Lipoprotein(a) (Lp(a)) Test

Lipoprotein(a) is the cholesterol test most people have never had. It’s mostly set by your genes, so one test usually tells you what you need to know for life.

Quick answer: Lp(a) is a cholesterol-carrying particle whose level is over 90% set by your genes, so one test is usually enough. European experts advise testing every adult once. Above 50 mg/dL (about 125 nmol/L) means higher heart attack, stroke and aortic stenosis risk. No Lp(a)-lowering medicine is approved yet, so treatment targets your other risks.

What the test measures

• Lp(a) is an LDL-like cholesterol particle with an extra protein, apolipoprotein(a), attached.
• High levels add to the build-up of fatty plaque in arteries and to calcium in the aortic valve. They’re linked to heart attack, stroke and narrowing of the aortic valve (aortic stenosis).
• It’s not part of a routine cholesterol test. Your doctor has to ask for it.

Why it’s mostly genetic

• Over 90% of your Lp(a) level is set by one gene (LPA), inherited from your parents.
• Diet and exercise barely change it, and it stays fairly stable through adult life, so a single test is usually enough.
• Levels differ by ancestry: on average they’re highest in people of African ancestry, then South Asian, White and Chinese ancestry. Women’s levels run about 5–10% higher than men’s.
• About 1.4 billion people worldwide have high Lp(a).
• Kidney disease, hormones and acute illness can shift results, so your doctor may interpret them in that context.

Who should test

• Europe (EAS 2022 consensus, European Heart Journal): measure Lp(a) at least once in every adult, ideally with the first cholesterol test.
• Australia (Australian Atherosclerosis Society 2023): test people with early (premature) heart or blood vessel disease and people at intermediate to high heart risk. It doesn’t yet advise testing everyone.
• Also worth discussing if you have familial hypercholesterolaemia, or a parent, brother or sister with high Lp(a) or early heart disease.
• If yours is high, close relatives may want testing too (cascade testing).
• Ask whether there’s an out-of-pocket fee before the test.

Units: mg/dL vs nmol/L

• nmol/L counts particles. mg/dL weighs them. The Australian position statement recommends nmol/L.
• The apolipoprotein(a) part comes in many sizes, so particle weight differs between people. That’s why there’s no exact conversion.
• The EAS panel advises against converting with a fixed factor. Rough guides of 2 to 2.5 nmol/L per mg/dL exist, but compare your result in the unit your lab reports.

What a high result means

The EAS 2022 consensus uses these interim levels:

• Under 30 mg/dL (under 75 nmol/L): no extra risk from Lp(a).
• 30–50 mg/dL (75–125 nmol/L): grey zone.
• Over 50 mg/dL (over 125 nmol/L): higher risk of heart attack, stroke and aortic stenosis.
• Risk keeps climbing with the level: around 100 mg/dL (about 250 nmol/L) roughly doubles the risk of heart and blood vessel disease.
• A high result isn’t a diagnosis. It adds to your other risks, which is why your doctor looks at the whole picture.

What happens next

• Lower everything else: LDL cholesterol, blood pressure, smoking, diabetes, weight and activity. Lifestyle doesn’t lower Lp(a) much, but it lowers your overall risk.
• Cholesterol medicines such as statins, ezetimibe and, for some, PCSK9 inhibitors, aimed at your overall risk. See high cholesterol and statins.
• Lipoprotein apheresis (filtering the blood) is an option for a few people whose heart disease keeps progressing despite best treatment.
• Niacin and aspirin aren’t recommended just to treat a high Lp(a).

New drugs: promising numbers, no proof yet

• Pelacarsen (an antisense medicine) was the first to finish a heart outcome trial. In Lp(a)HORIZON, 8,323 people with heart or blood vessel disease and Lp(a) of 70 mg/dL or more were followed for a median of 4.7 years.
• It cut Lp(a) by about 78%, but heart attacks, strokes, urgent stent procedures and heart deaths didn’t fall: 12.3% on pelacarsen vs 12.1% on placebo. Results were presented on 7 November 2026 and published in the New England Journal of Medicine.
• Olpasiran, lepodisiran and zerlasiran (small interfering RNA medicines) also lower Lp(a) sharply. None is approved, and their outcome trials are still to report.
• The lesson: lowering a number isn’t the same as preventing heart attacks. Testing still matters, because a high Lp(a) helps your doctor judge how hard to treat your other risks.

Get urgent help (000 in Australia, or your local emergency number) for chest pain or pressure, or signs of stroke (face drooping, arm weakness, slurred speech), whatever your Lp(a). See your GP soon if you have a high Lp(a) and notice chest discomfort, breathlessness, dizziness or fainting when you exert yourself: these can be signs of heart disease or a narrowed aortic valve.

Practise reading results. Play Panelysis, the daily blood-test puzzle: a fictional patient, a real-looking panel, three guesses. More in medical games.

Evidence and more information

• Kronenberg et al, Eur Heart J 2022: Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis, a European Atherosclerosis Society consensus statement
• American College of Cardiology: Key points of the 2022 EAS Lp(a) consensus
• Ward et al, Heart Lung Circ 2023: Australian Atherosclerosis Society position statement on lipoprotein(a)
• American Heart Association, 7 November 2026: Lp(a) HORIZON trial results
• HCPLive, November 2026: Lp(a)HORIZON event rates (Cho et al, NEJM 2026)
• TCTMD, September 2026: Lp(a)HORIZON top-line results and other Lp(a) drugs in development

Updated 9 November 2026. General education, not personal medical advice. Reference ranges differ between laboratories, so use the range printed on your own report and talk to your GP about your result.

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