If you have a family history of early heart disease, or you have worked hard on your cholesterol and blood pressure and still feel uneasy about your heart, there is one blood test that rarely gets mentioned in a standard NHS check: lipoprotein(a), usually written as Lp(a). It is one of the best-established inherited cardiovascular risk factors, linked to heart attack, stroke and narrowing of the aortic valve, yet most people go their whole lives without ever having it measured. That position is starting to change. In March 2026 the two main US heart organisations, the American College of Cardiology and the American Heart Association, began recommending that every adult has their Lp(a) checked at least once. UK guidance is more targeted for now, although several major international and specialist groups now support wider Lp(a) testing. This article explains what Lp(a) is, why it matters, what your number means, and what you can do about a high result.
Key points
Lp(a) is an inherited cholesterol-carrying particle linked to heart attack, stroke and narrowing of the aortic valve.
It is not measured in a standard cholesterol test and has to be requested separately.
For most people it only needs measuring once, because the level is largely set by your genes.
Diet, exercise and weight loss do not meaningfully lower Lp(a), but they still help your overall heart risk.
A high result is a prompt to tighten everything else you can control: LDL cholesterol, blood pressure, smoking, diabetes and family risk.
What is lipoprotein(a)?
Lp(a) is a cholesterol-carrying particle in your blood. Structurally it looks like LDL, the so-called bad cholesterol, with an extra protein called apolipoprotein(a) wrapped around it. That extra component makes Lp(a) both more likely to lodge in artery walls and more likely to promote clotting, which is part of why it carries risk over and above ordinary LDL.
The most important point for patients is this: your Lp(a) level is set almost entirely by the genes you inherit. It is largely fixed from childhood, stays fairly stable across your life, and is barely moved by diet, exercise or losing weight. The 2026 ACC/AHA dyslipidemia guideline makes exactly this point, which is also why the test usually only needs doing once.
Why a standard cholesterol test won't show it
A standard lipid profile does not measure Lp(a) directly. It usually reports your total cholesterol, HDL, triglycerides, and a calculated LDL and non-HDL cholesterol, which is the panel NICE describes for cardiovascular risk. None of those numbers tells you your Lp(a). It is a separate, specific measurement that has to be requested in its own right, which is a large part of why someone can have an otherwise reassuring cholesterol result and still carry a significant inherited risk.
There is a subtlety worth knowing. Because Lp(a) carries some cholesterol of its own, a little of it gets counted inside your LDL figure, so a normal-looking LDL can still sit on top of a raised Lp(a). This matters most for people who develop heart disease despite normal cholesterol, or who have a strong family history that their usual results do not seem to explain. In those situations Lp(a) is often the missing piece, and testing it once gives a more complete picture of your cardiovascular risk than cholesterol alone can provide.
Why Lp(a) matters
For years Lp(a) was treated as an interesting curiosity. The genetics changed that. Because your level is inherited, researchers could use large genetic studies (a method called Mendelian randomisation) to test whether Lp(a) actually causes heart disease rather than simply travelling alongside it. In 2009, a study of over 40,000 people found that the genetic variants which raise Lp(a) also raise the risk of heart attack, strong evidence that Lp(a) is a genuine cause and not just a bystander.
The European Atherosclerosis Society reviewed the full body of evidence in 2022 and concluded that raised Lp(a) is a causal risk factor for both atherosclerotic cardiovascular disease and narrowing of the aortic valve, known as aortic stenosis. In other words, a high level does not only threaten your coronary arteries. Over time it can also stiffen and narrow a heart valve.
How common is a high level?
This is not a rare problem. Around one in five people worldwide carries an Lp(a) level high enough to raise their cardiovascular risk. Because it runs in families, a raised result in you has implications for your parents, brothers and sisters, and children too. That family dimension is one of the reasons specialist groups now support wider testing.
What the guidelines now say
The 2026 ACC/AHA guideline, a US guideline that retired and replaced the previous 2018 blood cholesterol guideline, recommends for the first time that Lp(a) is measured at least once in every adult, to help identify people at higher risk.
In the UK, the picture is more targeted for now. HEART UK has published a consensus statement calling for testing, particularly in people with a personal or family history of premature cardiovascular disease, a first-degree relative with a very high Lp(a), a diagnosis of familial hypercholesterolaemia, calcific aortic valve disease, or a borderline 10-year cardiovascular risk score. The European Atherosclerosis Society goes further and recommends measuring Lp(a) at least once in each person's lifetime.
On the NHS, Lp(a) is not usually part of routine cholesterol screening, though it can be requested in some settings, particularly lipid clinics and cardiology services, and availability varies from area to area. The main UK guideline for heart risk and cholesterol, NICE NG238, does not recommend measuring everyone's Lp(a), which is why it is not a routine part of an NHS check. That is not a failing of the NHS. It reflects the current UK national guidance.
