How Taking an Lp(a) Test Can Reveal Hidden Heart Risks
The cholesterol number that could predict your stroke risk isn't on your standard lab report.
Most American adults get their cholesterol tested regularly. But a lesser-known marker called lipoprotein(a) can expose the cardiovascular risk hiding behind an otherwise normal cholesterol panel — and most doctors don’t test for it.
A landmark 2026 analysis of data from three NIH trials shows the value of taking an lp(a) test:
- 1 in 5 people have elevated lipoprotein(a) levels
- People with high Lp(a) levels have a 64% higher risk of stroke
- People with high Lp(a) levels have a 49% higher risk of cardiovascular death1
Despite these risks, fewer than 1% of people in the U.S. have ever been tested for high lipoprotein(a).2 Standard cholesterol panels don’t include it, and because your genes largely determine your level, even the healthiest, fittest, cleanest eaters may be affected and not know it.
“This gives us a real opportunity to intervene early,” says Abid Husain, M.D., a cardiologist and integrative medicine physician at the Boulder Longevity Institute and Hone Health’s Head of Heart Health. “A patient who knows that their Lp(a) is dangerously high can work with their physician to aggressively manage every other risk factor — and that could be the difference between a stroke at 55 and never having one at all.”
About the Expert
Abid Husain, M.D., is a triple-board-certified cardiologist and integrative medicine physician and head of heart health at Hone Health.
What is Lp(a)?
Lipoprotein(a), or Lp(a), is a particle that carries cholesterol through your bloodstream. It resembles LDL (“bad” cholesterol) but has an additional protein called apolipoprotein(a), or apo(a), attached to its surface that’s especially “sticky,” making the particle more prone to latching onto artery linings and contributing to plaque buildup. It may also interfere with the body’s ability to dissolve blood clots, which raises stroke risk, says Husain.
What does it mean if your lipoprotein(a) is high?
Lp(a), levels of which are largely determined by variants in the LPA gene, can trigger inflammation inside the arteries, creating a vicious cycle: Lp(a) contributes to plaque buildup and inflammation, which further damages artery walls and makes it easier for Lp(a) to stick to them.3 Over time, this cycle may raise the risk of heart attack, stroke, aortic stenosis (narrowing of the heart’s main valve) and peripheral artery disease (reduced blood flow to the limbs).4 5
Husain compares cholesterol to wood and inflammation to the fire that heightens heart risk. “If cholesterol is the wood and inflammation is the fire, Lp(a) is the gasoline poured over top,” he says. “It can make an already troublesome situation worse.”
What is a dangerously high lipoprotein(a) level?
While the American College of Cardiology considers Lp(a) to be elevated around ≥125 nmol/L, the 2026 NIH analysis shows increased stroke and cardiac death risk in those with levels of ≥175 nmol/L.6
Getting an Lp(a) test might help you understand heart risk earlier in life and can inform how aggressively you need to manage the lifestyle factors you can control.
“Lp(a) tends to be a risk amplifier,” Husain says. “If someone has metabolic syndrome, obesity, high triglycerides, or insulin resistance, for example, Lp(a) can have a much more profound effect on their health outcomes.”
What Does a Lipoprotein(a) Test Measure?
Standard lipid panels measure LDL, HDL, total cholesterol, and triglycerides, providing a snapshot of how much fat is circulating in your bloodstream. Getting an Lp(a) test can help you understand your odds of developing cardiovascular disease.7 A higher Lp(a) score means the LPA gene has programmed your body to produce more of the Lp(a) particle — and the more you have, the greater your risk.
Lp(a) is an independent risk factor for cardiovascular disease and stroke, which is why you can have otherwise healthy looking cholesterol levels and still be at risk.
Leading medical organizations, including the American College of Cardiology (ACC) and the American Heart Association, now recommend that every adult get an Lp(a) test at least once.8 But that guidance is relatively new: The National Lipid Association didn’t start recommending universal testing till 2024, and Lp(a) still isn’t routinely included in standard cholesterol screening.9 10
Why don’t doctors test for lipoprotein(a)?
Part of the reason doctors don’t test Lp(a), Husain says, is that there’s no FDA-approved treatment that directly lowers your levels, so many physicians see limited value in testing for it. “Practitioners and patients are left thinking there’s nothing that can be done,” he says. “That couldn’t be further from the truth.” Husain views any Lp(a) level above 125 nmol/L as a signal to set more aggressive targets for LDL cholesterol, blood pressure, and blood sugar.
