The marker that changes how you think about your other heart markers

Lp(a) is one of the strongest known genetic risk factors for heart disease, and it barely responds to diet, exercise, or most current medications. That's exactly why it's worth testing. Knowing your number can impact how aggressively you and your doctor manage everything else that is in your control, like LDL, blood pressure, and smoking. A high Lp(a) is essentially a signal to tighten the reins on the levers you can move. Since levels stay stable for life, this is a test you take once, not something to add to a rotating panel.

The one-time heart test →

The Basics

What it is

Lp(a) is an LDL-like particle, but unlike LDL or ApoB, which respond meaningfully to diet and exercise, your Lp(a) level is set almost entirely by genetics.

Why it matters

It's "stickier" than regular LDL, promotes clotting, and triggers inflammation in vessel walls, three separate mechanisms a standard cholesterol test won't show you. Genetic studies that isolate Lp(a)-raising variants find a corresponding jump in heart attack risk, so this is one of the few markers where the science has moved past correlation to established causality. Whether lowering it with medication actually reduces that risk is still being tested in ongoing trials.

Healthy range

Below 75 nmol/L. Roughly 20 to 30 percent of people carry a genetically elevated level.

What moves it

Very little. Diet and exercise typically shift Lp(a) by only 10 to 15 percent at most. It can tick up somewhat with hypothyroidism, chronic kidney disease, or after menopause.

When to test

Worth doing once in adulthood, especially with a family history of early heart disease or high cholesterol that doesn't add up. Levels stay stable for life, so there's rarely a reason to retest once you know your number.

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