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A lipoprotein(a) test, also known as an Lp(a) test, measures the level of lipoprotein(a) in the blood. Lipoprotein(a) is a type of low-density lipoprotein (LDL), often referred to as “bad” cholesterol, that transports cholesterol through the bloodstream. It is structurally similar to LDL but contains an additional protein called apolipoprotein(a), making it stickier and more likely to contribute to plaque buildup in artery walls. This can increase the risk of atherosclerosis, heart disease, heart attack, stroke, and other cardiovascular conditions.

Unlike routine cholesterol tests that measure total LDL, HDL, and triglycerides, the lipoprotein(a) test specifically assesses the concentration of Lp(a) particles, which are not captured by standard lipid panels. This is important because even if traditional cholesterol levels are within a healthy range, elevated Lp(a) levels can still indicate a high risk for cardiovascular events. High Lp(a) levels are an independent predictor of coronary artery disease and are associated with abnormal clotting and stroke.

The test is typically not part of routine medical checkups and is usually recommended for individuals with specific risk factors, such as a personal or family history of premature cardiovascular disease (e.g., heart attack or stroke before age 55 in men or 65 in women), very high LDL cholesterol, or a diagnosis of familial hypercholesterolemia. It may also be used to guide treatment decisions, such as whether to initiate or adjust cholesterol-lowering medications, especially if LDL levels do not respond as expected to therapy.

Lipoprotein(a) levels are largely determined by genetics, with studies indicating that 70% to 90% of variation is due to inherited genes. This means levels tend to run in families, and individuals with a family history of high Lp(a) or early heart disease may benefit from testing. The test is performed by drawing a blood sample, usually from the arm, and sending it to a laboratory for analysis. Results are typically available within a few days.

The normal range for lipoprotein(a) is generally considered to be 30 milligrams per deciliter (mg/dL) or less, though some experts suggest that levels above 50 mg/dL may indicate increased risk. Currently, there are no FDA-approved drugs specifically designed to lower Lp(a) levels, although research into treatments is ongoing. While lifestyle changes such as maintaining a healthy diet low in saturated fats and avoiding processed foods do not significantly affect Lp(a) levels, they can help manage other cardiovascular risk factors.

“Can anything be done to manage or decrease LP(a) levels?”

While lipoprotein(a) [Lp(a)] levels are largely genetically determined and resistant to lifestyle changes, several medical interventions can help manage or reduce them.

1. Medications

PCSK9 inhibitors (e.g., evolocumab, alirocumab): These injectable drugs lower Lp(a) by 20–30% and are effective in reducing cardiovascular risk, especially in individuals with high baseline Lp(a).

Niacin (vitamin B3): High-dose niacin can reduce Lp(a) by 30–40%, but its use is limited due to side effects like flushing, liver toxicity, and increased blood sugar.

CETP inhibitors (e.g., obicetrapib): In clinical trials, these have shown significant Lp(a) reductions—up to 56%—and are under investigation for future use.

Antisense oligonucleotides and siRNA therapies (e.g., pelacarsen): These emerging treatments target the apolipoprotein(a) gene and have demonstrated up to 80–90% reduction in Lp(a) in early studies.

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