- Main driver
- Genetics (over 90% per the European Atherosclerosis Society)
- Included in a routine lipid panel?
- No, order separately
- Risk-enhancing level (ACC/AHA)
- 50 mg/dL or 125 nmol/L and above
- How often to test
- At least once in adulthood for most people
What makes Lp(a) different
Lp(a) looks much like an LDL particle, the main carrier of "bad" cholesterol, with an additional protein called apolipoprotein(a) attached. That extra piece appears to make it more likely to promote plaque, inflammation and blood clotting.
The American Heart Association estimates that about 1 in 5 people worldwide have a high level. Most have no symptoms and normal routine cholesterol results.
Who should be tested
The American Heart Association recommends that every adult be tested at least once, and the European Atherosclerosis Society's 2022 consensus says Lp(a) should be measured at least once in adults. Testing is especially valuable if you have:
- Heart disease or stroke at a young age, or a family history of it (before 55 in men or 65 in women).
- A relative known to have high Lp(a).
- Familial hypercholesterolemia or very high LDL.
- Heart disease that seems out of proportion to your other risk factors.
Reading the result
Labs report Lp(a) in either mg/dL or nmol/L, and the two units cannot be converted precisely, so check which one your report uses. The 2019 ACC/AHA prevention guideline treats a level of 50 mg/dL or 125 nmol/L or higher as a risk-enhancing factor. The AHA notes that around 250 nmol/L (100 mg/dL) or above may roughly double risk.
Because your level is mostly genetic and fairly stable, one measurement is usually enough. If yours is high, close relatives may want to be tested too.
What can be done about a high level
Diet and exercise do not meaningfully lower Lp(a). The practical response today is to drive down every other risk factor you can control: LDL cholesterol or ApoB, blood pressure, blood sugar and smoking. A high Lp(a) can tip a clinician toward starting or intensifying cholesterol-lowering treatment.
Medicines designed specifically to lower Lp(a) are being tested in large trials, and it is not yet known whether lowering it reduces heart attacks. Statins remain useful for overall risk even though they do not lower Lp(a) and may raise it slightly.
Why it matters after 45
Midlife is when the cumulative effect of a high Lp(a) tends to show up, through heart attacks, strokes or a narrowing aortic valve. Knowing your number earlier helps you and your clinician set more ambitious targets for the risk factors you can change. Women may want to ask about it as cholesterol rises around menopause, since a routine panel will not reveal it.
Lipoprotein(a): common questions
Can I lower Lp(a) with diet?
Not meaningfully. It is largely genetic, so the focus shifts to lowering your other risk factors.
Do I need to repeat the test?
For most people one measurement is enough because the level is mostly stable. Your clinician may repeat it in special situations.
Is Lp(a) the same as LDL?
No. It is a related but distinct particle, and a normal LDL does not rule out a high Lp(a).
Does menopause change Lp(a)?
Levels can shift somewhat around menopause, but genetics remains the main determinant. Ask your clinician whether to recheck if your first test was before menopause.
Should my children be tested?
If you have a high level, relatives may benefit from testing because it is inherited. Discuss timing with their own clinicians.
How does Lp(a) relate to ApoB?
Each Lp(a) particle carries one ApoB molecule, so it is counted within total ApoB, but Lp(a) adds risk beyond what ApoB alone shows.
Sources
We cite government agencies, professional societies and peer-reviewed research. See our editorial policy.
- Lipoprotein(a)American Heart Association
- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular DiseaseAmerican College of Cardiology / American Heart Association
- Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: consensus statement (2022)European Atherosclerosis Society