Skip to main content
Log in

Effects of Exercise on Lipoprotein(a)

  • Leading Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Lipoprotein(a) [Lp(a)] is a unique lipoprotein complex in the blood. At high levels (>30 mg/dl), Lp(a) is considered an independent risk factor for cardiovascular diseases. Serum Lp(a) levels are largely genetically determined, remain relatively constant within a given individual, and do not appear to be altered by factors known to influence other lipoproteins (e.g. lipid-lowering drugs, dietary modification and change in body mass). Since regular exercise is associated with favourable changes in lipoproteins in the blood, recent attention has focused on whether serum Lp(a) levels are also influenced by physical activity. Population and cross-sectional studies consistently show a lack of association between serum Lp(a) levels and regular moderate physical activity.Moreover, exercise intervention studies extending from 12 weeks to 4 years indicate that serum Lp(a) levels do not change in response to moderate exercise training, despite improvements in fitness level and other lipoprotein levels in the blood. However, recent studies suggest the possibility that serum Lp(a) levels may increase in response to intense load-bearing exercise training, such as distance running or weight lifting, over several months to years. Cross-sectional studies have reported abnormally high serum Lp(a) levels in experienced distance runners and body builders who train for 2 to 3 hours each day. However, the possible confounding influence of racial or ethnic factors in these studies cannot be discounted.

Recent intervention studies also suggest that 9 to 12 months of intense exercise training may elevate serum Lp(a) levels. However, these changes are generally modest (10 to 15%) and, in most individuals, serum Lp(a) levels remain within the recommended range. It is unclear whether increased serum Lp(a) levels after intense exercise training are of clinical relevance, and whether certain Lp(a) isoforms are more sensitive to the effects of exercise training. Since elevation of both low density lipoprotein cholesterol (LDL-C) and Lp(a) levels in the blood exerts a synergistic effect on cardiovascular disease risk, attention should focus on changing lifestyle factors to decrease LDL-C (e.g. dietary intervention) and increase high density lipoprotein cholesterol (e.g. exercise) levels in the blood.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Berg K. A new serum type system in man: the Lp system. Acta Pathol Microbiol Scand 1963; 59 Suppl.: 369

    PubMed  CAS  Google Scholar 

  2. Albers JJ, Taggart HM, Applebaum-Bowden D, et al. Reduction of lecithin-cholesterol acyltransferase apolipoprotein D and the Lp(a) lipoprotein with the anabolic steroid stanozolol. Biochem Biophys Acta 1984; 795: 293–6

    Article  PubMed  CAS  Google Scholar 

  3. Albers JJ, Marcovina SM, Lodge MS. The unique lipoprotein(a): properties and immunochemical measurement. Clin Chem 1990; 36: 2019–26

    PubMed  CAS  Google Scholar 

  4. Bartens W, Wanner C. Lipoprotein(a): new insights into an atherogenic lipoprotein. Clin Invest 1994; 72: 558–67

    Article  CAS  Google Scholar 

  5. Berg K. Lipoprotein(a): an overview. Chem Phys Lipids 1994; 67/68: 9–16

    Article  Google Scholar 

  6. Kronenberg F, Steinmetz A, Kostner GM, et al. Lipoprotein(a) in health and disease. Crit Rev Clin Lab Sci 1996; 33: 495–543

    Article  PubMed  CAS  Google Scholar 

  7. Utermann G. The mysteries of lipoprotein(a). Science 1989; 246: 904–10

    Article  PubMed  CAS  Google Scholar 

  8. Armstrong VW, Cremer P, Eberle E, et al. The association between serum Lp(a) concentrations and angiographically assessed coronary atherosclerosis. Atherosclerosis 1986; 62: 249–57

    Article  PubMed  CAS  Google Scholar 

  9. Guyton JR, Dahlen GH, Patsch W, et al. Relationship of plasma lipoprotein(a) levels to race and apoprotein B. Arteriosclerosis 1985; 5: 265–72

