# Lp(a): The heart risk you inherit > Lp(a) is an inherited particle that raises heart risk, and one test is usually enough. Check your result and see what helps if yours is high. - Also called Lipoprotein(a) and Lipoprotein little a - Not on a standard checkup - No fasting needed - Web page: https://picardo.health/guides/biomarkers/lipoprotein-a ## The short answer Lp(a) is a cholesterol-carrying particle whose level is set mostly by your genes. A high level raises your risk of a heart attack or stroke, whatever your LDL. It barely changes over your life, so one test is usually enough. US guidelines count 125 nmol/L or more as high.[2] - **A good result:** Under 75 nmol/L, which Labcorp calls low risk.[4] About 1 in 5 people have 125 or more.[2] - **If yours is high:** Diet and exercise barely move it, and statins don’t lower it. What helps is pushing your LDL and blood pressure lower, and getting your family tested.[2] - **Should you test?** Yes, once. Guidelines recommend it for every adult, and a standard cholesterol test leaves it out.[1][2] ## What is a normal Lp(a) level? Risk climbs steadily with Lp(a), so there’s no sharp line between normal and high.[2] Labcorp calls under 75 nmol/L low risk.[4] European guidelines start counting Lp(a) as a risk factor above 105, and US guidelines at 125:[2][3] | Result (nmol/L) | What it means | | --- | --- | | Under 75 | Low: Lp(a) isn’t adding to your risk | | 75 to 104 | Slightly raised | | 105 to 124 | Intermediate on your report, raised by European guidelines | | 125 to 249 | High: a risk factor in its own right | | 250 or more | Very high: about double the risk, or more | ### Low: Lp(a) isn’t adding to your risk **Range:** Under 75 nmol/L. At this level, Lp(a) adds little or nothing to your risk of heart disease.[1] It’s set mostly by your genes, so it usually stays about the same for life.[2] **How worried to be:** Nothing to worry about. **What to do next:** 1. You usually don’t need to test it again.[1] 2. Your heart risk now comes down to things you can change, such as LDL, blood pressure and smoking. ApoB is a good next check. [Test ApoB, $8.40](https://app.picardo.health/labs/order?tests=167015&ref=guide-lipoprotein-a) ### Slightly raised **Range:** 75 to 124 nmol/L. Labcorp calls this intermediate risk.[4] At this level, your risk of heart disease is about 1.2 times that of someone with a typical Lp(a): a small increase.[2] **How worried to be:** Not a worry on its own. It matters more if you have other risk factors. **What to do next:** 1. Make sure your LDL or ApoB, blood pressure and blood sugar are where they should be. 2. If you’re deciding whether to start a statin, mention your Lp(a). Above 105, European guidelines count it toward that decision.[3] [Test ApoB and HbA1c, $12.40](https://app.picardo.health/labs/order?tests=167015,001453&ref=guide-lipoprotein-a) ### Intermediate on your report, raised by European guidelines **Range:** 105 to 124 nmol/L. Labcorp calls this intermediate,[4] but European guidelines count anything over 105 as raising your risk, enough to tip a borderline decision about treatment.[3] US guidelines draw that line at 125.[2] **How worried to be:** Not urgent. It matters most if your overall risk is close to the line for a statin. **What to do next:** 1. Tell your clinician your Lp(a) when you talk about your heart risk. It can move you into a higher risk group.[3] 2. Keep your LDL or ApoB, blood pressure and blood sugar in range. [Test ApoB and HbA1c, $12.40](https://app.picardo.health/labs/order?tests=167015,001453&ref=guide-lipoprotein-a) ### High: a risk factor in its own right **Range:** 125 to 249 nmol/L. US guidelines count 125 or more as a risk-enhancing factor. At 125, your risk of heart disease is about 1.4 times that of someone with a typical level, and it rises as Lp(a) does.[2] **How worried to be:** Worth acting on over the next few months. It isn’t urgent. **What to do next:** 1. See a clinician to work out your overall risk. A high Lp(a) favors starting or stepping up cholesterol treatment.[2] 2. Aim to keep your LDL, blood pressure and blood sugar lower than you otherwise would.[2] 3. Ask your parents, brothers, sisters and children to get tested once.[2] [Test ApoB and HbA1c, $12.40](https://app.picardo.health/labs/order?tests=167015,001453&ref=guide-lipoprotein-a) ### Very high: about double the risk, or more **Range:** 250 nmol/L or higher. At 250, your risk of heart disease is about twice that of someone with a typical level. At 430 or more, it’s about four times, similar to inherited high cholesterol.[2] **How worried to be:** Book an appointment in the next few weeks. It isn’t an emergency. **What to do next:** 1. See a clinician about lowering your LDL further than usual. If you already have heart disease and your LDL stays above goal on a statin, guidelines recommend adding a PCSK9 antibody injection, which also lowers Lp(a) a little.[2] 2. Ask your parents, brothers, sisters and children to get tested.[1][2] 3. Ask whether seeing a lipid specialist makes sense for you.