Lipoprotein(a): The Inherited Risk Factor Your Doctor May Not Test
Lp(a) is a genetic risk factor for heart disease that affects 1 in 5 people. Learn what elevated Lp(a) means and what you can do about it.
3 min read
Lipoprotein(a), or Lp(a), is a genetic risk factor for cardiovascular disease that affects about 20% of the population. Unlike other cholesterol markers, Lp(a) levels are largely determined by your genes and don't respond much to diet or most medications.
What Is Lp(a)?
Lp(a) is an LDL particle with an extra protein called apolipoprotein(a) attached. This makes it:
- More likely to get trapped in artery walls
- Pro-inflammatory
- Prone to promoting blood clots
It's essentially a more dangerous version of LDL, and its levels are 80-90% determined by genetics.
Why Lp(a) Matters
Elevated Lp(a) significantly increases risk of:
- Heart attacks
- Strokes
- Aortic valve stenosis
- Peripheral artery disease
This risk is independent of LDL cholesterol. You can have perfect LDL and still have high cardiovascular risk from elevated Lp(a).
What Are Normal Lp(a) Levels?
- Desirable: Below 30 mg/dL (or below 75 nmol/L)
- Borderline: 30-50 mg/dL (75-125 nmol/L)
- High: Above 50 mg/dL (above 125 nmol/L)
Note: Units vary between labs. Make sure you know whether your result is in mg/dL or nmol/L — they're not directly comparable.
Who Should Be Tested?
Consider Lp(a) testing if you have:
- Family history of early heart disease (before age 55 in men, 65 in women)
- Personal history of cardiovascular disease, especially at a young age
- Family history of elevated Lp(a)
- Familial hypercholesterolemia
- Cardiovascular events despite optimal LDL control
Many experts recommend everyone get tested once, since it's genetic and doesn't change much over time.
What If Your Lp(a) Is High?
Unfortunately, options are currently limited:
What Doesn't Work Well
- Statins: Don't lower Lp(a) (may slightly increase it)
- Diet and exercise: Minimal effect
- Most supplements: No proven benefit
What May Help
- Niacin: Can lower Lp(a) by 20-30%, but has side effects and uncertain clinical benefit
- PCSK9 inhibitors: Reduce Lp(a) by 20-30%, though not approved specifically for this
- Lipoprotein apheresis: For extremely high levels, this blood-filtering procedure can help
New Treatments in Development
RNA-targeted therapies (antisense oligonucleotides) can reduce Lp(a) by 80-90%. Clinical trials are ongoing, and approval may come within the next few years.
Managing Risk with High Lp(a)
If you have elevated Lp(a), focus on controlling everything else:
- Keep LDL as low as possible — high Lp(a) means less room for error
- Maintain optimal blood pressure
- Don't smoke
- Manage blood sugar
- Stay physically active
You can't change your Lp(a), but you can reduce your overall cardiovascular risk by optimising other factors.