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Lp(a): Who Should Be Tested?

Medically Reviewed and Written By: Kathleen O’Shea Northrup, MD 

Lp(a) – pronounced L-p-little-a- is a type of lipoprotein that is associated with much higher risks of acute coronary and vascular disease. It is estimated that 20-30% of the population has an elevated level. Lp(a) can not only cause narrowing of the arteries but can also increase inflammation and make blood vessels more prone to blood clots.  Unlike LDL and HDL cholesterol, it changes very little with diet and exercise, and there are no routinely used therapies to treat elevated levels. Fortunately, there are a number of new medications on the horizon that may soon be used to treat high levels of Lp(a). So who should be tested?

The short answer to this question is “everyone,” but it is especially important if you have a “healthy” relative who has had a heart attack or stroke at a young age. 

Should I be tested for Lp(a)?

In Europe and Canada, it is recommended that all adults have their Lp(a) levels tested once in their lifetime. In the United States, however, providers have typically only recommended testing levels for those with the risk factors outlined below. This should change as better treatments for elevated Lp(a) emerge.  Specific health conditions or family history might make your healthcare provider suspect that you could have an elevated Lp(a) level. These conditions include:

  • A history of early heart disease or stroke in your close relatives (before age 55 for a father or brother, or before age 65 for a mother or sister)
  • A known family history of elevated Lp(a) levels
  • If you personally have had a heart attack or stroke, despite not having any of the usual risk factors for this (high cholesterol, smoking, obesity, diabetes, etc.)
  • High LDL levels despite taking cholesterol-lowering medications
  • A known history of an inherited condition called Familial Hypercholesterolemia

It is estimated that 1 in 5 people have an elevated Lp(a) level. You are more likely to have an elevated level if you are of African or South Asian heritage, though it can occur in people from all backgrounds. Unlike the more commonly known LDL and HDL cholesterol, Lp(a) levels remain fairly constant throughout your lifetime. They are 80-90% determined by genes. Because of this, your level is going to be almost the same at age 50 as it was at age 5- so it only needs to be checked once in your lifetime.

Where can I get help for managing my cholesterol?

If understanding all the different cholesterol types has your head spinning, there are ways you can start managing your health. Check out patientslikeme.com/groups/healthy_living/overview to join our discussion. You can share what you are going through, ask for advice, and plan a path forward from people who understand. ⁠

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