What is the Best Way to Treat High Lipoprotein(a)?
If a patient scores high on an Lp(a) test and already shows signs of plaque buildup in the arteries, Husain says most physicians turn to statins. “By dropping the overall LDL number, fewer Lp(a) particles get exposed to the circulatory system,” he explains.
PCSK9 inhibitors for high Lp(a)
Doctors may also consider PCSK9 inhibitors, medications that lower LDL more sharply by slowing activity of PCSK9, a protein in the liver. These drugs may also modestly reduce Lp(a); one analysis found an average reduction of just under 18%.11
Hormone therapy for high Lp(a)
Hormone therapy may offer some benefit for certain patients with high Lp(a). Research shows that estrogen-based hormone therapy can reduce Lp(a) levels in women — one study found a 25% reduction in women with diabetes — though evidence in men remains limited. For patients with low hormone levels, it’s worth discussing cardiovascular risk with a physician who understands both hormonal and metabolic health.
New treatments for high Lp(a)
Researchers are working to develop more targeted treatments. Lepodisiran, currently in Phase 3 trials, reduced Lp(a) levels by as much as 94% in early testing. Whether that translates into fewer cardiovascular events is still an open question, however. That’s a cautionary note from a separate drug, pelacarsen, which substantially lowered Lp(a) but failed to reduce cardiovascular events in its own Phase 3 trial. Both results illustrate that lowering Lp(a) on paper and reducing real-world risk are not yet the same thing.
Until the standard cholesterol panel is amended to include Lp(a), Husain recommends asking your physician to order one and discussing whether a broader cardiovascular panel makes sense given your medical history, family history, and existing risk factors.
How Much Does An Lp(a) Test Cost?
Hone’s Advanced Heart Health Panel costs $99 and tests for Lp(a) alongside the inflammation and metabolic markers standard cholesterol panels miss, including hs-CRP, HbA1c, fasting insulin, homocysteine, ApoB, Lp-PLA2, and uric acid. You can purchase the $99 advanced panel after completing initial testing ($65). Together, these tests give your Hone physician a materially fuller picture of your cardiovascular risk.
The Bottom Line
Getting an Lp(a) test can help detect elevated stroke and cardiovascular risk earlier in life. While lipoprotein(a) levels are inherited and can’t be meaningfully reduced, understanding your levels can help your physician set more aggressive targets for the risk factors you can control.
FAQs
Is Lp(a) genetic?
Yes — more than almost any other cardiovascular risk factor. Research shows that 70–90% of your Lp(a) level is determined by your DNA, specifically variants in the LPA gene on chromosome 6.
How do I reduce lipoprotein(a) naturally?
Unfortunately, it’s impossible to reduce Lp(a) naturally. However, lifestyle measures — regular exercise, a heart-healthy diet, sufficient sleep, weight management, and avoiding tobacco — can reduce the overall cardiovascular burden surrounding it.
How often should I test Lp(a) levels?
For most people, once is enough. Because Lp(a) is genetically fixed and changes very little over a lifetime, a single measurement taken in adulthood gives your physician the information needed for lifelong risk assessment. Both the American College of Cardiology and the American Heart Association now recommend that every adult get tested at least once.
There are a few situations where retesting makes sense: if your initial result was borderline and a clinical decision hinges on a more precise number, or if you’re about to start or change a treatment aimed at reducing cardiovascular risk and your physician wants an updated baseline. Pregnant women may also see temporary changes and benefit from a post-pregnancy check. Otherwise, a single test — ideally in your 20s or 30s, or as soon as you become aware of the risk — is the standard recommendation.
How is an Lp(a) test different from a cholesterol test?
A standard cholesterol panel (lipid panel) measures four things: LDL (“bad” cholesterol), HDL (“good” cholesterol), total cholesterol, and triglycerides. It tells you how much fat is circulating in your blood, but it doesn’t identify the type of particles carrying it.
An Lp(a) test is an add-on blood test that specifically measures lipoprotein(a) — an LDL-like particle that a standard panel doesn’t capture. Lp(a) particles carry their cholesterol payload differently than regular LDL: They’re stickier and more prone to triggering inflammation, and they may interfere with the body’s blood-clot-dissolving system. You can have a completely “normal” LDL number and still have dangerously elevated Lp(a) — and a standard cholesterol panel will never show that. The two tests answer different questions, which is why a physician has to order the Lp(a) test separately.
