Lipoprotein(a) — Lp(a) — is the most important cardiovascular risk factor most people have never had measured. Here’s what it is, why it matters, and what to do about it.
What is Lp(a)?
An Lp(a) particle is an LDL particle with an extra protein — apolipoprotein(a), or apo(a) — attached to its ApoB. In effect, every Lp(a) is an LDL particle carrying a passenger. That passenger makes the particle more inflammatory, more likely to lodge in the artery wall, and more likely to promote clotting.
Why it matters
Lp(a) raises the risk of heart attack and stroke independently of your LDL and ApoB — it adds risk on top of them. Raised levels are linked to coronary artery disease, ischaemic stroke, peripheral artery disease, narrowing of the aortic valve (aortic stenosis) and abnormal clotting. The higher your Lp(a), the more aggressively I want to manage everything else that can be changed.
It’s written into your genes
Your Lp(a) level is roughly 80–90% inherited, set by the LPA gene, and it barely moves with diet, exercise or weight. That sounds like bad news, but it’s genuinely useful: you only ever need to measure it once. And a high result isn’t a verdict — it’s early information, which is exactly what you want.
How to get tested
Guidelines now recommend that everyone has their Lp(a) checked once in their life. It’s a cheap, widely-available blood test — but plenty of clinicians still don’t order it by default, so ask for it by name and have it added to your usual lipid bloods. Where you can, ask for the result in nmol/L (a particle count) rather than mg/dL — it’s the more reliable unit. You can convert between the two and see your risk band here.
Can you lower it?
Honestly — not much, yet. Statins don’t lower Lp(a) (they can nudge it up slightly). Diet and exercise don’t shift it meaningfully. What we can do today is treat a high Lp(a) as a reason to be aggressive about the risks we can change: ApoB, blood pressure, smoking and weight. Several drugs designed specifically to lower Lp(a) — pelacarsen, olpasiran and others — are in late-stage trials, but none is approved yet, and none has yet been shown to prevent heart attacks. We should know more over the next couple of years, and I’ll update this article when the outcome data lands.
If your Lp(a) is high
- Don’t panic — plenty of people with a high Lp(a) never have an event.
- Get the modifiable risks as low as you sensibly can, especially your ApoB.
- Mention it to close relatives. It’s inherited, so a parent, sibling or child has roughly a 50% chance of being high too.
The one-line version: Lp(a) is a largely-inherited, independent risk factor. Measure it once — and if it’s high, manage everything else harder.
This is general information, not medical advice. Bring it to your own doctor as a starting point.
Dr Mike MacDonald
Consultant cardiologist in Singapore writing about preventive cardiology, lipid management and longevity medicine.
