Lipoprotein(a) – Lp(a)
What is lipoprotein(a) (Lp(a))?
Lipoprotein(a), written Lp(a) and said “L-P-little-a”, is a cholesterol-carrying particle in the blood that is similar to LDL cholesterol but has an extra protein attached. Your Lp(a) level is mostly set by your genes. It stays about the same throughout life and is little affected by diet or exercise. About 1 in 5 people have a raised level.
How is lipoprotein(a) inherited?
Your level is set mainly by a single gene, LPA, and more than 90% of the difference between people is genetic. You inherit one copy of the gene from each parent, so if one parent has a high Lp(a), each of their children has about a 50% chance of inheriting it. Levels are usually established in early childhood and then change little through adult life.
Lipoprotein(a) vs LDL cholesterol: what is the difference?
Lp(a) is built like an LDL particle, with an extra protein called apolipoprotein(a) attached. It carries inflammatory oxidised fats and is thought to promote the build-up of plaque in artery walls. A standard cholesterol test does not measure Lp(a), and a normal LDL result does not rule out a high Lp(a).
High lipoprotein(a) and heart disease risk
A high Lp(a) is an independent, inherited risk factor for heart attack, stroke, and narrowing of the aortic valve (aortic stenosis). The risk rises with the level. A high Lp(a) does not mean you will get heart disease; it adds to your other risks, such as cholesterol, blood pressure, diabetes and smoking.
Lipoprotein(a), heart attack and stroke
Large genetic and population studies show that the risk of heart attack and stroke rises steadily as Lp(a) rises, and the effect is seen even when LDL cholesterol is well controlled. The risk is greatest in people with the highest levels.
Lipoprotein(a) and aortic stenosis (aortic valve narrowing)
A high Lp(a) is also linked to calcification and narrowing of the aortic valve. Your doctor may suggest an echocardiogram if you have symptoms or a heart murmur. Read more about echocardiography.
Lipoprotein(a) and blood clots in the veins
Current evidence does not show that a high Lp(a) increases the risk of venous clots such as deep vein thrombosis, so a clot on its own is not a reason to test.
How high is the risk with a high lipoprotein(a)?
A high Lp(a) raises the chance of heart disease; it does not mean you will develop it. Most of your overall risk still comes from factors you can change, which is why treatment focuses on LDL cholesterol, blood pressure, blood sugar, weight, smoking and activity.
Lipoprotein(a) test: who should be tested?
European guidance (the 2022 European Atherosclerosis Society consensus) recommends measuring Lp(a) at least once in every adult. In the UK, testing is not yet part of routine NHS screening and availability varies. The HEART UK Lp(a) Taskforce suggests testing particularly in:
- people who have had heart disease or a stroke at a young age
- people with a family history of early heart disease or stroke
- people with familial hypercholesterolaemia or another inherited cholesterol disorder
- people with calcific aortic valve stenosis
- people whose 10-year cardiovascular risk is borderline, where a high Lp(a) could change treatment decisions
- close relatives of someone with a markedly raised level (above 200 nmol/L)
Lipoprotein(a) blood test: what does it involve?
It is a single blood test, and you do not need to fast. Ask for the result in nmol/L, the unit recommended in the UK, because some laboratories still report mg/dL and the two cannot be converted exactly. Lp(a) is not part of a standard cholesterol panel, so it has to be requested specifically.
Lipoprotein(a) levels: what your result means
Lp(a) is usually reported in nmol/L. The HEART UK Taskforce grades results as follows:
- below about 32 nmol/L: not raised
- 32 to 90 nmol/L: minor elevation
- 90 to 200 nmol/L: moderate elevation
- 200 to 400 nmol/L: high
- above 400 nmol/L: very high
European guidance regards levels above about 125 nmol/L (50 mg/dL) as associated with higher risk.
High lipoprotein(a) levels: what a raised result means
A raised result is not a diagnosis of disease. It tells you that your future risk is higher than your other risk factors suggest. It should be combined with your cholesterol, blood pressure, blood sugar, smoking status, family history and age to estimate your overall risk, and it is best interpreted by a clinician. Because Lp(a) rarely changes, the main decisions are how strongly to treat your other risks and whether your relatives should be tested.
Lowering lipoprotein(a) risk: treatment options
Currently there is no widely available medicine licensed specifically to lower Lp(a), and the first large trial of a targeted treatment has not shown fewer heart events (see Latest research). The practical approach is to lower every other risk more strongly.
