Lipoprotein(a): The Inherited Cholesterol Risk You Should Be Tested For

Updated July 2026

Not all heart risk shows up on a standard cholesterol panel. There's a separate, inherited factor that can dramatically raise your risk even when your LDL looks perfect, and most people have never been tested for it. It's called lipoprotein(a), or Lp(a), and understanding it could genuinely save your life or a family member's.

What is Lp(a)?

It's an LDL particle with an extra protein attached that makes it far more dangerous. You can think of lipoprotein(a) as a regular LDL ("bad" cholesterol) particle carrying an additional protein that makes it much more toxic and much more likely to accumulate in your artery walls. Critically, your Lp(a) level is not related to your regular LDL level at all. You can have a beautiful cholesterol panel and still carry a high Lp(a), which is exactly why it goes undetected unless you specifically test for it.

The celebrity trainer Bob Harper, of “Biggest Loser” fame, learned this the hard way. Lean, athletic, and only 52, with normal cholesterol his whole life, he suffered a massive heart attack while working out. He had no idea his Lp(a) was elevated. The one clue in hindsight was a strong family history of heart disease.

How much does elevated Lp(a) raise your risk?

Enough to matter a great deal: high levels can triple your risk of heart disease. About one in five people has an Lp(a) level that's too high. These are often the families where heart attacks strike early or repeatedly across several relatives. Because the trait is genetic, it tends to run in families, which is the whole reason testing matters so much.

A quick but important note on the numbers: Lp(a) is reported in one of two different units, and they are not interchangeable. Some labs measure it by mass (mg/dL) and others by particle number (nmol/L), and because the Lp(a) protein varies a lot in size from person to person, there's no reliable way to convert one into the other. Always read your result in the units your lab actually used. As a rough guide, a level under about 30 mg/dL (or under 75 nmol/L) is considered normal. Under the 2026 ACC/AHA guideline, a level at or above 125 nmol/L (about 50 mg/dL) counts as a risk-enhancing factor, associated with roughly 1.4 times the cardiovascular risk, and a level at or above 250 nmol/L (about 100 mg/dL) is associated with double the risk or more. Just know that risk rises along a continuum, so a number sitting just under a cutoff isn't a clean bill of health, and a high number matters even more if you also have high LDL, diabetes, high blood pressure, or a positive calcium scan.

Who should get tested, and how often?

Essentially every adult, once. As of 2026, the American College of Cardiology and American Heart Association recommend that every adult have their Lp(a) measured at least once. It's a simple blood test, and because your level is genetically fixed and doesn't meaningfully change over your lifetime, it's truly a once-in-a-lifetime test. If you have a family history of heart disease, especially in younger relatives or several relatives, getting checked is all the more important. And if your Lp(a) comes back high, tell your first-degree relatives, because they should all be screened too. This includes your children.

Can you lower Lp(a)?

Historically, not really, and that's been the frustrating part. Lp(a) is genetically driven and stubbornly resistant to the tools that work on regular cholesterol. Diet, exercise, and statins, all essential for overall heart health, don't meaningfully lower Lp(a) itself. Niacin and PCSK9 inhibitors produce only modest reductions and aren't practical or approved for this purpose. Plus, high dose niacin has so many potential downsides, it's really no longer prescribed as part of cardiac prevention efforts.

But this is a field on the cusp of real change. Several new medications designed specifically to lower Lp(a), using RNA-based technology to switch off its production in the liver, are in advanced clinical trials and have reduced Lp(a) by 80 to 95 percent in studies. The furthest along, pelacarsen, is expected to report its first major results in 2026.

Here's the essential caveat, though: these drugs are not yet available, and just as importantly, we don't yet have proof that lowering Lp(a) with them actually prevents heart attacks and strokes. That's precisely the question these trials are designed to answer. It's genuinely exciting, but it's tomorrow's tool, not today's.

So what do you do if your Lp(a) is high right now?

My first piece of advice is – do not panic! Lp(a) is a RISK FACTOR, not a disease guarantee. I have seen plenty of patients with high Lp(a) levels and clean coronary artery calcium scans. Your strategy should be to double down on controlling all the risk factors you CAN modify - and that includes blood pressure, blood sugar, weight, exercise and LDL.

Since we can't yet safely lower Lp(a) itself, the strategy is to minimize the LDL that Lp(a) makes so dangerous: if there's very little LDL around to become toxic, elevated Lp(a) has less to work with. In practical terms, that means treating a high Lp(a) as a reason to pursue more aggressive LDL and ApoB targets than you'd otherwise aim for, essentially moving yourself down a category in terms of how low your cholesterol should go. Your doctor can help set the right number, but you can read more about what your LDL level should be.

Reaching those lower LDL targets often means higher statin doses, which can mean more side effects. That's exactly why anyone with elevated Lp(a) should do everything possible through diet and lifestyle to lower LDL naturally, both to reduce the dose of medication needed and to capture all the other cardiovascular benefits of eating well. This is where Step One Foods can genuinely help, lowering LDL through whole-food fiber, plant sterols, and healthy fats so your medications don't have to work as hard. For the two blood tests that give you the fullest picture of your risk, see the two tests your doctor should order.

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