Should I Get a Lipoprotein (a) Test?

Yearly blood tests keep track of common heart health markers, like cholesterol levels, white blood cell count, and more. But did you know there’s another type of blood test to help understand your risk of heart disease?

Having high levels of lipoprotein (a), or Lp(a), can clog your arteries and increase your risk of heart attack or stroke. An Lp(a) test measures how many of these fatty particles you have in your bloodstream.

“Lipoprotein (a) is determined primarily by genetics—not your diet or how much you exercise—so you may only need to take the Lp(a) blood test once,” says Michelle O'Donoghue, MD, MPH, a cardiologist with the Mass General Brigham Heart and Vascular Institute and a leader in heart disease research. “I recommend it for everyone to understand their overall heart disease risk, so they can take action with their health care provider if needed.”

Dr. O’Donoghue cares for patients and is the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women’s Hospital. She recently published a paper in the European Heart Journal explaining the importance of Lp(a) testing for everyone, not just those at higher risk. Here, she explains more about Lp(a) testing and what to know if your levels are elevated.

What is lipoprotein (a), and how does it affect heart health?

Lipoprotein (a) is found in your blood and is made of protein and fat. Lp(a)—pronounced “L-P-little A”—is like a boat that carries cholesterol, a type of fat, through your bloodstream. If you have high levels of Lp(a), these boats can damage the walls of your blood vessels and cause inflammation, making them narrower and harder for blood to flow through.

High levels of Lp(a) can cause plaque buildup, which may block blood from getting to important parts of your body. This can lead to serious conditions like:

• Stroke
• Heart attack
• Coronary artery disease
• Peripheral artery disease (poor circulation in the legs)

High Lp(a) may also increase the risk of developing aortic stenosis, a type of heart valve problem.

Your genetics, or family history, largely determines your Lp(a) levels. This means you could live a healthy lifestyle and still have high Lp(a).

Lp(a) blood test

A normal cholesterol test doesn’t measure your Lp(a) levels, so your primary care provider (PCP) needs to order a separate Lp(a) blood test. You normally only get the Lp(a) test once because these levels generally stay the same after you turn 5 years old. In women, Lp(a) can rise further around menopause. 

Lp(a) is similar to a type of “bad cholesterol” called low-density lipoprotein (LDL) cholesterol, which is included in a regular blood test. Even if you know your LDL level, it’s important to get the Lp(a) test because you can have a normal level of LDL cholesterol and still have high Lp(a).

Who should get an Lp(a) test?

The National Lipid Association (NLA) now recommends that every adult gets the lipoprotein (a) test at least once. 

Some people are at higher risk of having an elevated Lp(a) concentration in their blood. The NLA recommends Lp(a) testing in particular for people with:

• Family history of high lipoprotein (a)
• Family or personal history of heart disease at a young age (under 45 years old for men and under 55 years old for women)
• Familial hypercholesterolemia (FH), a condition where your body doesn’t recycle bad cholesterol properly
• Poor circulation in the legs due to peripheral artery disease
• Aortic stenosis (a type of sticky heart valve)

Anyone can have high Lp(a) value, but South Asian and Black people of African descent often have higher levels. Women over 50 years old also tend to have higher Lp(a) levels than men.

“Even if you don’t have a family history or specific risk factors, getting the Lp(a) test helps us understand the full picture of your heart health,” she says. “You may have high Lp(a) and not know it—many people don’t experience symptoms until they have a serious event, like a heart attack.”

Understanding lipoprotein (a) levels

A lipoprotein (a) blood test gives you a number that represents your Lp(a) levels. Based on your results, your health care provider explains your heart disease risk within 3 categories:

• Low risk: less than 75 nmol/L (or 30 mg/dL)
• Intermediate risk: 75 to 125 nmol/L (or 30 to 50 mg/dL)
• High risk: 125 nmol/L or higher (or 50 mg/dL or higher)

What if I have elevated lipoprotein (a)?

If your Lp(a) test result is elevated, you may be at higher risk of heart disease. Your health care provider may refer you to a cardiologist to better understand and improve your heart health. They also may recommend other people in your family get an Lp(a) blood test.

How to lower lipoprotein (a)

If you have high levels of Lp(a), your health care provider discusses treatment options. Your provider will discuss strategies to manage your risk factors for heart disease such as blood pressure, cholesterol and blood sugar. The Food and Drug Administration (FDA) approved lipoprotein apheresis to treat elevated lipoprotein (a), which may be an option for you if your levels are very elevated. Apheresis is a treatment where a machine removes Lp(a) and LDL cholesterol from your blood. 

Your provider may also recommend medication like PCSK9 inhibitors to lower your LDL cholesterol, although it’s not officially approved by the FDA. In a recent clinical trial, Mass General Brigham researchers found that patients at high risk who started taking a PCSK9 inhibitor had a significantly lower risk of first heart attack or stroke.

Dr. O’Donoghue and team are researching more ways to lower Lp(a) levels. They’re currently studying new medications that block Lp(a) production in the body. This could be a new therapy for people with elevated Lp(a) in the near future. 

Heart-healthy lifestyle changes if you have high Lp(a)

While lifestyle changes won’t lower your Lp(a) level, they’re important for your overall heart health. They also help lower LDL cholesterol, which helps reduce your heart disease risk.

Here are some steps you can take to improve your heart health if you have elevated Lp(a):

• Take all prescribed medications.
• Avoid smoking. Talk to your doctor or get tips to quit smoking or vaping here.
• Eat a healthy diet. Aim for a heart-healthy grocery list and seek out foods that lower cholesterol.
• Stay active. Exercise, like walking or strength training, is a great way to help keep your heart and arteries healthy.
• Maintain a healthy weight. If diet and exercise changes aren’t helping, talk to your health care provider to see if weight loss medication may be right for you.
• Get enough sleep. Lack of sleep affects your heart. If you have trouble sleeping, follow these tips to sleep better and wake up rested.

“We’re researching new ways to lower Lp(a), but there’s so much you can do to improve your overall heart health,” says Dr. O’Donoghue. “Knowing your Lp(a) level is an important step for you—and your family—to understand heart disease risk. Hopefully new treatments will be available soon.”