Lp(a): The Inherited “Bad” Cholesterol You Should Know About

When you think about cholesterol, you may think about LDL, often called “bad cholesterol.” But there is another cholesterol-carrying particle that can affect your heart and blood vessels: lipoprotein(a), or Lp(a).

About 1 in 5 people have elevated Lp(a), yet many people have never heard of it. Lp(a) usually causes no symptoms and is not included in a standard cholesterol panel, so the only way to know your level is through a specific blood test.¹

Because Lp(a) is largely inherited, knowing your level can provide information about your cardiovascular risk that a standard cholesterol test may not show.

What Is Lp(a), or Lipoprotein(a)?

Lp(a), pronounced “L-P little a,” is a particle in your blood that carries cholesterol and other substances through your body.

It is similar to LDL, but it has an additional protein called apolipoprotein(a) attached to it. This structure gives Lp(a) properties that can make it more likely to contribute to plaque buildup and inflammation in the walls of blood vessels.²

Your body needs cholesterol for important functions, including making hormones and building cells. But certain cholesterol-carrying particles can contribute to plaque buildup in the arteries when levels are elevated.

Lp(a) vs. LDL cholesterol

Lp(a) and LDL are different, but both can contribute to cardiovascular risk.

• LDL cholesterol is influenced by many factors, including genetics, diet, physical activity, and certain medications.
• Lp(a) is different. Your level is primarily determined by your genes and usually stays relatively stable throughout your life. Lifestyle changes that lower LDL generally have little effect on Lp(a).²

That means you can have a healthy lifestyle and a healthy LDL level while still having elevated Lp(a).

Why Is High Lp(a) Dangerous?

High Lp(a) is considered an independent risk factor for cardiovascular disease. Research has linked elevated Lp(a) with a higher risk of conditions including:

• Heart attack
• Stroke
• Coronary artery disease
• Peripheral artery disease
• Aortic valve stenosis, a narrowing of the heart's aortic valve

Lp(a) can contribute to cardiovascular risk in several ways. It can contribute to plaque buildup in artery walls, promote inflammation, and may contribute to processes involved in blood clotting.²

Importantly, Lp(a) can increase cardiovascular risk even when LDL cholesterol is well controlled. This is one reason Lp(a) can provide information that a standard cholesterol panel does not.²

The newest American Heart Association and American College of Cardiology guidance recognizes elevated Lp(a) as a risk-enhancing factor. An Lp(a) level of 125 nmol/L (50 mg/dL) or higher is associated with increased long-term cardiovascular risk.³

What Causes High Lp(a)? It’s Mostly Genetic

For most people, Lp(a) is largely determined by genetics. An American Heart Association scientific statement estimates that approximately 70% to 90% of the variation in Lp(a) levels between people is genetically determined.²

Unlike LDL cholesterol, Lp(a) is not meaningfully lowered through diet or exercise. Your level is generally established early in life and remains relatively stable.

Lp(a) levels can also vary among populations. Higher levels are more common among people of African ancestry, and elevated levels can run in families.¹

This is why knowing your family history can be helpful. If a close family member has high Lp(a) or experienced cardiovascular disease at a younger age, ask about whether Lp(a) testing may be appropriate.

Because Lp(a) is inherited, testing family members can also help identify people who may have elevated levels.

How Is Lp(a) Tested?

An Lp(a) test is a simple blood test. It is different from the standard lipid panel that measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Because Lp(a) usually does not change much over time, current guidelines recommend that every adult have their Lp(a) level measured at least once in their lifetime. Testing may be particularly useful for people with a family history of high Lp(a), premature heart disease, or certain inherited cholesterol conditions.^1,3

Why isn't Lp(a) included in a standard cholesterol test?

A routine cholesterol panel does not typically include Lp(a). That means someone can have a cholesterol panel that looks normal while still having elevated Lp(a).

Testing has also historically been less common because there have been fewer treatment options specifically targeting Lp(a). But that is changing as researchers continue to study Lp(a) and develop potential treatments.

The only way to know your Lp(a) level is to test it.

Care Access offers access to Lp(a) testing through its cardiometabolic health program. Learn more about testing and available locations.

Or you can purchase an Lp(a) blood test to test your levels.

What Do My Lp(a) Levels Mean?

Lp(a) can be reported using different units, most commonly milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L).

The American Heart Association and American College of Cardiology identify 125 nmol/L (50 mg/dL) or higher as a level associated with increased cardiovascular risk. Levels of 250 nmol/L (100 mg/dL) or higher are associated with an estimated twofold higher long-term risk.³

What Should I Do If My Lp(a) Is High?

If your Lp(a) is elevated, the goal is not simply to find a food or supplement that will lower the number. Lifestyle changes have little effect on Lp(a) itself.

Instead, knowing that you have elevated Lp(a) gives you and your healthcare team an opportunity to pay closer attention to the cardiovascular risk factors that can be changed.

Depending on your individual risk, this may include:

• Managing LDL cholesterol
• Keeping blood pressure in a healthy range
• Not smoking
• Eating a heart-healthy diet
• Staying physically active
• Maintaining a healthy weight
• Managing blood sugar
• Getting enough sleep
• Following recommended preventive care

The 2026 ACC/AHA dyslipidemia guideline recommends more intensive management of other cardiovascular risk factors when Lp(a) is elevated, particularly LDL cholesterol.³

Can you lower Lp(a)?

At this time, there is no FDA-approved medication specifically designed to lower Lp(a) and reduce cardiovascular events.

Some existing medications can lower Lp(a) to some degree. For example, PCSK9 inhibitors can reduce Lp(a) while also lowering LDL cholesterol. However, these medications are primarily used to manage LDL cholesterol and overall cardiovascular risk rather than specifically to treat Lp(a).⁵

You may not be able to change your Lp(a) level very much, but you can take steps to reduce your overall cardiovascular risk.

The Future of Lp(a) Treatment

Lp(a) has become an active area of cardiovascular research. Scientists are developing therapies designed to reduce the production of Lp(a) in the liver, including RNA-based treatments.

Several investigational therapies have been able to substantially lower Lp(a) levels in clinical trials. However, an important question remains: Does lowering Lp(a) actually reduce heart attacks, strokes, and other cardiovascular events?

Recent research has provided a reminder that lowering a biomarker does not automatically mean that a treatment will improve health outcomes. In September 2026, Novartis announced that its Phase 3 Lp(a)HORIZON trial of pelacarsen lowered Lp(a) but did not meet its primary goal of reducing cardiovascular events.⁶

Other Lp(a)-targeted treatments, including olpasiran and lepodisiran, remain under investigation in Phase 3 cardiovascular outcomes trials. Researchers are studying whether these newer approaches can translate substantial reductions in Lp(a) into meaningful reductions in cardiovascular events.⁷

This research could help answer one of the biggest remaining questions in cardiovascular medicine: If we can lower Lp(a), can we lower the heart and stroke risk associated with it?

• Silencing the Messenger: The Future of Lp(a) Treatment
• High Lp(a): Expert Insights & Future Possibilities

Know Your Lp(a)

Lp(a) is an inherited risk factor that many people do not know they have. Because it usually causes no symptoms and is not included in a standard cholesterol panel, testing is the only way to find out your level.

Understanding your Lp(a) can give you a more complete picture of your cardiovascular risk and help you make informed decisions about your health.