitting smoking if you’re a smoker, and maintaining good oral hygiene. Some supplements may also help, like omega-3 fatty acids.