Introduction

If you've recently had a blood test that included Lipoprotein(a) — often written as Lp(a) — and your result came back elevated, you may be wondering what it means and what you should do about it. This article explains what Lp(a) is, why it matters, and what steps you and your doctor can take.

What Is Lp(a)?

Lp(a) is a type of lipoprotein particle in the blood. It is similar to LDL cholesterol (sometimes called "bad cholesterol"), but with an extra protein called apolipoprotein(a) attached to it. This additional protein makes Lp(a) behave differently from standard LDL — and, importantly, makes it an independent risk factor for cardiovascular disease.

Lp(a) is measured in nmol/L or mg/dL. Levels above 50 nmol/L (or approximately 30 mg/dL) are generally considered elevated. Around 20% of the global population — roughly 1.4 billion people — have elevated Lp(a), which can nearly double the risk of cardiovascular disease, heart attack, stroke, and aortic valve disease.

Why Does It Matter?

Elevated Lp(a) increases your cardiovascular risk independently of your other cholesterol levels. It promotes plaque buildup in the arteries, increases the risk of blood clots, and can contribute to inflammation in the vessel walls.

This is an important distinction: even people with otherwise "normal" cholesterol levels can have elevated Lp(a) and be at significantly increased cardiovascular risk. It is one of the reasons why some patients develop heart disease despite having a seemingly healthy lipid profile.

Is It Genetic?

Lp(a) levels are largely determined by your genetics — up to 90%. Unlike LDL cholesterol, Lp(a) levels are relatively stable throughout your life and do not change significantly with age, diet, or exercise. This is not something you caused through your lifestyle.

Large genetic studies — known as Mendelian randomisation analyses — have confirmed a direct causal link between elevated Lp(a) and coronary artery disease, stroke, aortic valve disease, and peripheral arterial disease. This means elevated Lp(a) is not merely a marker of risk; it actively contributes to disease.

If your Lp(a) is elevated, it may be worth testing close family members, as the trait is highly heritable.

What Can You Do About It?

Lifestyle Measures

While lifestyle changes will not dramatically lower Lp(a) itself, they reduce your overall cardiovascular risk — which is the real goal when Lp(a) is elevated. The most important steps include:

Heart-healthy diet: Mediterranean-style eating with plenty of oily fish, nuts, seeds, and vegetables. Reduce processed foods, saturated fat, and trans fats. Increase omega-3 fatty acid intake.
Regular exercise: Aim for at least 150 minutes of moderate-intensity activity per week.
Maintain a healthy weight.
Stop smoking — smoking compounds the risk from elevated Lp(a) significantly.
Limit alcohol consumption.
Manage stress and prioritise sleep — aim for 7 to 9 hours per night.

Medical Management

Because Lp(a) itself is difficult to lower with current medications, your doctor will likely focus on aggressively managing your other modifiable risk factors — LDL cholesterol, blood pressure, and blood sugar — since these compound the risk from elevated Lp(a).

Some important points about medications:

Statins do not lower Lp(a) and may slightly raise it. However, they remain critically important for overall cardiovascular risk reduction and should not be avoided because of an elevated Lp(a) result.
PCSK9 inhibitors (such as evolocumab and alirocumab) can reduce Lp(a) by approximately 20–30%. Trial data from the FOURIER and ODYSSEY OUTCOMES studies suggest this reduction contributes independently to fewer cardiovascular events — particularly in patients with higher baseline Lp(a) levels.
Niacin (vitamin B3) can lower Lp(a) by 20–30%, but is no longer widely recommended. Two large trials — AIM-HIGH and HPS2-THRIVE — failed to demonstrate additional cardiovascular benefit when niacin was added to statin therapy, and significant side effects were observed.
Lipoprotein apheresis — a dialysis-like blood-filtering procedure — can acutely reduce Lp(a) by 60–75% and is available in limited specialist centres for patients with progressive cardiovascular disease despite optimal medical therapy.
Aspirin may be considered in some cases — this should be discussed with your doctor based on your overall risk profile.

Can Lowering Lp(a) Reduce Your Risk?

The short answer is that we do not know that yet. While genetic studies strongly suggest that elevated Lp(a) causes cardiovascular disease, the crucial next question — whether directly lowering Lp(a) actually prevents heart attacks and strokes — has not been definitively answered.

There are multiple trials and treatments that look promising, but we do not know for sure. Several large clinical trials are currently underway to answer this question, and actual medication specifically targeting Lp(a) will likely be several years off for now.

What the evidence suggests so far

Genetic studies consistently confirm that elevated Lp(a) causes cardiovascular disease — it is not merely a bystander marker.
Analysis of the FOURIER trial found that patients with higher Lp(a) saw a 23% reduction in major cardiac events with evolocumab, and every 25 nmol/L decrease in Lp(a) corresponded to roughly a 15% further risk reduction.
The ODYSSEY OUTCOMES trial showed that Lp(a) lowering with alirocumab was an independent predictor of fewer cardiovascular events, separate from the benefit of LDL cholesterol lowering.
Epidemiological modelling suggests that lowering Lp(a) by approximately 50 mg/dL (105 nmol/L) over five years could reduce cardiovascular events by around 20% in people with established heart disease.
However, these findings are considered suggestive rather than conclusive. No completed trial has yet proven that specifically targeting Lp(a) reduces cardiovascular events.

The bottom line: the evidence is promising, but no medication is currently approved specifically to lower Lp(a). New treatments are in development and being tested in large clinical trials. Until those results are available, the focus should be on managing all of your other cardiovascular risk factors as effectively as possible.

Key Takeaways

Elevated Lp(a) is genetic and not your fault.
You generally only need to test it once — levels do not change significantly over time.
Focus on what you can control: diet, exercise, smoking cessation, and managing other risk factors.
Work with your doctor to optimise all modifiable cardiovascular risk factors — this is especially important when Lp(a) is elevated.
Evidence suggests that lowering Lp(a) may reduce cardiovascular risk, but this has not yet been proven. Large clinical trials are underway.
New treatments are in development but are likely still several years away from being available.

When to Discuss With Your Doctor

If you have a family history of early heart disease.
If you want to understand your personal risk in more detail.
If you are unsure whether your current medications are optimal given your Lp(a) level.
If you would like to discuss PCSK9 inhibitors, which can modestly lower Lp(a) and are available now.
If you are interested in whether clinical trials for new Lp(a) therapies may be appropriate for you.

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According to Dr Matthew Balerdi, Consultant Cardiologist, knowing your Lp(a) level is valuable because it helps build a complete picture of your cardiovascular risk — and allows you and your doctor to take proactive steps to protect your heart health, even before specific Lp(a)-lowering medications become available.

Frequently Asked Questions

What is Lp(a) and why should I care? Lp(a) is a genetically determined lipoprotein particle that independently increases your risk of heart disease, stroke, and aortic valve disease — even if your other cholesterol levels are normal.

Is there a cure for high Lp(a)? Not yet. No medication is currently approved to specifically lower Lp(a). However, several promising treatments are in advanced clinical trials and may become available in the coming years.

Do I need to keep testing my Lp(a)? Generally, no. Because Lp(a) levels are genetically determined and remain stable throughout life, a single measurement is usually sufficient.

Should my family be tested? If your Lp(a) is elevated, it is reasonable to test first-degree family members (parents, siblings, children) as the trait is up to 90% heritable.

Will statins help my Lp(a)? Statins do not lower Lp(a) and may slightly raise it. However, they remain essential for managing overall cardiovascular risk and should not be stopped because of an elevated Lp(a) result.

Understanding Your Lipoprotein(a) Result