Lp(a), short for lipoprotein(a), is an inherited cholesterol-carrying particle that raises the risk of heart attack, stroke, and aortic valve narrowing. Your level is mostly set by your genes, a standard cholesterol test doesn't measure it, and roughly 1 in 5 people have a high one. One blood test tells you where you stand.
What is Lp(a)?
Lp(a) looks a lot like an LDL particle, with an extra protein, apolipoprotein(a), attached. It's pronounced "L-P-little-a."
That extra protein makes Lp(a) particles more prone to building plaque and to promoting blood clots.
Your genes mostly determine your Lp(a) level. Unlike LDL cholesterol (LDL-C), diet and exercise don't change it much. You're born with your level, and it stays fairly stable through life.
Key Takeaway
Lp(a) is genetically determined and does not change with lifestyle. One test is enough, and the result stays useful for life.
Why does Lp(a) matter?
High Lp(a) raises your risk of heart disease, stroke, and aortic valve disease on top of your other risk factors. That's what "independent risk factor" means: even with a well-controlled LDL-C, a high Lp(a) still adds risk.
Elevated Lp(a) is common. About 1 in 5 people have a level of 50 mg/dL (about 125 nmol/L) or higher, and most of them haven't been tested, because Lp(a) isn't included in standard lipid panels. It has to be ordered by name.
Source
Kronenberg F et al. “Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement.” European Heart Journal (2022).
View paperParticle for particle, Lp(a) is also more harmful than LDL. A 2024 genetic analysis estimated it is about 6 times as likely to cause coronary disease per particle.
Source
Björnson E, Adiels M, Taskinen MR, et al. “Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis.” Journal of the American College of Cardiology (2024).
View paperWhat is a normal Lp(a) level?
Under 75 nmol/L (about 30 mg/dL) is considered lower risk, and 125 nmol/L (about 50 mg/dL) or higher is high risk, according to the National Lipid Association. Labs report Lp(a) in either nmol/L or mg/dL, and the units don't convert cleanly because Lp(a) particle size varies from person to person, so compare your result to the cutoff in the same unit.
Lp(a) risk levels (National Lipid Association, 2024)
Source
Koschinsky ML, Bajaj A, Boffa MB, et al. “A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice.” Journal of Clinical Lipidology (2024).
View paperThe higher the level, the greater the risk.
Can Lp(a) be treated?
No FDA-approved medicine targets Lp(a) yet. For now, you lower your other risks harder, and PCSK9 inhibitors lower Lp(a) modestly along the way.
What helps now
- Lower LDL-C and ApoB further. A high Lp(a) gives you more reason to push LDL-C and ApoB lower to offset the extra risk. Our guide on how to lower ApoB covers the options.
- PCSK9 inhibitors lower Lp(a) by roughly 20 to 30% as a side benefit, on top of their main job of lowering LDL (in pooled evolocumab studies, Lp(a) fell by about 20 to 38%). The class now includes Repatha, Praluent, the once-monthly Lerochol, and the daily pill Lipfendra. See our PCSK9 inhibitor prescription page for who qualifies.
- Statins still help. They don't lower Lp(a), and in a pooled analysis of six trials they raised it slightly, but they lower LDL and ApoB, which lowers total risk.
Source
Toth PP, Jones SR, Monsalvo ML, Elliott-Davey M, López JAG, Banach M. “Effect of Evolocumab on Non-High-Density Lipoprotein Cholesterol, Apolipoprotein B, and Lipoprotein(a): A Pooled Analysis of Phase 2 and Phase 3 Studies.” Journal of the American Heart Association (2020).
View paperKnowing your Lp(a) tells you how aggressively to treat your other risk factors, which makes the test valuable.
What is coming
Several drugs built to lower Lp(a) directly are in large outcome trials. They cut Lp(a) dramatically in earlier studies. The outcome trials will show whether that prevents heart attacks and strokes.
Lepodisiran (Eli Lilly) is an siRNA, a medicine that tells the liver to make less of the protein Lp(a) is built from. In the phase 2 ALPACA trial, a single high dose lowered Lp(a) by about 94% over six months. A phase 3 outcomes trial is under way.
Source
Nissen SE, Ni W, Shen X, et al. “Lepodisiran: A Long-Duration Small Interfering RNA Targeting Lipoprotein(a).” New England Journal of Medicine (2025).
View paperMuvalaplin (Eli Lilly) is a daily pill that blocks Lp(a) particles from forming. In the phase 2 KRAKEN trial, it lowered Lp(a) by up to about 70 to 86% at 12 weeks compared with placebo, depending on the lab method used. A phase 3 outcomes trial began in 2025.
Source
Nicholls SJ et al. “Oral Muvalaplin for Lowering of Lipoprotein(a): A Randomized Clinical Trial.” JAMA (2025).
View paperResults have been mixed so far. In September 2026, Novartis announced that pelacarsen, the first Lp(a)-lowering drug to finish a large outcomes trial (Lp(a)HORIZON), lowered Lp(a) but did not meet its main goal of reducing cardiovascular events. Results for the siRNA drugs are still pending. Our guide to emerging Lp(a) therapies tracks where each one stands.
Should you get tested?
Yes, at least once as an adult. The 2026 ACC/AHA multisociety guideline on dyslipidemia recommends measuring Lp(a) at least once in every adult, in line with the European Atherosclerosis Society (2022) and the National Lipid Association (2024). Since the result rarely changes, one test gives lasting information.
Source
Blumenthal RS, Morris PB, Gaudino M, et al. “2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2026).
View paperTesting is especially worthwhile if you have:
- A family history of early heart disease (before age 55 in men, 65 in women)
- A personal history of cardiovascular events despite well-controlled cholesterol
- A family member with known elevated Lp(a)
- Other cardiovascular risk factors where a more complete picture would help guide treatment
Lp(a) is a simple blood test available through Quest, Labcorp, and most large lab networks. Our guide on how to get an ApoB or Lp(a) test covers what to ask for and what it costs. Because Lp(a) is inherited, it also runs in families; our genetic testing page covers the optional add-on for inherited cholesterol conditions.
Summary
Lp(a) is a common, inherited risk factor, and one test tells you whether you have it. Knowing your level shapes what you and your care team do about your overall cardiovascular risk.
If your Lp(a) is high, treating ApoB and LDL-C more aggressively helps offset the extra risk, and drugs aimed at Lp(a) itself are working through outcome trials.
At Preval Health, we include Lp(a) testing in every initial assessment because it changes risk assessment and treatment decisions.