This is general health information only and is not a substitute for advice from your GP or healthcare professional.
1. What is lipoprotein(a)?
Lipoprotein(a), commonly called Lp(a), is a type of lipoprotein that carries cholesterol and other lipids in the bloodstream. It is structurally similar to LDL cholesterol but contains an additional protein called apolipoprotein(a). High Lp(a) is an important inherited risk factor for cardiovascular disease.
2. Why is high Lp(a) important?
High Lp(a) can promote atherosclerosis and inflammation within blood vessels and is associated with an increased risk of coronary artery disease, heart attack, stroke, and aortic valve stenosis. The risk generally increases as Lp(a) levels become higher.
3. Is Lp(a) mainly determined by genetics?
Yes. Lp(a) levels are largely genetically determined and are relatively stable throughout life. Unlike LDL cholesterol, they are not usually substantially changed by diet, exercise, or weight loss. This is why Lp(a) can be elevated even in people who have an otherwise healthy lifestyle.
4. Who should have an Lp(a) test?
Current guidelines increasingly recommend measuring Lp(a) at least once in adulthood, particularly in people with premature cardiovascular disease, a strong family history of cardiovascular disease, familial hypercholesterolaemia, or unexplained cardiovascular risk. Testing can also help refine cardiovascular risk when the need for preventive treatment is uncertain.
5. What level of Lp(a) is considered high?
Lp(a) can be reported in either mg/dL or nmol/L, and the two units should not be converted using a single universal formula because the relationship varies between individuals. In general, an Lp(a) level around 50 mg/dL or 125 nmol/L or higher is considered elevated and associated with increased cardiovascular risk.
6. Can lifestyle changes lower Lp(a)?
Lifestyle measures such as a healthy diet, regular physical activity, maintaining a healthy weight, and not smoking are extremely important for reducing overall cardiovascular risk, but they usually have little effect on the Lp(a) level itself. When Lp(a) is elevated, controlling other modifiable risk factors becomes particularly important.
7. Do statins lower Lp(a)?
Statins are not primarily used to lower Lp(a), and they may cause a small increase in Lp(a) in some people. However, statins remain an important treatment because they substantially reduce LDL cholesterol and cardiovascular risk. An elevated Lp(a) is generally a reason to take LDL-C reduction and other cardiovascular risk factors particularly seriously rather than to stop statin therapy.
8. Can PCSK9 inhibitors lower Lp(a)?
PCSK9 inhibitors such as evolocumab and alirocumab can produce a modest reduction in Lp(a), in addition to their substantial LDL-C lowering effect. However, their established clinical role is primarily LDL-C reduction and cardiovascular risk reduction. Dedicated therapies specifically designed to lower Lp(a) are being actively investigated.
9. What should I do if my Lp(a) is high?
A high Lp(a) level does not mean that cardiovascular disease is inevitable. Instead, it is an additional risk factor that should be considered alongside LDL-C, blood pressure, diabetes, smoking, family history, and other cardiovascular risk factors. Your doctor may recommend more intensive management of LDL-C and other modifiable risks.
10. Can high Lp(a) run in families?
Yes. Because Lp(a) is strongly genetically determined, close relatives of someone with markedly elevated Lp(a) may also have high levels. Family members may therefore benefit from having their Lp(a) measured at least once, particularly when there is a history of premature cardiovascular disease or familial hypercholesterolaemia.