What's the difference in ApoB vs Lipoprotein(a)?
ApoB tells you how many potentially harmful cholesterol particles are circulating in your blood. Lp(a) identifies one especially risky type. Standard cholesterol panels don’t directly measure either one.
- ApoB is a particle count. Every plaque-forming particle, including LDL, VLDL, IDL, and Lp(a), carries one ApoB protein. The more ApoB particles you have, the more opportunities they have to enter your artery walls and form plaque. ApoB can often be lowered with medication, diet, exercise, and weight management.
- Lp(a) is a specific particle. It resembles LDL but has an extra, “sticky” protein attached that makes it more likely to promote plaque, inflammation, and clotting. One analysis estimated that each Lp(a) particle carries about five to six times the coronary risk of a typical LDL particle. Your genes largely determine your Lp(a) level, so lifestyle changes have little effect on it.
That’s why the two tests answer different questions: ApoB measures how many risky particles you have; Lp(a) reveals whether a particularly dangerous kind is among them.
At Hone, our Advanced Heart Health Panel measures ApoB and Lp(a) as well as other important markers like hs-CRP, homocysteine, and Lp-PLA2.
Does lipoprotein(a) change over time?
For most people, lipoprotein(a) levels never change. Lp(a) levels are set by your genes and reach their adult range by around age 5. Because they never change, the American College of Cardiology and the American Heart Association recommend testing once: A single result is enough to inform your lifetime risk picture.
That said, there are a few situations where Lp(a) can shift meaningfully:
- Menopause. The clearest exception is the menopausal transition in women. Research shows Lp(a) levels can rise by roughly 25–27% after menopause, likely due to the decline in estrogen. This is one reason post-menopausal women with a personal or family history of cardiovascular disease may benefit from retesting — and why the potential cardiovascular benefit of hormone therapy is worth discussing with a physician who understands both hormonal and metabolic health.
- Kidney disease. Declining kidney function is one of the few non-genetic factors known to raise Lp(a). As the kidneys lose their ability to filter efficiently, Lp(a) concentrations tend to climb. Kidney transplantation has been shown to restore Lp(a) to lower levels. If you have chronic kidney disease, your physician may want to monitor Lp(a) more actively.
- Acute illness or significant inflammation. Lp(a) can fluctuate temporarily during periods of major physiological stress, including serious infection or liver disease. These are generally temporary changes rather than permanent shifts.
At what age should people take an Lp(a) test?
Adults should take an Lp(a) test ideally in their 20s or 30s, before cardiovascular risk has had decades to build. Because Lp(a) is genetically fixed and stable through adulthood, earlier testing means earlier action on the risk factors you can control.
Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions (2026) Lipoprotein(a) Linked to Elevated Cardiovascular Risk Despite Standard Treatment
↑Subhash Banerjee (2026) Lipoprotein(a) Identifies Residual Cardiovascular Risk in NIH Randomized Trials
↑Reyes-Soffer G, et al. (2021) Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association
↑Aaron W. Aday, et al. (2019) Targeting Residual Inflammatory Risk: A Shifting Paradigm for Atherosclerotic Disease
↑American Heart Association (2026) What is Lipoprotein(a) and How Does It Impact My Heart Health?
↑Subhash Banerjee (2026) Lipoprotein(a) Identifies Residual Cardiovascular Risk in NIH Randomized Trials
↑Cleveland Clinic (2024) Lipid Panel
↑Roger S Blumenthal, et al. (2026) 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
↑Agam Bansal, et al. (2025) Prevalence of Lipoprotein(a) Testing in a Contemporary Cohort
↑Harvard Health Publishing (2025) Lipoprotein(a): An update on testing and treatment
↑Harpreet S Bhatia, et al. (2025) Impact of PCSK9 inhibitors on lipoprotein(a) levels: a multi-centre study
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About the author
Lauren Ramakrishna is a freelance writer who covers health. Her work has appeared on digital sites by Good Housekeeping, Redbook, and Woman's Day, among others.
About the reviewer
Candice Knight, M.D., is a longevity-focused phsycian who is board-certified in Family Medicine and Integrative Medicine, with additional certifications in Functional Medicine and Quantum Biology. She earned her undergraduate degree from Yale University, a Master of Public Health from Tulane University, and her medical degree from LSU School of Medicine, where she also completed her residency.