[2] [Test ApoB and HbA1c, $12.40](https://app.picardo.health/labs/order?tests=167015,001453&ref=guide-lipoprotein-a) ## What is Lp(a)? > Think of Lp(a) like your height. Your genes set it, it’s fixed by adulthood, and no diet or workout will change it much. What you can change is everything else that adds to your risk. Lp(a), short for lipoprotein(a), is an LDL-like particle with an extra protein, apo(a), attached to its ApoB.[2] How much you have is more than 90% down to your genes.[1] High levels raise the risk of a heart attack, a stroke and a narrowed aortic valve. Genetic studies suggest Lp(a) helps cause this damage rather than just marking it.[1][2] ## Is Lp(a) genetic? Mostly, yes. Your Lp(a) usually reaches its adult level by about age 5, then stays about the same for life.[1][2] You inherit it from your parents, so a high level tends to run in families. That’s why guidelines advise testing the parents, brothers, sisters and children of anyone with a high result.[2] A few things can push it up:[1][2] - Kidney disease, especially with protein in the urine - An underactive thyroid - Pregnancy - Menopause, in some women ## Why does Lp(a) matter if your LDL is normal? High Lp(a) raises heart risk even when LDL cholesterol is low, and its extra risk multiplies with your other risk factors.[2] In one estimate from UK data, an Lp(a) of about 250 nmol/L roughly doubles the lifetime risk of a major heart event or stroke: from 5% to 10% for someone at low risk, but from 20% to 40% for someone at higher risk.[1] A normal LDL or ApoB result doesn’t tell you your Lp(a). It needs its own test.[2] | Lp(a) | Risk of heart disease | | --- | --- | | Under 75 nmol/L | No real increase | | 75 to 124 nmol/L | About 1.2 times | | 125 nmol/L | About 1.4 times | | 250 nmol/L | About 2 times | | 350 nmol/L | About 3 times | | 430 nmol/L | About 4 times | Compared with a typical level of about 20 nmol/L, from UK Biobank data. Treat it as a rough guide; other studies differ.[2] ## Can you lower Lp(a)? Not by much, with what’s available today.[2] - **PCSK9 inhibitors:** Lower Lp(a) by about 15% to 30%, along with a large drop in LDL. If you have heart disease, high Lp(a) and an LDL that stays above goal on a statin, guidelines recommend the antibody injections proven to cut heart events.[2] How much it helps: some. How sure we are: very sure. - **Lipoprotein apheresis:** A machine filters Lp(a) and LDL out of your blood, in repeated sessions. In the US it’s approved for Lp(a) of 130 nmol/L or more only in people who also have inherited high cholesterol and narrowed heart or leg arteries.[2] How much it helps: some. How sure we are: early evidence. - **Drugs that target Lp(a):** Cut Lp(a) by 80% to 98% in trials.[3] None is approved, and the first outcome trial didn’t show a reduction in heart attacks, strokes and other major heart events.[5] How much it helps: a lot. How sure we are: early evidence. - **Diet and exercise:** Barely move it. Exercise has little or no effect, and diet changes shift Lp(a) by about 10% to 15% at most, sometimes upward.[1] How much it helps: a little. How sure we are: fairly sure. Statins don’t lower Lp(a), and may nudge it up slightly.[2] Niacin isn’t recommended for high Lp(a), because two large outcome trials found no benefit.[1] What you can do is lower everything else. When Lp(a) is high, guidelines advise earlier and tighter control of LDL, blood pressure and blood sugar. They also stress not smoking.[2] Drugs built to lower Lp(a) are still being tested. The first to finish an outcome trial, pelacarsen, lowered Lp(a) but didn’t show a reduction in its main measure, heart attacks, strokes and other major heart events, in 8,323 people with heart disease, Novartis announced in September 2026. Full results haven’t been published yet.[5] Olpasiran, lepodisiran and muvalaplin are in outcome trials expected to finish between 2028 and 2031.[6][7][8] ## Who should get an Lp(a) test? Every adult, once. US guidelines and the European Atherosclerosis Society both recommend it.[1][2] It matters most if: - A parent, brother, sister or child has high Lp(a).[1][2] - Heart disease, stroke or a narrowed aortic valve came early in your family.[2] - You’ve had a heart attack, stroke or narrowed arteries yourself.[2] - You have inherited high cholesterol (familial hypercholesterolemia).[1] - Your risk is close to the line for starting a statin.[3] Keep a copy of your result. Unless you develop kidney or liver disease, you’re unlikely to need the test again.[1] ## How to get an Lp(a) test, and what it costs An Lp(a) test costs $16.00 through Picardo. The Heart Health panel adds 16 more tests from the same visit for $150.90. - **Recommended:** [the Heart Health panel, $150.90](https://app.picardo.health/labs/order?panels=heart-health&ref=guide-lipoprotein-a). 