Lipoprotein(a), or Lp(a), is an inherited cholesterol particle, and about 1 in 5 people has a level of 50 mg/dL (125 nmol/L) or higher, and the 2026 US guideline says every adult should be tested at least once.
Lp(a) isn't on the standard lipid panel, so most people have never had it checked. You can eat well, exercise, have a fine LDL and still have a high Lp(a), because your genes set it.
If yours comes back high, you did nothing wrong. Diet won't move Lp(a) much. Your habits can still lower the risk that comes with it.
The book's grade: For lowering Lp(a) itself, diet, exercise and weight loss are UNLIKELY TO HELP (Skip as an Lp(a) fix). For your overall risk, lifestyle stays a Start here item, because it lowers the risk that comes with a high Lp(a) even when the number doesn't budge. The test itself is Start here (as a test), once in your life.
What is lipoprotein(a)?
Lp(a) is an LDL-like particle with an extra protein strand, called apo(a), bound to it (2026 ACC/AHA guideline).
- More than 90% of the difference in Lp(a) between people comes from genes.
- Your level is usually close to its adult value by about age 5. It can creep up until you're grown, and after that it tends to stay put (European consensus on Lp(a)).
- Levels run highest on average in people of African and South Asian ancestry. The added risk at a given level looks similar across groups.
The strongest links are with heart attack and with aortic stenosis, a stiff, narrowed heart valve. The links with stroke and with death from all causes are weaker (2025 European update).
What is a normal Lp(a) level?
There's no magic cutoff. Risk climbs steadily as the number rises. The US line for "elevated" is 50 mg/dL or 125 nmol/L, and about 1 in 5 people is at or above it.
Using the guideline's general guide, this is how risk rises compared with someone at the median, about 7 mg/dL (20 nmol/L):
- Under 30 mg/dL (under 75 nmol/L): the reference level.
- 30 to 49 mg/dL (75 to 124 nmol/L): about 1.2 times the risk.
- 50 mg/dL (125 nmol/L): about 1.4 times.
- 100 mg/dL (250 nmol/L): about 2 times.
- 150 mg/dL (350 nmol/L): about 3 times.
- 180 mg/dL (430 nmol/L): about 4 times, similar to the risk with familial hypercholesterolemia (FH), the inherited form of very high LDL.
These are risks of heart attack and stroke from clogged arteries. A level of 50 mg/dL or more also counts as a "risk enhancer," something your risk calculator leaves out that can tip a borderline decision toward treatment.
Lp(a) in mg/dL vs nmol/L
Lp(a) is reported in either nmol/L or mg/dL, and the two don't convert with a simple formula. The US guideline pairs 50 mg/dL with 125 nmol/L. The European guideline pairs 50 mg/dL with 105 nmol/L.
The apo(a) strand comes in many lengths, set by your genes. A test by weight (mg/dL) counts a long strand as more Lp(a) than a short one, even with the same number of particles. A test that counts particles (nmol/L) avoids that, and the US guideline prefers it.
Check which unit is on your report before you compare it with anything, and don't try to convert it yourself.
Who should get a lipoprotein(a) test?
Every adult, at least once. That's the 2026 US guideline. The European guideline agrees and suggests doing it with your first lipid panel, or the next one if you've had those before. Ask for it with your next blood draw.
- No fasting needed.
- One test is usually enough, because the level stays similar over time.
- Coverage can be spotty, so if cost matters, ask your doctor's office or your insurer before the draw.
A second test is reasonable after menopause, when women's levels can rise, especially if the first result was close to the cutoff. A repeat also makes sense if the first was drawn during kidney, liver or thyroid disease or pregnancy.
If yours is high, test the family. The guideline recommends testing your parents, brothers and sisters, and children. In one family-screening program for FH, testing the children and teens of a parent with high Lp(a) found a raised level, 30 mg/dL or more, in about 1 of every 2 tested (family screening study).
Can you lower lipoprotein(a) naturally?
Not in any way that matters. The 2026 guideline says lifestyle "minimally impacts" Lp(a).
- Diet. In the European consensus table, swapping saturated fat for carbohydrate or unsaturated fat nudged Lp(a) up about 10% to 15%. A low-carb diet high in saturated fat nudged it down about 15%. That second diet often raises LDL, which drives far more of the risk, so I wouldn't keep the butter for Lp(a)'s sake, though no trial has tested that trade.
- Exercise hasn't shown a consistent effect on Lp(a) (Norfolk study).
- Flaxseed lowered Lp(a) about 2 mg/dL across 7 trials with 629 people (flaxseed review). Soy isoflavones had no effect across 10 trials (soy isoflavone review). Both are UNLIKELY TO HELP as Lp(a) treatments.