Who should consider testing?
Lp(a) is most useful to know in a few specific situations. UK and international guidance highlights groups like these:
| Situation | Why it matters |
|---|---|
| A heart attack or stroke at a young age, in you or a close relative | Can point to an inherited risk running in the family |
| Familial hypercholesterolaemia (an inherited high-cholesterol condition) | A raised Lp(a) adds further to the risk |
| Heart disease despite normal cholesterol | Lp(a) may explain the risk your cholesterol does not |
| Narrowing of the aortic valve (aortic stenosis) | Raised Lp(a) is linked with calcium build-up on the valve |
| A parent, sibling or child with a very high Lp(a), especially above 200 nmol/L | Worth checking your own, and considering family (cascade) testing |
| A borderline 10-year cardiovascular risk score | A high Lp(a) can tip the balance toward earlier treatment |
These are the situations where Lp(a) testing is most clearly useful in current UK practice, rather than the only people who can be tested.
When this article mentions heart disease at a young age, that usually means before around 60, though your doctor may read it differently depending on your family history.
Understanding your result: what the numbers mean
Rather than a simple pass or fail, it is more useful to think of Lp(a) as a spectrum. Risk rises steadily as the number climbs. Different guidelines draw the lines in slightly different places. The bands below are one commonly used way to read the number, not a hard global rule:
| Lp(a) level (nmol/L) | What it usually means |
|---|---|
| Below 75 | Low, generally reassuring |
| 75 to 125 | Intermediate, a grey zone |
| 125 or above | High, enough to add to your risk |
| 250 or above | Very high |
| Above about 430 | Extremely high. Some guidance suggests the lifetime cardiovascular risk may be in the range seen with untreated familial hypercholesterolaemia |
In the UK, HEART UK flags results above 90 nmol/L for attention, which sits inside that intermediate-to-high zone. The 2026 ACC/AHA guideline treats 125 nmol/L or above as high, carrying about a 1.4 times higher long-term risk of heart attack or stroke, with the risk roughly doubling as levels approach 250 nmol/L. The European Atherosclerosis Society stresses that there is no single on/off threshold: risk climbs continuously as the level rises, which is why different guidelines pick slightly different points to call a result high.
Lp(a) can be reported in nmol/L or in mg/dL. The two units do not convert cleanly, because the apo(a) protein varies in size from person to person, so it is best to read your result against the units and reference range your own laboratory gives. Whatever the number, a result in the reassuring range does not cancel out other risks such as smoking, a high LDL or high blood pressure. Your Lp(a) is one piece of a bigger picture.
A question patients often ask is whether the test needs repeating. For most people it does not. Because the level is mostly genetic and fairly stable, a single measurement is usually enough to know where you stand, which is why the guidelines frame it as a once-in-a-lifetime test rather than an annual one. A small number of situations can shift the level, but these are the exception rather than the rule. Around the menopause, in pregnancy, or with some kidney or thyroid conditions, Lp(a) can rise, and your doctor may then want to repeat the test or read an earlier result with that in mind.
How to lower lipoprotein(a) and reduce your risk
A high Lp(a) is not a reason to panic, and it does not mean a heart attack is inevitable. It is information you can act on, and if you are worried it is worth discussing the result with your GP or a lipid specialist. Because lifestyle changes barely shift Lp(a) itself, the strategy is to lower every other risk factor you can control, so your overall risk comes down even though this one number stays put. In practice that usually means:
Keeping LDL cholesterol as low as your doctor advises, with a statin if one is recommended
Treating high blood pressure and keeping it well controlled
Not smoking
Staying physically active and keeping to a healthy weight
Managing diabetes carefully if you have it
One point that confuses people: statins are not prescribed to lower Lp(a), and their effect on Lp(a) itself is not clinically useful. That is not a reason to avoid them. NICE still recommends statins as the main treatment for lowering cardiovascular risk, because bringing your LDL cholesterol down lowers your overall risk even when Lp(a) itself stays put.
People often search for how to lower lipoprotein(a) naturally, or which foods to avoid. Here it is worth being straight with you. Because the level is inherited, no specific diet, food or exercise routine has been shown to bring it down by a meaningful amount, and there is no lipoprotein(a) diet as such. Some supplements, including niacin, can nudge the number down a little, but they have not been shown to lower the risk of heart attack or stroke, so they are not recommended for that purpose. A heart-healthy diet still matters a great deal, but for your cholesterol, blood pressure and weight rather than for Lp(a) itself.