17 tests, fast for 12 hours first. A high Lp(a) makes the rest of your risk count for more. The panel adds ApoB and an advanced cholesterol test to show what you can lower, plus hs-CRP, HbA1c, insulin, and kidney, liver and thyroid tests. [What’s in it](https://picardo.health/guides/panels/heart-health.md). - [Lp(a) on its own, $16.00](https://app.picardo.health/labs/order?tests=120188&ref=guide-lipoprotein-a). Labcorp 120188, no fasting needed. Every order comes with: - Results in 2 to 3 days, in the app - Physician follow-up if you want one - Free Labcorp draw, or $75 at home - No other fees. HSA and FSA eligible. It’s also part of the [Base Core Annual – Men](https://picardo.health/labs/panels/base-core-men) and [Base Core Annual – Women](https://picardo.health/labs/panels/base-core-women) panels, if you want a wider checkup. Already have a result? [Ask Picardo about it](https://app.picardo.health/auth). ## Questions people ask ### Do I need to fast for an Lp(a) test? No. Eating doesn’t change Lp(a), so you can test at any time of day.[1][2] If other tests in the same draw need fasting, follow their instructions instead. ### How do I convert Lp(a) from mg/dL to nmol/L? There’s no exact formula, because Lp(a) particles differ in size from person to person and lab tests handle that differently.[2] Multiplying mg/dL by 2 to 2.5 gives a rough figure, which experts call a best guess.[1] As a guide, US guidelines treat 50 mg/dL as about 125 nmol/L.[2] If you test again, use a lab that reports the same unit. ### Is Lp(a) higher in Black or South Asian people? On average, yes. Levels run highest in people of African ancestry, followed by South Asian ancestry.[1][2] But a given level seems to raise risk by a similar amount whatever your ancestry.[2] ### Does Lp(a) affect your heart valves? Yes. High Lp(a) is linked to calcium building up in the aortic valve, which can narrow it over time (aortic stenosis).[1] Trials haven’t yet shown whether lowering Lp(a) slows this.[1] ### Should I stop my statin if it raises my Lp(a)? No. Any rise is small, about 1 mg/dL on average in trials, and statins still protect people with high Lp(a).[2] In the JUPITER trial, a high-dose statin cut heart events by about 38% in the half of people with higher Lp(a), and by about 54% in the other half, a gap that could be chance.[9] ## Often checked alongside - [ApoB](https://picardo.health/guides/biomarkers/apob.md): How many plaque-building particles you have - [LDL cholesterol](https://picardo.health/guides/biomarkers/ldl-cholesterol.md): The main cholesterol behind plaque - [hs-CRP](https://picardo.health/guides/biomarkers/hs-crp.md): Low-grade inflammation linked to heart risk - [LDL particle number](https://picardo.health/guides/biomarkers/ldl-particle-number.md): How many LDL particles you have ## Test details - **Labcorp test:** Lipoprotein(a), 120188 - **LOINC:** 43583-4 - **Sample:** Blood - **Fasting:** Not needed[2] - **Typical lab range:** Under 75 nmol/L - **Units:** nmol/L at Labcorp. Some labs use mg/dL, and there’s no exact conversion.[1] ## Sources 1. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925–3946. https://doi.org/10.1093/eurheartj/ehac361 2. Blumenthal RS, Morris PB, Gaudino M, et al. 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. Circulation. 2026;153(17):e1154–e1276. https://doi.org/10.1161/CIR.0000000000001423 3. Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 focused update of the 2019 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2025;46(42):4359–4378. https://doi.org/10.1093/eurheartj/ehaf190 4. Labcorp. Lipoprotein(a), test 120188. Labcorp test menu. Accessed October 28, 2026. https://www.labcorp.com/tests/120188/lipoprotein-a 5. Novartis. Novartis announces Lp(a)HORIZON Phase III topline results for pelacarsen in patients with elevated Lp(a) and established cardiovascular disease (CVD) [press release]. Basel: Novartis; September 4, 2026. https://www.novartis.com/news/media-releases/novartis-announces-lpahorizon-phase-iii-topline-results-pelacarsen-patients-elevated-lpa-and-established-cardiovascular-disease-cvd 6. Amgen. Olpasiran trials of cardiovascular events and lipoprotein(a) reduction (OCEAN(a)) outcomes trial. ClinicalTrials.gov identifier NCT05581303. Updated October 27, 2026. https://clinicaltrials.gov/study/NCT05581303 7. Eli Lilly and Company. A study to investigate the effect of lepodisiran on the reduction of major adverse cardiovascular events in adults with elevated lipoprotein(a) (ACCLAIM-Lp(a)). ClinicalTrials.gov identifier NCT06292013. Updated October 8, 2026. https://clinicaltrials.gov/study/NCT06292013 8. Eli Lilly and Company. Assessing the impact of muvalaplin on major cardiovascular events in adults with elevated lipoprotein(a) (MOVE-Lp(a)). ClinicalTrials.gov identifier NCT07157774. Updated September 24, 2026. https://clinicaltrials.gov/study/NCT07157774 9. Khera AV, Everett BM, Caulfield MP, et al. Lipoprotein(a) concentrations, rosuvastatin therapy, and residual vascular risk: an analysis from the JUPITER Trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin). Circulation. 2014;129(6):635–642. https://doi.org/10.1161/CIRCULATIONAHA.113.004406 Updated 2026-11-03. This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.