- High-dose niacin does lower Lp(a), but the European consensus advises against using it for that, because outcome trials of niacin found no benefit. It can also injure the liver.
What to do if your Lp(a) is high
What you can change is everything around the number. The risk from Lp(a) multiplies with your other risk factors, and the guideline calls for "optimal early control" of everything else.
In about 14,000 people in Norfolk, England, followed for more than 11 years, those with Lp(a) of 50 mg/dL or more and the best heart-health scores had about one-third the heart disease and stroke risk of those with the worst (Norfolk study). A US study of about 6,700 adults found nearly the same thing, with about 65% lower risk at the best scores in people with high Lp(a) (US study). Both were observational, so they show a strong link but can't prove cause.
In practice, with a high Lp(a):
- Your LDL counts for more. A lower LDL is your main tool.
- Keep blood pressure and blood sugar in range, and don't smoke.
- Ask your doctor to rerun your risk with the Lp(a) result in mind. A very high Lp(a) can justify cholesterol treatment even when your calculated risk is low.
Does a statin lower Lp(a)?
No. In a review of 39 trials, statins raised Lp(a) about 1 mg/dL on average compared with placebo (statin and Lp(a) review). The 2026 guideline says that small change "would not justify discontinuing the statin." Keep taking yours.
The PCSK9 antibody shots lower Lp(a) by about 15% to 30%, though they aren't approved for that use. As of October 2026, no medicine is approved to lower Lp(a) to prevent heart attacks. In early trials, shots called olpasiran and lepodisiran lowered it by about 70% to nearly 100% (olpasiran trial, lepodisiran trial). The first big outcome trial, Lp(a)HORIZON, tested pelacarsen in 8,323 people with heart disease and high Lp(a). In September 2026 the company reported that it lowered Lp(a) but didn't significantly lower heart deaths, heart attacks, strokes and urgent artery-opening procedures counted together (Lp(a)HORIZON commentary). Full results weren't yet published, and outcome trials of the other drugs are still running.
Aspirin for high Lp(a) still needs proper trials, and it can cause bleeding, so that decision belongs with your doctor.
When to call your doctor
- A high Lp(a) is a reason to call your doctor's office and set up a visit, not a reason to panic.
- Don't stop a statin because your Lp(a) is normal, or because a statin nudged it up.
- Don't start aspirin or a supplement because of an Lp(a) result.
- Chest pain or pressure, shortness of breath, or sudden weakness, numbness or trouble speaking means emergency help, whatever your test results say.
Bottom line
Lp(a) is an inherited particle that raises heart attack risk, and about 1 in 5 people has a high level. Every adult should have it checked once, with no fasting, noting the units. Diet and supplements barely move it, and no medicine is yet approved to lower Lp(a) to prevent heart attacks. A high result is a reason to work harder on your LDL, blood pressure, blood sugar and smoking, and to test your family.
Questions people ask
What is lipoprotein(a)?
An LDL-like particle with an extra protein strand attached. More than 90% of the difference between people comes from genes, and a high level raises the risk of heart attack and a narrowed heart valve.
What is a normal lipoprotein(a) level?
The US line for elevated is 50 mg/dL or 125 nmol/L. Risk rises steadily, to about twice the median risk at 100 mg/dL (250 nmol/L). Check your report's units first.
Who should get a lipoprotein(a) test?
Every adult, at least once, under the 2026 US guideline, with no fasting. If yours is high, your parents, siblings and children should be tested too.
Can you lower lipoprotein(a) naturally?
Not by much. Diet moved it about 10% to 15% at most, and flaxseed only about 2 mg/dL. Lifestyle still cuts the risk that comes with it, through your LDL, blood pressure and blood sugar.
The rest of the panel, graded
Your Cholesterol by the Numbers, coming soon, covers Lp(a) alongside the other tests, such as when apoB is worth asking for (Add next as a test, if your triglycerides are high or you have diabetes). It also grades what lowers LDL, the number you can move:
- Swapping butter for liquid vegetable oils: SUPPORTED (works), about 9 to 16 mg/dL lower LDL for every 10% of calories moved.
- Aerobic exercise, about 150 minutes a week: SUPPORTED (works), small effect for LDL.
- High-dose niacin: SUPPORTED on paper, but a Skip, because it moves the numbers without preventing heart attacks.
If your Lp(a) is high and you're unsure about treatment, read what a coronary calcium score tells you. For the full list of what lowers LDL, see how to lower cholesterol naturally.