A high result also raises understandable worries about the future, and searches about life expectancy with high lipoprotein(a) are common. A raised level does shift your long-term odds, but it is not a fixed sentence. Many people with a high Lp(a) never have a heart attack, especially when other risk factors are well controlled, and the risk that comes with it can often be reduced meaningfully by controlling the factors you can change. The number on the page matters far less than what you and your GP decide to do about everything around it.
Knowing your number also lets your GP estimate your cardiovascular risk more accurately. Standard risk calculators may not fully take Lp(a) into account, so a high result can help show whether your overall risk is higher than your routine cholesterol numbers suggest, and whether earlier or more intensive treatment is worthwhile. If your result is high, it is worth mentioning to close relatives so they can consider testing too, a process HEART UK refers to as cascade testing.
For the small number of people with a very high Lp(a) and heart disease that keeps progressing despite everything else being well managed, specialist clinics can consider a treatment called lipoprotein apheresis, which filters Lp(a) out of the blood. It is only available through specialist referral and is not something most people will ever need, but it is a reminder that even now a high level is not a dead end.
There is also real momentum in treatment. At present, there is no routinely licensed medicine used specifically to lower Lp(a) with proven outcome benefit, although several targeted treatments are in advanced clinical trials. Knowing your level now means you and your GP are ready to act if effective treatments become available.
When to see your GP
Speak to your GP if you have a personal or family history of heart attack, stroke or aortic valve disease at a young age, if a close relative is known to have a high Lp(a), or if you have been diagnosed with familial hypercholesterolaemia. If you already have a high Lp(a) result from a private test, take it to your GP so it can be weighed up alongside your blood pressure, cholesterol and overall risk.
Call 999 straight away if you have symptoms of a heart attack or stroke, such as chest pain or tightness, sudden weakness or numbness, a drooping face, slurred speech, severe breathlessness or a collapse. These need urgent help right away, so do not wait for a blood test result.
Common questions about the lipoprotein(a) blood test
What counts as a normal or high lipoprotein(a) level? There is no single official cut-off, and risk rises steadily rather than switching on at one point. As a rough guide, below 75 nmol/L is low, 75 to 125 is an intermediate grey zone, and 125 nmol/L or above is high. In the UK, HEART UK flags anything above 90 nmol/L for attention.
Can you lower lipoprotein(a) naturally? Not by much. Because the level is set by your genes, diet, exercise and weight loss have very little effect on Lp(a) itself. The most useful thing you can do is lower your other risk factors, such as LDL cholesterol and blood pressure.
Are there foods to avoid with high lipoprotein(a)? No particular food meaningfully raises or lowers Lp(a), so there is no special lipoprotein(a) diet. A heart-healthy diet is still worthwhile for your overall cholesterol and cardiovascular risk.
Does a high lipoprotein(a) affect life expectancy? A high level raises the long-term risk of heart attack and stroke, roughly 1.4 times higher at 125 nmol/L and at least double near 250 nmol/L, according to the 2026 ACC/AHA guideline. It is not a fixed sentence though, and that added risk can often be reduced meaningfully by managing everything else well.
Testing your Lp(a) with Brooksby Medical
The section below is about our private service, separate from the medical information above.
Brooksby Medical offers a private Lipoprotein(a) blood test with a written interpretation from a practising GP. Because Lp(a) is inherited and stays stable through life, this is usually a once-in-a-lifetime check. If you would like a fuller picture of your cardiovascular risk, our Advanced Cholesterol Profile measures Lp(a) alongside apolipoprotein B and the standard lipid markers. This is a paid private service and is not a replacement for NHS cardiovascular care, but it can give you and your GP more information to work with.
References
National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238). 2023. https://www.nice.org.uk/guidance/ng238
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. Circulation. 2026;153:e1154-e1276. doi:10.1161/CIR.0000000000001423. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423
Cegla J, Neely RDG, France M, et al. HEART UK consensus statement on Lipoprotein(a): a call to action. Atherosclerosis. 2019;291:62-70. https://www.atherosclerosis-journal.com/article/S0021-9150(19)31528-X/fulltext
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://academic.oup.com/eurheartj/article/43/39/3925/6670882
Kamstrup PR, Tybjaerg-Hansen A, Steffensen R, Nordestgaard BG. Genetically elevated lipoprotein(a) and increased risk of myocardial infarction. JAMA. 2009;301(22):2331-2339. https://pubmed.ncbi.nlm.nih.gov/19509380/
Reyes-Soffer G, Ginsberg HN, Berglund L, et al. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42(1):e48-e60. https://www.ahajournals.org/doi/10.1161/ATV.0000000000000147
Medical disclaimer. This article is for informational purposes and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual symptoms, history, and clinical picture. If you have concerns about your health, please consult your GP.