Lp(a) (Lipoprotein(a)) is a marker that we get a lot of questions about, which is not surprising since its interpretation is complex and clinical guidance is constantly changing with emerging research. I have put together this explainer to summarize how we currently us Lp(a) and what the result might mean for you but we continue to follow the research closely. 

Lp(a) is a type of protein that carries cholesterol and fats in the blood (you can find a more detailed answer for how this works here). It is a similar kind of particle to ApoB and is known to increase the build up of atherosclerosis in arteries, which is the main cause of heart attacks and strokes.

The way we test  Lp(a) is quite different to our other heart health biomarkers. We usually only test it once because the level of Lp(a) in your blood is around 90% determined by your genes. This is very different to ApoB and ApoA1 which are much more dependent on lifestyle factors and medications. 

Around 1 in 5 people globally have high Lp(a) levels which significantly increases their risk of heart disease, heart failure, and strokes. Testing Lp(a) levels once in your lifetime is therefore more like having a genetic test. If you have high levels you know that you are in this higher risk group and you need to pay more attention to your heart health as you age. 

Evidence from clinical trials has also shown that, unlike ApoB or your LDL-C levels, Lp(a) levels do not respond to medications like statins - so it is not a modifiable risk factor in the same way.

There are a couple of other facts that are worth mentioning about Lp(a). 

It looks like the extra risk if you have high levels mostly come after the age of 50. Put another way, if you have high Lp(a) levels it increases your risk of heart attack overall but this doesn’t necessarily mean you are more likely to have a heart attack earlier in life. 

The practical impact of this is that you might want to consider starting medications like statins that lower your heart health risk a bit earlier to keep your ApoB levels lower. This might compensate for the additional risk from you Lp(a). 

The other important consideration is that Lp(a) levels in females can change after menopause. If this applies to you and you are pre-menopause then we recommend having a repeat test after menopause to check that your heart health risk profile hasn’t changed.

For more information about our heart health panel have a look at our sample dashboard or read these other blogs.  

Key Resources 

• 2023 update on Lp(a) from the American College of Cardiology:  https://www.acc.org/Latest-in-Cardiology/Articles/2023/09/19/10/54/An-Update-on-Lipoprotein-a

Key academic papers:

• Liu, Jin, et al. "Coronary Artery Disease: Optimal Lipoprotein (a) for Survival—Lower Is Better? A Large Cohort With 43,647 Patients." Frontiers in cardiovascular medicine 8 (2021): 670859.
• Nordestgaard, Børge G., et al. "Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine." European heart journal 37.25 (2016): 1944-1958.

All the views expressed here are based on careful research conducted by the research team at Niahealth. However, in some places we have omitted certain details for the sake of clarity and simplicity. If you have any questions about our research or the content of this blog email our head of research Dr Robin Brown at : robin@niahealth.co