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Heart & Vascular

Lipoprotein(a)

Lipoprotein(a) is an inherited cholesterol particle that raises your cardiovascular risk, apart from cholesterol.

What is Lipoprotein(a)?

Lipoprotein(a), or Lp(a) for short, is a cholesterol-carrying particle that closely resembles LDL but has an extra protein attached. That extra protein makes it more harmful: it promotes both the clogging of your arteries and the formation of blood clots. Your Lp(a) level is almost entirely determined by your genes and stays stable throughout life. Diet, weight, and exercise barely affect it. A single measurement is therefore usually enough — the value will not change much anyway. The result can come in two units (mg/dL or nmol/L); always compare values within the same unit.

Why is Lipoprotein(a) relevant?

Lp(a) is one of the few risk factors for heart and vascular disease that falls entirely outside the usual cholesterol story. You can have a perfect LDL, ApoB, and HDL and still have a markedly elevated Lp(a) — invisible on a standard lipid profile. The higher the value, the greater your risk of heart attack, stroke, and narrowing of the aortic valve. A raised Lp(a) is one of the most common explanations for an early heart attack in someone with otherwise normal values. Because it is inherited, an elevated result is also a signal to have close family tested — children of a carrier carry on average half the value.

Lipoprotein(a) high or low — what it means

Lp(a) does not need to be measured fasting and is reliable at any time. Unlike LDL, it barely responds to lifestyle, and statins do not lower it. You therefore reduce your risk not by targeting Lp(a) itself, but by keeping your other risk factors as tight as possible. So with an elevated Lp(a), the approach is: LDL as low as possible, blood pressure controlled, no smoking, and regular exercise — because these risks stack on top of each other. A markedly elevated value, especially with heart disease in the family, is worth discussing with a doctor to decide whether more intensive prevention is needed. Specific Lp(a)-lowering medications are also in development.

Lipoprotein(a) reference ranges

Normal (desirable)Equivalent to < 75 nmol/L< 30 mg/dL
BorderlineEquivalent to 75 - 125 nmol/L; risk rises gradually30 - 50 mg/dL
Elevated (high risk)Above the 80th percentile; equivalent to > 125 nmol/L (Dutch NIV guideline / ESC 2016)> 50 mg/dL

Cut-offs and units vary by lab and method. Lp(a) is reported in mg/dL or nmol/L; these do not convert one-to-one. Always compare values within the same unit and check the reference range on your own result.

Educational information only — not medical advice. Consult a healthcare professional for clinical decisions.

Read about our scientific approach →Read the guide: Heart health →

Frequently asked questions

What is a normal Lp(a) level?

An Lp(a) below 30 mg/dL (about 75 nmol/L) is considered normal. Between 30 and 50 mg/dL (75-125 nmol/L) is borderline, where risk gradually increases. Above 50 mg/dL (about 125 nmol/L) is considered elevated, with a higher risk of cardiovascular disease. Lp(a) can be reported in mg/dL or nmol/L; always compare within the same unit, as they don't convert directly.

What does a high Lp(a) mean?

A value above 50 mg/dL (> 125 nmol/L) sits above the 80th percentile and is linked to a higher risk of heart attack, stroke, and narrowing of the aortic valve, independent of your cholesterol. Above 30 mg/dL (0.3 g/L), the risk of a heart attack is already thought to roughly double; if your LDL is also raised, the risk stacks further. Your Lp(a) is almost entirely inherited and stays stable throughout life.

Can I have a low Lp(a)?

Yes, and that's favourable: a low Lp(a) does not add to your cardiovascular risk, so a low or undetectable value is no cause for concern. Lp(a) can also be lowered by liver disease and heavy alcohol use.

When is an Lp(a) level concerning?

Especially when your value is markedly elevated (well above 50 mg/dL / 125 nmol/L) and there is a family history of early cardiovascular disease. Because it is inherited, a raised result is also a signal to have close family tested. Lp(a) itself barely responds to lifestyle or statins; you lower your risk by keeping your other risk factors tight: LDL as low as possible, blood pressure controlled, no smoking, and regular exercise. Discuss a markedly elevated value with your doctor.

Related biomarkers

Apolipoprotein B (ApoB)
ApoB is a protein on every harmful cholesterol particle, so it counts how many of those particles circulate in your blood.
LDL Cholesterol
LDL cholesterol is the cholesterol in your blood that can lodge in artery walls and build up as plaque.
HDL Cholesterol
HDL is the 'good' cholesterol that carries excess cholesterol back to your liver.

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