    Article  PubMed  CAS  Google Scholar 

  10. Ranby M. Lp(a): strong hypervariable risk factor for atherosclerosis and cardiovascular disease. Clin Hemostas Rev 1991; 5: 9–10

    Google Scholar 

  11. Scanu AM. Lipoprotein(a): a genetic risk factor for premature coronary heart disease. JAMA 1992; 267: 3326–9

    Article  PubMed  CAS  Google Scholar 

  12. Wild SH, Fortmann SP, Marcovina SM. A prospective casecontrol study of lipoprotein(a) levels and apo(a) size and risk of coronary heart disease in Stanford Five-City project participants. Arterioscler Thromb Vasc Biol 1997; 17: 239–45

    Article  PubMed  CAS  Google Scholar 

  13. Marcovina SM, Morrisett JD. Structure andmetabolismof lipoprotein(a). Curr Opin Lipidol 1995; 6: 136–45

    Article  PubMed  CAS  Google Scholar 

  14. Dahlen GH. Incidence of Lp(a) lipoprotein among populations. In: Scanu AM, editor. Lipoprotein(a). San Diego (CA): Academic Press Inc., 1990: 151–76

    Google Scholar 

  15. Henriksson P, Angelin B, Berglund L. Hormonal regulation of serum Lp(a) levels: opposite effects after estrogen treatment and orchidectomy in males with prostatic carcinoma. J Clin Invest 1992; 89: 1166–71

    Article  PubMed  CAS  Google Scholar 

  16. Farish E, Spowart K, Barners JF, et al. Effects of postmenopausal hormone replacement therapy on lipoproteins including lipoprotein(a) and LDL subfractions. Atherosclerosis 1996; 126: 77–84

    Article  PubMed  CAS  Google Scholar 

  17. Yamato K, Ozaki I, Fukushima N, et al. Serum lipoprotein(a) levels before and after subtotal thyroidectomy in subjectswith hyperthyroidism. Metabolism 1995; 44: 4–7

    Article  Google Scholar 

  18. United States Office of the Surgeon General. Physical activity and health: a report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, 1996

    Google Scholar 

  19. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 5th ed. Baltimore (MD): Williams & Wilkins, 1995

    Google Scholar 

  20. Durstine L, Haskell WL. Effects of exercise training on plasma lipids and lipoproteins. Exerc Sport Sci Rev 1994; 22: 477–521

    PubMed  CAS  Google Scholar 

  21. Scanu AM, Fless GM. Lipoprotein(a): heterogeneity and biological relevance. J Clin Invest 1990; 85: 1709–15

    Article  PubMed  CAS  Google Scholar 

  22. Marcovina SM, Zhang ZH, Gaur VP, et al. Identification of 34 apolipoprotein(a) isoforms: differential expression of apolipoprotein(a) alleles between American blacks and whites. Biochem Biophys Res Commun 1993; 191: 301–12

    Article  Google Scholar 

  23. Lawn RM, Tomlinson JE, McLean JW, et al. Molecular biology of apolipoprotein(a). In: Scanu AM, editor. Lipoprotein(a). San Diego (CA): Academic Press Inc., 1990: 25–40

    Google Scholar 

  24. McLean JW, Tomlinson JE, Kuang W-J, et al. cDNA sequence of human apolipoprotein(a) is homologous to plasminogen. Nature 1987; 300: 132–7

    Article  Google Scholar 

  25. Schachinger V, Halle M, Minners J, et al. Lipoprotein(a) selectively impairs receptor-mediated endothelial vasodilator function in the human coronary circulation. JAmColl Cardiol 1997; 30: 927–34

    CAS  Google Scholar 

  26. White AL, Lanford RE. Biosynthesis and metabolism of lipoprotein( a). Curr Opin Lipidol 1995; 6: 75–80

    Article  PubMed  CAS  Google Scholar 

  27. Rader DJ, Mann WA, Cain W, et al. The low density lipoprotein receptor is not required for normal catabolism of Lp(a) in humans. J Clin Invest 1995; 95: 1403–8

