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Biomarker library / Lipids

Lipoprotein(a) (Lp(a))

Also called Lp little a, LPA

Lipoprotein(a) is an LDL-like particle with an extra protein (apolipoprotein(a)) attached. Your level is 80 to 90% genetic, changes little across life, and is not captured by a standard cholesterol panel.

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mg/dL. Cut points from the sources listed below.
Population Adults
Category Risk enhancer
Range 50 or higher mg/dL About 105 to 125 nmol/L. Used to refine ASCVD risk and intensify management of the other risk factors.
Source Lipoprotein(a) in ASCVD and aortic stenosis: EAS consensus statement (2022)

Effective

Population Adults
Category Very high: lifetime risk similar to untreated heterozygous FH
Range 180 or higher mg/dL Above about 430 nmol/L.
Source Lipoprotein(a) in ASCVD and aortic stenosis: EAS consensus statement (2022)

Effective

Normal vs optimal

There is no treatment target yet because there is no approved therapy that specifically lowers Lp(a) with proven outcomes (several are in trials). A high result is used to tighten everything else: earlier and more intense LDL and ApoB lowering, blood pressure control and lifestyle change.

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02  /  Why it matters

What the number tells you

The European Atherosclerosis Society's 2022 consensus recommends Lp(a) be measured at least once in adults, because an elevated level independently raises the risk of heart attack, stroke and aortic valve stenosis. Around 50 mg/dL it acts as a risk enhancer; about 100 mg/dL (~250 nmol/L) approximately doubles ASCVD risk irrespective of baseline; and very high levels (above 180 mg/dL, or over 430 nmol/L) carry lifetime risk similar to untreated heterozygous familial hypercholesterolemia.

03  /  In practice

Testing and what moves it

When it is tested

  • Once in adulthood, per the EAS consensus; repeat testing adds little because levels are stable and mostly genetic.
  • Especially worth knowing with a family history of early heart disease, familial hypercholesterolemia, or a personal event that seems out of proportion to the standard risk factors.
  • Units matter: labs report mg/dL or nmol/L, and the conversion is approximate (about 1 mg/dL to 2.1 to 2.5 nmol/L), so compare like with like.

What raises it

  • Genetics (LPA gene variants) set the level almost entirely.
  • Kidney disease and menopause can nudge it up modestly.

What lowers it

  • Lifestyle change barely moves Lp(a); that is not a reason to skip it, because it still lowers overall risk.
  • PCSK9 inhibitors reduce it 20 to 25%; dedicated Lp(a)-lowering drugs are in phase 3 trials.

04  /  Related

Read next

Apolipoprotein B ApoBHigh-sensitivity C-reactive protein hs-CRPLDL cholesterol LDL-C

Frequently asked questions

How often should Lp(a) be measured?

Once. The EAS consensus recommends measuring Lp(a) at least once in adults; because the level is mostly genetic and stable, repeat tests rarely change the answer.

My Lp(a) is high. What can I actually do?

Today, treat everything around it harder: LDL and ApoB lowering, blood pressure, glucose, not smoking. Statins do not lower Lp(a) (they may raise it slightly) but still cut overall risk; PCSK9 inhibitors lower it 20 to 25%; dedicated therapies are in outcome trials.

Is 50 mg/dL the same as 50 nmol/L?

No. The units measure different things (mass vs particle count) and the conversion is approximate: 50 mg/dL corresponds to roughly 105 to 125 nmol/L. Check which unit your lab reported before comparing against thresholds.