What Is Lipoprotein(a)
Lipoprotein(a) is a particle that carries cholesterol through your bloodstream. It is similar to LDL cholesterol, but it has an additional protein called apolipoprotein(a), or apo(a), attached to its surface.
Lp(a) works a lot like LDL (“bad”) cholesterol — it can get into your artery walls and contribute to plaque buildup. It’s able to do this because, like LDL, it carries a protein called ApoB that lets it latch onto artery walls.
Lp(a) also carries a substance that can trigger inflammation in blood vessels and in the heart’s aortic valve. This extra inflammatory effect is why high Lp(a) is linked to a stiffening and narrowing of the aortic valve called calcific aortic valve disease.3
Is Lp(a) Genetic?
Yes. Your Lp(a) level is primarily inherited and is largely determined by variants in the LPA gene. Levels are generally established early in life and remain relatively stable, which is why most adults don’t need repeated testing if their first result is reliable.
How Is Lipoprotein(a) Different From LDL and ApoB?
Because they are genetic, lipoprotein(a) levels can remain high even when LDL cholesterol is low or well controlled. Measuring Lp(a) alongside LDL-C and ApoB gives your physician additional information about cardiovascular risk.
- Standard LDL cholesterol tests measure how much cholesterol is being carried in LDL particles.
- ApoB testing helps estimate the total number of artery-clogging particles that can enter artery walls.
- Lp(a) identifies a specific inherited type of ApoB-containing particle with apo(a) attached.4
Why Does Lipoprotein(a) Matter?
- Reveals inherited heart risk that standard cholesterol testing can miss: Lp(a) can be elevated even when LDL cholesterol appears healthy.
- Increases heart attack and stroke risk: High lipoprotein(a) levels are associated with increased risk of coronary heart disease and ischemic stroke independent of many traditional cardiovascular risk factors. 5
- Increases the risk of aortic valve disease: Lipoprotein(a) can promote inflammation and calcium buildup in the aortic valve, increasing the risk of calcific aortic stenosis.
- Adds to other cardiovascular risks: High Lp(a) doesn’t replace risks like high ApoB, high cholesterol, high blood pressure, diabetes, or smoking. It adds another source of risk, which can change how aggressively your physician manages the factors you can control.
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How to Interpret Lipoprotein(a) Levels
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Who Should Get a Lipoprotein(a) Test?
Current guidelines recommend that every adult have lipoprotein(a) tested at least once in their lifetime.
Testing may be especially useful if you have:
- A personal or family history of premature heart disease or stroke, generally before age 55 in men or 65 in women
- Familial hypercholesterolemia (an inherited genetic disorder that causes high levels of LDL (“bad”) cholesterol
- A personal or family history of cardiovascular disease that isn’t fully explained by traditional risk factors
- A close relative with high Lp(a)
- Recurrent cardiovascular events despite well-controlled LDL cholesterol
- Calcific aortic stenosis
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Low Lipoprotein(a) Levels
Low Lp(a) is generally favorable because it reflects lower inherited cardiovascular risk. However, a low Lp(a) level does not eliminate your risk of heart disease. Blood pressure, ApoB, LDL cholesterol, diabetes, smoking, inflammation, family history, and lifestyle remain important contributors to overall cardiovascular health.
High Lipoprotein(a) Levels
High lipoprotein(a) levels on a blood test mean you have an inherited cardiovascular risk factor associated with a higher lifetime risk of atherosclerotic heart disease and aortic valve disease.
Risk increases as lipoprotein(a) rises. The 2026 ACC/AHA dyslipidemia guideline estimates that Lp(a) of 125 nmol/L is associated with about 1.4 times greater ASCVD risk, while levels of 250 nmol/L are associated with roughly twice the risk. 2
Although many clinical guidelines define elevated Lp(a) as ≥75 or ≥125 nmol/L, Hone uses a more preventive approach by aiming for levels below 50 nmol/L.
Symptoms:
High lipoprotein(a) levels cause no symptoms. Most people only discover they have elevated Lp(a) through a blood test.
Causes:
- Genetics: Variants in the LPA gene inherited from your parents are the main determinant of your Lp(a) level.
- Hypothyroidism: An underactive thyroid can modestly raise lipoprotein(a), and treating hypothyroidism may lower it.4
- Kidney disease: Certain kidney conditions, particularly nephrotic syndrome and advanced chronic kidney disease, can increase Lp(a)4
Healthspan Impacts:
- Higher risk of heart attack
- Elevated ischemic stroke risk
- Increased peripheral artery disease risk
- Increased aortic stenosis risk
How Hone Treats Out of Range Lipoprotein(a) Levels
Your Hone physician evaluates lipoprotein(a) levels from a blood test alongside other heart health markers such as LDL-C, ApoB, hs-CRP, and blood glucose. They may also assess kidney health and thyroid health, along with your personal and family history, to build a complete picture of your cardiovascular risk.
Since no currently approved therapy reliably and specifically lowers Lp(a) with proven outcome benefit, most current guidance leans toward aggressively lowering LDL-C and ApoB, controlling blood pressure, managing blood glucose, and addressing lifestyle factors.
Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