    Article  PubMed  CAS  Google Scholar 

  28. Hunninghake DB, Stein EA, Mellies MJ. Effects of one year treatment with pravastatin, an HMG-CoAreductase inhibitor, on lipoprotein(a). J Clin Pharmacol 1993; 33: 574–80

    PubMed  CAS  Google Scholar 

  29. Slunga L, Johnson O, Dahlen GH. Changes in Lp(a) lipoprotein levels during the treatment of hypercholesterolemia with simvastatin. Eur J Clin Pharmacol 1992; 43: 369–73

    Article  PubMed  CAS  Google Scholar 

  30. O’Connor P, Cooke T, Feely J. Effects of HMG Co-A reductase inhibitors on lipids and lipoprotein(a) in hypercholesterolemia. Drug Invest 1992; 4: 227–31

    Google Scholar 

  31. Hoffman SL, Eaton DL, Brown MS, et al. Overexpression of human low density lipoprotein receptors leads to accelerated catabolism of Lp(a) lipoprotein in transgenic mice. J Clin Invest 1990; 85: 1542–7

    Article  Google Scholar 

  32. Rader DJ, Cain W, Zech LA, et al. Variation in lipoprotein(a) concentrations among individuals with the same apolipoprotein(a) isoforms is determined by the rate of lipoprotein(a) production. J Clin Invest 1993; 91: 443–7

    Article  PubMed  CAS  Google Scholar 

  33. Berg K, Dahlen G, Borreson AL. Lp(a) phenotypes, other lipoprotein parameters, and a family history of coronary heart disease in middle-aged males. Clin Genet 1979; 16: 347–52

    Article  PubMed  CAS  Google Scholar 

  34. Dahlen GH, Guyton JR, Attar M, et al. Association of levels of lipoprotein(a), plasma lipids, and other lipoproteins with coronary artery disease documented by angiography. Circulation 1986; 4: 758–65

    Article  Google Scholar 

  35. Desmaris R, Sarembock IJ, Ayers CR, et al. Elevated serum lipoprotein(a) is a risk factor for clinical recurrence after coronary balloon angioplasty. Circulation 1995; 91: 1403–9

    Article  Google Scholar 

  36. Hoff HF, Beck GJ, Skibinski MS, et al. Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation 1988; 77: 1238–44

    Article  PubMed  CAS  Google Scholar 

  37. Kostner GM, Avogaro P, Cazzolato G, et al. Lipoprotein(a) and the risk for myocardial infarction. Atherosclerosis 1981; 38: 51–61

    Article  PubMed  CAS  Google Scholar 

  38. Valentine RJ, Grayburn PA, Vega GL, et al. Lp(a) lipoprotein is an independent, discriminating risk factor for premature peripheral atherosclerosis among white men. Arch Intern Med 1994; 154: 801–6

    Article  PubMed  CAS  Google Scholar 

  39. Zenker G, Koltringer P, Bone G, et al. Lipoprotein(a) as a strong indicator for cerebrovascular disease. Stroke 1986; 17: 942–5

    Article  PubMed  CAS  Google Scholar 

  40. Lamon-Fava S, Jimenez D, Christian JC, et al. TheNHLBI twin study: heritability of apolipoprotein A-I, B, and low density lipoprotein subclasses and concordance for lipoprotein(a). Atherosclerosis 1991; 91: 97–106

    Article  PubMed  CAS  Google Scholar 

  41. Howard BV, Le N-A, Belcher JD, et al. Concentrations of Lp(a) in black and white young adults: relations to risk factors for cardiovascular disease. Ann Epidemiol 1994; 4: 341–50

    Article  PubMed  CAS  Google Scholar 

  42. Haffner SM, Gruber KK, Morales PA, et al. Lipoprotein(a) concentration in Mexican Americans and non-Hispanic whites: the San Antonio heart study. Am J Epidemiol 1992; 136: 1060–8

