Lipoprotein(a): The Genetic Cardiovascular Risk Factor Most People Don't Know About

Quick answer

Lipoprotein(a), or Lp(a), is a cholesterol-like particle you inherit from your parents. About 80% of your level comes from your genes, and it stays about the same your whole life. A level over 30 mg/dL raises your risk for heart attack, stroke, and a heart valve problem. You only need this test once, and you use the result for the rest of your life.

What is lipoprotein(a)?

Lp(a) is a particle much like LDL, the "bad" cholesterol. But it carries an extra protein attached to it, called apolipoprotein(a).

This extra protein makes Lp(a) more likely to harm your artery walls. It can also make your blood more likely to form clots.

Your genes decide almost all of your Lp(a) level. Your number at 25 will look much like your number at 65. Diet and exercise, which can change your LDL a lot, barely move Lp(a) at all.

How common is a high Lp(a) level?

Around 20 to 25% of people worldwide have a high Lp(a) level, meaning over 30 mg/dL. Some groups carry this trait more often than others, and rates vary even within Asian populations.

Most people with a high level find out only after a heart attack or stroke. By then, the best window for prevention has already passed.

Reference ranges

Some labs report Lp(a) in a different unit, nmol/L, instead of mg/dL. Roughly, 1 mg/dL equals about 2 to 2.5 nmol/L, but this conversion is not exact. Always compare results using the same unit.

Why a high Lp(a) matters

Large studies link a high Lp(a) to a higher risk of several problems.

• Early heart disease. This means a heart attack before age 55 in men, or 65 in women.
• Stroke. Specifically the type caused by a blocked blood vessel.
• Poor circulation in your legs. Doctors call this peripheral artery disease.
• A stiff, narrowed heart valve. This can develop later in life.

The higher your Lp(a), the higher your risk. Someone with a level of 100 mg/dL carries roughly two to three times the heart disease risk of someone under 30 mg/dL, all else being equal.

How doctors test Lp(a)

This test needs one blood sample. You do not need to fast.

You only need to test once in your life. Since Lp(a) is set by your genes and does not change, testing again gives you no new information. The one exception is if you start a new medicine designed to lower Lp(a) specifically. These medicines are still in development.

What to do if your Lp(a) is high

This is the real question that matters. Since you cannot lower Lp(a) itself through lifestyle, the plan is to work harder on everything else you can control.

1. Aim for lower LDL and ApoB

If your Lp(a) is high, doctors often recommend tighter cholesterol targets.

• LDL under 70 mg/dL, instead of the usual under 100.
• ApoB under 80 mg/dL, instead of the usual under 90.

You reach these tighter targets through diet, exercise, weight management, and sometimes medicine like a statin.

2. Manage your blood pressure closely

Aim for under 130/80 mmHg. Your doctor may set an even lower target for you.

3. Keep your blood sugar in check

Aim for an HbA1c, a 3-month average of your blood sugar, under 5.6%. Catch insulin resistance early.

4. Build strong daily habits

• Get regular aerobic exercise, at least 150 minutes a week.
• Eat more like the Mediterranean diet.
• Sleep enough each night.
• Do not smoke.
• Drink alcohol in moderation, if at all.
• Manage stress.

5. Test your family

Lp(a) runs in families. If your level is high, your parents, siblings, and children each have roughly a 50% chance of a high level too. Encourage them to get tested.

If you have not tested it yet, there is no reason to wait. Book a &you Labs panel and get your one-time result.

New treatments on the horizon

A few new medicines aim to lower Lp(a) directly.

• Pelacarsen, which lowered Lp(a) by more than 80% in early trials, is now in larger trials to test heart outcomes.
• Olpasiran and lepodisiran, two other new medicines, are also in clinical trials.

None of these are approved for general use yet. For now, the standard plan for a high Lp(a) is to manage everything else aggressively. That may change in the next few years as these new medicines complete testing.

If you have a very high Lp(a) and a strong family history of early heart disease, ask your doctor about clinical trials near you.

Why Lp(a) testing is uncommon in the Philippines

A few reasons explain this.

1. Cost. Most insurance plans cover only the cheapest required tests.
2. Limited awareness among some doctors. Lp(a) is a newer area of focus in training.
3. Limited awareness among patients. Most people have never heard of it, so they never ask for it.

Even so, more and more heart doctors worldwide now recommend everyone test Lp(a) at least once.

What if your result falls in the gray zone, 30 to 50 mg/dL?

A moderate result is useful information, but it is not a clear verdict on its own. What it means depends on your other risk factors.

• If you are otherwise low risk: treat it as useful information, and keep managing your other numbers well.
• If you have other risk factors, like high LDL, diabetes, high blood pressure, or family history: consider tighter targets and an earlier conversation about medicine.
• If you already have heart disease: a result in this range supports a more aggressive treatment plan.

Where Lp(a) fits into a full heart health check

Lp(a) is one piece of a complete heart health picture. A &you Labs panel checks heart and vascular markers along with markers for weight, hormones, and more. You can see the full list of what a &you Labs panel covers. Every result comes with the standard lab range plus a healthy target range, and a doctor writes up what it means for you.

Frequently asked questions

Does diet or exercise lower Lp(a)?

Not by much. Even major weight loss usually moves Lp(a) by only 5 to 10%, and doctors are not sure this small change matters much. The real plan for a high Lp(a) is to manage your other risk factors harder, not to chase a lower Lp(a) number through lifestyle.

Do statins help if my Lp(a) is high?

Statins do not lower Lp(a) itself, and in some people they may raise it slightly. But statins still help, because they lower LDL and ApoB, the parts of your risk you can control. Most people with a high Lp(a) end up taking a statin for this reason.

What about PCSK9 inhibitors?

These are newer cholesterol medicines. They can lower Lp(a) by 20 to 30% and lower LDL by a lot more. Doctors usually reserve them for high-risk patients already on a statin, especially those who already have heart disease.

Should children get tested for Lp(a)?

Most guidelines do not recommend routine testing in children. Testing adult first-degree relatives is more common. A doctor may recommend testing a child only if the family has a known high Lp(a) level and a history of early heart disease.

Will insurance cover my Lp(a) test?

This varies by plan, and most Philippine HMOs do not cover it routinely. Since you only need it once, many people find it worth paying for directly.

Key takeaways

• Lipoprotein(a), or Lp(a), is a genetic heart disease marker. About 1 in 5 people worldwide has a high level.
• Your level is set mostly by your genes and stays stable for life. Test it once.
• A level over 30 mg/dL raises your risk for heart attack, stroke, and heart valve disease.
• Lifestyle does not meaningfully lower Lp(a). The plan is to manage your other risk factors harder.
• If your Lp(a) is high, encourage your close family members to get tested too.