Lipoprotein(a): what your result means
Last reviewed: November 2026
Lipoprotein(a), usually written Lp(a) and pronounced "L-P-little-a", is an inherited type of cholesterol particle. A high level increases the risk of heart attack, stroke and narrowing of the aortic valve, even when the rest of your cholesterol looks normal. Around one in five people has a raised level, and most do not know it, because it is not part of a standard cholesterol test.
What is Lp(a)?
Lp(a) is a particle similar to LDL ("bad") cholesterol, with an extra protein attached. It can build up in artery walls, promotes inflammation, and makes blood slightly more likely to clot.
Unlike most cholesterol, your Lp(a) level is set almost entirely by your genes. It is largely fixed from early childhood and changes very little with diet, exercise or weight loss. That is why a single test is usually enough for life.
Who should be tested?
European guidelines recommend that every adult has their Lp(a) measured at least once. It is particularly worth checking if you:
Early heart disease
Have had a heart attack, stent, bypass or stroke, especially at a younger age, or with few other risk factors.
Family history
Have a close relative with early heart disease, or with a known high Lp(a).
High cholesterol
Have familial hypercholesterolaemia, or cholesterol that responds poorly to statins.
It is also helpful if you are on the borderline of needing cholesterol-lowering treatment, or have narrowing of the aortic valve.
Understanding your result
Lp(a) is reported in one of two units, depending on the laboratory: nanomoles per litre (nmol/L) or milligrams per decilitre (mg/dL). The two cannot be converted exactly, so always check which unit your result uses.
| Result | nmol/L | mg/dL |
|---|---|---|
| Low risk | below 75 | below 30 |
| Borderline | 75 to 125 | 30 to 50 |
| Raised | above 125 | above 50 |
Risk rises steadily with the level, so a very high result (for example above 200 nmol/L) carries more risk than one just above the threshold. Your Lp(a) is always interpreted alongside your other risk factors, never on its own.
What to do if your Lp(a) is high
A high Lp(a) is a risk factor, not a diagnosis of heart disease. Many people with a high level never have a heart problem. The aim is to bring your overall risk down as far as possible.
- Treat everything else more firmly. Lower your LDL cholesterol further than you otherwise would, usually with a statin and sometimes additional medicines. Control blood pressure tightly, stop smoking, and manage diabetes and weight.
- Look for disease that is already there. A CT coronary angiogram shows whether plaque has already built up in your heart arteries. Finding plaque, or finding none, helps decide how intensive your treatment should be.
- Check your aortic valve. High Lp(a) is linked to narrowing of the aortic valve. An echocardiogram may be recommended, particularly if a murmur is heard.
- Consider medicines that lower Lp(a) as a side effect. PCSK9 inhibitor injections, used to lower LDL cholesterol, also reduce Lp(a) by around a quarter. For a small number of people with very high levels and progressive disease, lipoprotein apheresis, a blood-filtering treatment, may be considered at specialist centres.
- Tell your family. See below.
New treatments: the latest
Several new medicines can lower Lp(a) by 70 to over 90%. They are being tested in large trials to find out whether lowering Lp(a) actually prevents heart attacks and strokes.
November 2026: first major trial result
The Lp(a)HORIZON trial, presented at the American Heart Association meeting in November 2026, tested pelacarsen in 8,350 people with previous heart disease and high Lp(a). The drug lowered Lp(a) by almost 80%, but did not reduce heart attacks, strokes or cardiovascular deaths over about five years.
This was disappointing, but experts do not see it as the final word. The patients already had advanced heart disease, and newer medicines lower Lp(a) further and are given less often. Trials of olpasiran, lepodisiran and muvalaplin are ongoing, and their results will tell us much more.
For now, the best approach remains to measure Lp(a) once, and to use the result to treat your other risk factors more firmly. I follow these trials closely and will update this page as results are published. See also my research.
Your family
Lp(a) is inherited. If your level is high, each of your parents, brothers, sisters and children has about a one in two chance of having a high level too. A simple blood test lets them find out and, if needed, manage their own risk from an earlier age. Children can be tested where there is a strong family history; please discuss this with your GP or paediatrician.
Questions patients ask
Do I need to fast for an Lp(a) test?
No. Lp(a) is not affected by what you have eaten, so the test can be done at any time of day.
How often should Lp(a) be tested?
For most people, once in a lifetime is enough, because the level is set by your genes and stays largely stable through adult life.
Can diet or exercise lower Lp(a)?
Not meaningfully. A healthy lifestyle is still important because it lowers your overall heart risk, but it has little effect on the Lp(a) level itself.
Do statins lower Lp(a)?
No. Statins do not lower Lp(a), but they remain very important because they lower LDL cholesterol and overall risk, which matters even more when Lp(a) is high.
Is there a medicine for high Lp(a)?
Not yet. Several new medicines can lower Lp(a) dramatically and are being tested in large trials. The first of these to report, in November 2026, did not reduce heart attacks or strokes, and results from the others are awaited.
Should my family be tested?
Yes. Lp(a) is inherited, so each of your parents, brothers, sisters and children has about a one in two chance of also having a high level. Testing them can help them manage their own risk early.
Testing and fees
Lp(a) is measured as part of every heart health check. If you already have a result and would like advice on what it means for you, a consultation is the best next step.
Book a consultation
Dr Tom Kaier is a Consultant Interventional Cardiologist at Royal Papworth Hospital, with a PhD in cardiac blood tests. He sees self-funding and insured patients on the Cambridge Biomedical Campus.
View booking optionsThis page provides general information and is not a substitute for individual medical advice. If you have chest pain at rest, or chest pain that does not settle, call 999.
Written and reviewed by Dr Thomas Kaier MD MRCP(UK) MBA PhD, GMC No. 7025841.
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