    PubMed  CAS  Google Scholar 

  43. Campbell B, Tate J, Lepre F, et al. Lipoprotein(a): biology, clinical utility and measurement. Clin Biochem Rev 1992; 13: 55–9

    Google Scholar 

  44. Marcovina SM, Albers JJ, Gabel B, et al. Effect of the number of apolipoprotein(a) kringle 4 domains on immunochemical measurements of lipoprotein(a). Clin Chem 1995; 41: 246–55

    PubMed  CAS  Google Scholar 

  45. Berg K, Frey I, Baumstark M, et al. Physical activity and lipoprotein lipid disorders. Sports Med 1994; 17: 6–21

    Article  PubMed  CAS  Google Scholar 

  46. MacAuley D, McCrum EE, Stott G, et al. Physical activity, lipids, apolipoproteins, and Lp(a) in the Northern Ireland health and activity survey. Med Sci Sports Exerc 1996; 28: 720–36

    Article  PubMed  CAS  Google Scholar 

  47. Taimela A, Viikari JS, Porkka KV, et al. Lipoprotein(a) levels in children and young adults: the influence of physical activity. The Cardiovascular Risk in Young Finns Study. Acta Paediatr 1994; 83: 1258–63

    CAS  Google Scholar 

  48. Israel RG, Sullivan MJ, Marks RHL, et al. Relationship between cardiorespiratory fitness and lipoprotein(a) in men and women. Med Sci Sports Exerc 1994; 26: 425–31

    PubMed  CAS  Google Scholar 

  49. Hubinger LM, Mackinnon LT, Lepre F. Lipoprotein(a) [Lp(a)] levels in middle-aged male runners and sedentary controls. Med Sci Sports Exerc 1995; 27: 490–6

    PubMed  CAS  Google Scholar 

  50. Szymanski LM, Durstine JL, Davis PG, et al. Factors affecting fibrinolytic potential: cardiovascular fitness, body composition, and lipoprotein(a). Metabolism 1996; 45: 1427–33

    Article  PubMed  CAS  Google Scholar 

  51. Halle M, Berg A, von Stein T, et al. Lipoprotein(a) in endurance athletes, power athletes, and sedentary controls. Med Sci Sports Exerc 1996; 28: 962–6

    Article  PubMed  CAS  Google Scholar 

  52. Oyelola OO, Rufai MA. Plasma lipid, lipoprotein and apolipoprotein profiles inNigerian university athletes and non-athletes. Br J Sports Med 1993; 27: 271–3

    Article  PubMed  CAS  Google Scholar 

  53. Suter E, Hawes MR. Relationship of physical activity, body fat, diet, and blood lipid profile in youths 10–15 yr. Med Sci Sports Exerc 1993; 25: 748–54

    PubMed  CAS  Google Scholar 

  54. Duell PB, Hagemenas F, Connor WE. The relationship between serum lipoprotein(a) and insulinemia in healthy nondiabetic adult men. Diabetes Care 1994; 17: 1135–40

    Article  PubMed  CAS  Google Scholar 

  55. Austin A, Janosky J, Warty V, et al. The relationship of physical fitness to lipid and lipoprotein(a) levels in adolescents with IDDM. Diabetes Care 1993; 16: 421–5

    Article  PubMed  CAS  Google Scholar 

  56. Cardoso GC, Posadas C, Orvananos OO, et al. Long distance runners and body-builders exhibit elevated plasma levels of lipoprotein(a). Chem Phys Lipids 1994; 67/68: 207–21

    Article  Google Scholar 

  57. Cohen LI, Hartford CG, Rogers GG. Lipoprotein(a) and cholesterol in body builders using anabolic androgenic steroids. Med Sci Sports Exerc 1996; 28: 176–9

