Lipoprotein (a) Test

What is Lipoprotein (a)?

Lipoprotein (a) or Lp(a) is a Low-Density Lipoprotein (LDL; the “bad” cholesterol) that contains apolipoprotein B-100 (apoB) linked to apolipoprotein A (apoA). (An apo is a particular protein that attaches to fats – read The Online Clinic webpages to find out more about apoB and apoA).

Lp(a) is produced in the liver. Importantly, Lp(a) is under genetic control, meaning Lp(a) blood levels are inherited and remain relatively constant throughout your life.

What is a Lipoprotein (a) test?

The Lp(a) test measures the level of Lp(a) in the blood. Lp(a) is not among the usual lipids measured in a standard blood test or lipid panel. Because Lp(a) is controlled genetically and serum levels remain relatively unchanged from childhood through to old age, the test is usually only required once in a person’s lifetime.

Why is a Lipoprotein (a) test important?

Lp(a) is an independent risk factor of cardiovascular disease (CVD), specifically atherosclerosis, coronary artery disease, and calcific aortic valvular disease (aortic stenosis), and for cardiovascular mortality.

Atherosclerosis is a process whereby a fatty material called plaque, consisting of cholesterol, fat, and calcium, is deposited and builds up inside the arteries. The plaque hardens and narrows the blood vessels, thus limiting the flow of blood carrying oxygen to vital organs (e.g., heart, brain) and tissues. If pieces of plaque break away from the blood vessel this can cause blood clots (thrombosis). Both restricted blood supply and blood clots can lead to a heart attack or stroke.

Calcific aortic valvular disease is a heart condition in which calcium deposits progressively build up on the heart valve ‘leaflets’ (flaps). The leaflets open and close, pumping blood out of the heart into a major blood vessel called the aorta, carrying blood to the body. Calcification of the aortic valve causes it to stiffen and narrow so that it will not open properly. This also limits the amount of blood flowing out of the heart, potentially leading to a heart attack or stroke.

Who should have their Lipoprotein (a) level tested?

The Lp(a) test may be done together with other blood lipid tests to assess an individual’s risk of developing CVD. However, the test is especially relevant for individuals who have:

• a family history of CVD, including heart disease or stroke at a relatively young age
• a family history of high Lp(a)
• an inherited lipid disorder, e.g., familial hyperlipidaemia and familial hypercholesterolaemia
• a history of CVD, e.g., heart attack, stroke, poor blood circulation in the legs
• calcific aortic valve disease (aortic stenosis)
• recurrent cardiovascular events, despite lifestyle and medical management of major risk factors (e.g., high LDL cholesterol)
• other conditions such as diabetes, high blood pressure, and obesity

Serum Lp(a) levels vary considerably between ethnic groups. Lp(a) levels are highest among Afro-Americans, followed by South Asian, then White, and lowest in the Chinese. There is also a gender difference, with women having higher Lp(a) levels than men.

While usually a once-in-a-lifetime test, repeat Lp(a) tests over time may benefit Afro-Americans, females, and individuals with comorbidities including diabetes, hypertension, and elevated urine albumin.

How to test for Lipoprotein a?

Your Lp(a) level is measured in a blood sample. The small sample of blood can be collected by you at home using a blood sample collection kit provided by The Online Clinic. Full instructions on how to do the finger prick test and details of where to send the sample are provided with the kit. Alternatively, the blood sample can be collected by a healthcare professional from a vein in your arm. The results are sent to a doctor at The Online Clinic who will explain what they mean to you.

Tell your doctor if you are taking any form of hormone, niacin (vitamin B3) supplements and/or medicines as these may affect the results of the test. Hormones including oestrogen, hormone replacement therapy, androgens, anabolic steroids, and thyroid hormone therapy can lower Lp(a) levels. Medicines such as tamoxifen and raloxifene (that treat breast cancer); PCSK9 inhibitors and prescription niacin (that treat high LDL-cholesterol levels); and niacin supplements also lower Lp(a). Conversely, the LDL-cholesterol lowering statins may slightly increase Lp(a) levels, but are still important to lower overall cardiovascular risk.

What are normal Lipoprotein a test results?

There is a direct association between Lp(a) level and cardiovascular risk. However, there is debate over the optimal cutoff level for high Lp(a) levels. Also, some believe measuring nmol/L (measures Lp(a) particles in the blood) is more accurate than measuring mg/dL (measures mass).

• Normal: less than 31 nmol/L (or less than 30 mg/dL)
• Increased cardiovascular risk: 32–99 nmol/L (or 30–49 mg/dL)
• High cardiovascular risk: 100 nmol/L and above (or 50 mg/dL and above)

High lipoprotein(a) levels mean that there is a greater risk of having CVD, regardless of whether other cholesterol measurements are normal.

How to maintain normal Lipoprotein a levels

Worldwide, 20–30% of people have elevated Lp(a) levels and are at increased risk of CVD. Living a healthy lifestyle is important to lower the risk of elevated levels of ‘bad’ LDL-cholesterol in the blood and the risk of CVD. However, the impact of modifying diet and exercise on Lp(a) levels is confusing, since reducing the amount of ‘bad’ saturated fats while increasing ‘good’ unsaturated fats may raise Lp(a) levels and the effect of increasing exercise varies. Additionally, the lipid-lowering statins may slightly increase Lp(a) levels, although this slight increase does not appear to increase your risk of CVD.

Nevertheless, it is important to keep the heart and blood vessels in good working order by addressing cardiovascular risk factors by:

• A healthy lifestyle: stop smoking, healthy well-balanced diet (eating fresh, unprocessed foods, e.g., vegetables, fruit, nuts and flaxseed), maintaining a healthy bodyweight, regular exercise, and managing stress.
• Using medicines that lower LDL-cholesterol: there is no specific therapy for treating raised Lp(a), but the LDL-cholesterol-lowering medicines called PCSK9 inhibitors may directly lower Lp(a) and statins lower other types of LDL-cholesterol; both also improve cardiovascular outcomes. Prescription high-dose niacin may lower Lp(a) levels (but not improve cardiovascular outcomes).
• Good management of other conditions that can lead to CVD, such as diabetes, high blood pressure, and obesity through treatment and lifestyle.

References

Cleveland Clinic. Lipoprotein (a). Last updated 31 Aug 2023. Available at: https://my.clevelandclinic.org/health/articles/25226-lipoprotein-a Accessed 07 Jul 2026.

Deshotels MR, Sun C, Nambi V, et al. Temporal Trends in Lipoprotein(a) Concentrations: The Atherosclerosis Risk in Communities Study. J. Am. Heart Assoc. 2022;11:e026762.

Greco A, Finocchiaro S, Spagnolo M, et al. Lipoprotein(a) as a Pharmacological Target: Premises, Promises, and Prospects. Circulation. 2025;151(6):400-415.

Kronenberg F. Lipoprotein(a): from Causality to Treatment. Curr Atheroscler Rep. 2024;26(3):75-82.

Schmidt K, Noureen A, Kronenberg F, et al. Structure, function, and genetics of lipoprotein (a). J Lipid Res. 2016;57(8):1339-1359.

Tsioulos G, Kounatidis D, Vallianou NG, et al. Lipoprotein(a) and Atherosclerotic Cardiovascular Disease: Where Do We Stand? Int J Mol Sci. 2024;25(6):3537.

Xu R, Wang Z, Dong J, et al. Lipoprotein(a) and panvascular disease. Lipids Health Dis. 2025;24(1):186.