Lp(a)
Lipoprotein(a) – genetically determined cardiac risk marker
Also known as
Definition
Lipoprotein(a) is an LDL-like particle carrying an additional apolipoprotein(a) moiety and is strongly genetically determined. Elevated Lp(a) levels are an independent, causally established risk factor for myocardial infarction, stroke, and aortic valve stenosis. Because Lp(a) is largely unresponsive to lifestyle changes, testing primarily serves risk stratification and treatment decision-making.
| Parameter | Value |
|---|---|
| Unit | mg/dl (nmol/l) |
| Reference Range | < 50 mg/dl (< 125 nmol/l) per ESC guidelines 2019 |
Agree on your personal target range with your doctor.
Lp(a) is measured in mg/dl (mass) or nmol/l (particle number) — the two units are not directly interchangeable because particle size varies. ESC threshold: < 50 mg/dl or < 125 nmol/l. International studies increasingly prefer nmol/l.
↓ What a low value means
A low Lp(a) value is associated with a lower cardiovascular risk. Because Lp(a) is largely genetically determined, a low value mainly reflects genetic makeup, not lifestyle. Clinically there is no lower limit for Lp(a).
↑ What a high value means
Lp(a) 30–50 mg/dl: moderate risk, dependent on other cardiovascular risk factors. Lp(a) > 50 mg/dl: elevated independent risk for heart attack, stroke, and aortic valve stenosis. Lp(a) > 180 mg/dl: very high risk, equivalent to heterozygous familial hypercholesterolemia. Lp(a) has been shown to be causal for atherosclerosis (Mendelian randomization). Heart attack risk doubles above 50 mg/dl.
✓ What can influence this value
The Lp(a) value is about 80–90% genetically determined and is barely influenced by lifestyle factors. Certain medications have an influence: PCSK9 inhibitors and niacin can lower the value; RNA-based agents are being studied in Phase 3 clinical trials. Other cardiovascular risk factors remain relevant to the overall risk assessment regardless. The assessment is made by the treating doctor.
When to test
The 2019 ESC guideline names a measurement once in adult life, because the value is genetically largely stable, especially with family cardiovascular history, premature atherosclerosis, heart attack with normal cholesterol, or treatment-refractory hypercholesterolemia. No fasting required. Lp(a) does not change significantly with age or diet.
Frequently asked questions
Can diet or exercise affect Lp(a)? +
Barely. Because Lp(a) is 80–90% genetically determined, diet and exercise have only minimal influence (< 5–10%). Conditions such as hypothyroidism or kidney insufficiency can raise Lp(a) secondarily. Your doctor decides whether and how to treat.
How often is Lp(a) measured? +
According to the 2019 ESC guideline, once in adult life: Lp(a) is stable throughout adult life and barely changes with lifestyle or aging. A repeat measurement mainly comes into question with conditions that can secondarily raise Lp(a) (hypothyroidism, nephrotic syndrome). Your doctor decides how often it is measured.
How does elevated Lp(a) factor into the risk assessment? +
Elevated Lp(a) increases overall cardiovascular risk and is taken into account in the overall risk assessment together with the other risk factors (blood pressure, smoking, blood glucose, LDL). The assessment is made by the doctor.
Lp(a)
Sources
Last updated: May 28, 2026
This information is for orientation only and does not replace medical advice. Reference ranges can vary by laboratory, method and country.