    PubMed  CAS  Google Scholar 

  58. Hellsten G, Boman K, Hallmans G, et al. Lipids and endurance physical activity. Atherosclerosis 1989; 75: 93–4

    Article  PubMed  CAS  Google Scholar 

  59. Hubinger LM, Mackinnon LT. The effect of endurance training on lipoprotein(a) [Lp(a)] levels in middle-aged males. Med Sci Sports Exerc 1996; 28: 757–64

    Article  PubMed  CAS  Google Scholar 

  60. Seip RL, Moulin P, Cocke T, et al. Exercise training decreases plasma cholesteryl ester transfer protein. ArteriosclerThromb 1993; 13: 1359–67

    Article  CAS  Google Scholar 

  61. Lobo RA, Notelovitz M, Bernstein L, et al. Lp(a) lipoprotein: relationship to cardiovascular disease risk factors, exercise, and estrogen. Am J Obstet Gynecol 1992; 166: 1182–90

    PubMed  CAS  Google Scholar 

  62. Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. Circulation 1994; 89: 975–90

    Article  PubMed  CAS  Google Scholar 

  63. Holme I, Urdal P, Anerssen S, et al. Exercise-induced increase in lipoprotein(a). Atherosclerosis 1996; 122: 97–104

    Article  PubMed  CAS  Google Scholar 

  64. Ponjee GA, Janssen EM, van Wersch JW. Long-term physical exercise and lipoprotein(a) levels in a previously sedentary male and female population. Ann Clin Biochem 1995; 32: 181–5

    PubMed  Google Scholar 

  65. Morris R, Digenio A, Padayachee GN, et al. The effect of a 6-month cardiac rehabilitation programme on serum lipoproteins and apoproteins A1 and B and lipoprotein a. S Afr Med J 1993; 83: 315–8

    PubMed  CAS  Google Scholar 

  66. Mankowitz K, Seip R, Semenkovich CF, et al. Short-term interruption of training affects both fasting and post-prandial lipoproteins. Atherosclerosis 1992; 95: 181–9

    Article  PubMed  CAS  Google Scholar 

  67. Maeda S, Abe A, Seishima M, et al. Transient changes of serum lipoprotein(a) as an acute phase protein. Atherosclerosis 1989; 78: 145–50

    Article  PubMed  CAS  Google Scholar 

  68. Dufaux B, Order U, Geyer H, et al. C-reactive protein serum concentration in well-trained athletes. Int J Sports Med 1984; 5: 102–6

    Article  PubMed  CAS  Google Scholar 

  69. Liesen H, Dufaux B, Hollmann W. Modifications of serum glycoproteins the days following a prolonged physical exercise and the influence of physical training. Eur J Appl Physiol Occup Physiol 1977; 37: 243–54

    Article  PubMed  CAS  Google Scholar 

  70. Hubinger LM, Mackinnon LT, Barber L, et al. The acute effects of treadmill running on lipoprotein(a) levels in males and females. Med Sci Sports Exerc 1997; 29: 436–42

    Article  PubMed  Google Scholar 

  71. Durstine JL, Ferguson MA, Szymanski LM, et al. Effect of a single session of exercise on lipoprotein(a). Med Sci Sports Exerc 1996; 28: 1277–81

    Article  PubMed  CAS  Google Scholar 

  72. Gruden G, Olivetti C, Taliano C, et al. Lipoprotein(a) after acute exercise in healthy subjects. Int J Clin Lab Res 1996; 26: 140–1

    Article  PubMed  CAS  Google Scholar 

  73. Cannon JG, Meydani SN, Fielding RA, et al. Acute phase response in exercise. II. Association between vitamin E, cytokines and muscle proteolysis. Am J Physiol 1991; 260 (6 Pt 2): R1235–40

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laurel Mackinnon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mackinnon, L., Hubinger, L.M. Effects of Exercise on Lipoprotein(a). Sports Med 28, 11–24 (1999). https://doi.org/10.2165/00007256-199928010-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199928010-00002

Keywords

Navigation