Lowering LDL cholesterol when lipoprotein(a) is high
Lowering LDL cholesterol reduces cardiovascular risk in everyone, including people with a high Lp(a), and your clinician may set a lower LDL target than usual. Statins do not lower Lp(a) and may raise it slightly, but they reduce LDL and remain strongly worthwhile. Ezetimibe, bempedoic acid, PCSK9 inhibitors or inclisiran may be added when LDL stays too high. PCSK9 inhibitors also lower Lp(a) by roughly a fifth to a third, but they are prescribed for LDL cholesterol, not for Lp(a) itself. Read more about high cholesterol.
Control your other risk factors
Blood pressure, blood sugar, weight, smoking and activity carry much of your overall risk. A healthy diet, regular exercise, stopping smoking, a healthy weight and well-controlled blood pressure and diabetes all matter. Diet and exercise change Lp(a) very little, so they work by lowering your other risks.
Look for plaque
A coronary calcium score or a CT coronary angiogram can show whether plaque has already built up in your heart arteries, which helps decide how intensively to treat.
Specialist options
Lipoprotein apheresis, a procedure that filters Lp(a) from the blood, is reserved for a small number of people with a very high Lp(a) and progressive heart disease despite optimal treatment. It is available only through specialist centres.
Lipoprotein(a) research: new treatments and trials
Several new medicines that sharply lower Lp(a) are being tested, and the first large outcomes trial has now reported.
Pelacarsen and the Lp(a)HORIZON trial (September 2026)
In September 2026 the manufacturer announced the top-line result of Lp(a)HORIZON, the first large trial to test whether lowering Lp(a) prevents heart events. It studied pelacarsen in 8,323 people with raised Lp(a) and established cardiovascular disease. Pelacarsen lowered Lp(a) but did not reduce the risk of major cardiovascular events, which was the main aim of the trial. Full results have not yet been published, so the reasons are not yet clear.
Other trials
Trials of lepodisiran, olpasiran and muvalaplin are continuing and will show whether other approaches make a difference.
What this means for you now
The result does not change the advice to measure Lp(a) at least once, and it reinforces the focus on treating your other risk factors thoroughly. Lp(a) remains an independent risk factor for cardiovascular disease.
Is lipoprotein(a) inherited? Family testing
Because Lp(a) is inherited, the close relatives of someone with a high level have about a 50% chance of having it too. Testing parents, brothers, sisters and children (cascade testing) can identify relatives who would benefit from closer attention to their cholesterol and blood pressure, especially where there is early heart disease or familial hypercholesterolaemia in the family. Testing children is usually considered only in families with a very high Lp(a), early heart disease or familial hypercholesterolaemia, and is best decided with a specialist.
Questions to ask your cardiologist about Lp(a)
- What is my Lp(a) level in nmol/L, and what does it mean alongside my other risks?
- What is my overall cardiovascular risk, and how much does my Lp(a) add to it?
- What should my LDL cholesterol target be?
- Do I need to start or change cholesterol-lowering treatment?
- Do I need other tests, such as a coronary calcium score, a CT coronary angiogram or an echocardiogram?
- Which lifestyle changes will make the biggest difference for me?
- Should my relatives be tested, and who should be tested first?
- Do my blood pressure, blood sugar and weight need closer monitoring?
- Would I be suitable for any specialist treatment or a clinical trial?
- How often should I be reviewed, and do I need to repeat the Lp(a) test?
Lipoprotein(a) FAQs: common questions
Can I lower Lp(a) with diet?
Do I need to repeat the test?
Is Lp(a) the same as LDL?
Does a high Lp(a) mean I will have a heart attack?
Is Lp(a) linked to blood clots in the veins?
Should my children be tested?
Can I have my Lp(a) checked privately?
Guidelines and sources
- Kronenberg F, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. European Heart Journal 2022;43:3925–3946. doi:10.1093/eurheartj/ehac361
- HEART UK Lipoprotein(a) Taskforce. A call to action. August 2023. heartuk.org.uk
- National Lipid Association. Top-line results from the phase 3 Lp(a)HORIZON trial. September 2026. lipid.org
If you have a family history of early heart disease or a raised Lp(a) result and want to understand what it means for you. You can book a video consultation or telephone consultation from anywhere in the UK, or a face to face consultation in Peterborough or Corby.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last reviewed: . This page is for general information and does not replace personal medical advice.