This Blood Test Helps Predict Your Heart Disease Risk — Here's How
There’s no “one thing” that causes cardiovascular disease. Instead, it’s the result of numerous lifestyle, genetic, and environmental factors that build over time. This often happens quietly and without obvious warning signs.
That’s part of what makes heart disease tricky to predict. You might eat well, exercise regularly, and have a “normal” cholesterol panel, yet still be at elevated risk. Traditional lipid tests are helpful, but they don’t always capture the full picture of what’s happening beneath the surface.
That’s where lipoprotein(a), or Lp(a), comes in. This blood biomarker is genetically determined and can independently raise your risk of heart attack and stroke, even in otherwise healthy individuals. Now, major organizations like the American Heart Association are encouraging people to get their Lp(a) checked at least once in their lifetime.
Understanding your Lp(a) level can add an important layer of insight, helping you take a more personalized, proactive approach to your long-term heart health. Here's what you need to know
What is Lp(a) & why does it matter
Lipoprotein(a), or Lp(a), is a type of cholesterol particle that’s structurally similar to LDL, but with an added protein called apolipoprotein(a). The addition of apolipoprotein(a) makes it more likely to stick to artery walls and contribute to plaque buildup.
When Lp(a) levels are high, this buildup and reduced blood flow can increase your risk of heart attack, stroke1, peripheral artery disease, and aortic stenosis (a narrowing of the heart's aortic valve).
Approximately 20-25% of the global population has elevated Lp(a) levels. That's roughly 1 in 5 people walking around with a cardiovascular risk factor they they may not know about, as it's not routinely tested and there are no symptoms.
Who should get tested (and when)
Lp(a) testing is straightforward and only requires one blood draw. Remember the number isn't impacted by lifestyle factors so just getting this blood test once in your life is sufficient to determine your risk.
While everyone should know their Lp(a) levels (ideally with insurance plans covering the cost), testing is especially important if you have2:
- A family history of premature cardiovascular disease (heart attack or stroke before age 55 in men or 65 in women)
- A personal history of cardiovascular events without clear explanation
- Familial hypercholesterolemia or very high LDL cholesterol
- A family history of elevated Lp(a)
What your results actually mean
Lp(a) can be measured in two different units—mg/dL or nmol/L—and the thresholds differ2 depending on which unit your lab uses.
- ≥125 nmol/L (or ≥50 mg/dL): Generally considered to be at an elevated risk of heart disease and stroke
- ≥250 nmol/L (or ≥100 mg/dL): Your risk may double
Your healthcare provider will then likely look at your Lp(a) alongside other indicators of cardiovascular health to determine your current (and potentially future) risk of heart disease.
- LDL cholesterol (and ideally ApoB, another underutilized marker)
- Blood pressure
- Blood sugar and metabolic health
- Family history
- Lifestyle factors like smoking status
Can you lower Lp(a)?
Lp(a) levels are approximately 70-90% genetically determined. Unlike LDL cholesterol, which responds to diet, exercise, and medications like statins, Lp(a) doesn't really budge.
There are some medications currently being studied for their role in lowering Lp(a) levels, but that research is still evolving.
- Pelacarsen: An antisense oligonucleotide3 that has shown Lp(a) reductions of up to 80% in phase 2 trials
- Olpasiran and other siRNA therapies: Also demonstrating significant Lp(a) lowering in trials4
However, this research is still evolving, and for now, we don't have a direct way to treat elevated Lp(a).
What to do if your Lp(a) is high
So if you can't lower Lp(a) directly, what's the point of knowing your level? It's to better understand your risk.
Lp(a) is a risk marker, not a direct treatment target. An elevated Lp(a) doesn't mean something is immediately wrong. Rather, it signals that your baseline cardiovascular risk may be higher than average. And that makes it even more important to optimize the factors you can control.
If your Lp(a) is elevated, the focus shifts to aggressively managing your modifiable risk factors:
- Lower your LDL cholesterol: Since you can't change your Lp(a), reducing LDL becomes even more critical (often lower than standard targets).
- Prioritize a fiber-rich, heart-healthy diet: Soluble fiber helps lower LDL cholesterol, and a Mediterranean-style eating pattern has strong evidence for cardiovascular protection.
- Stay physically active: Regular exercise supports healthy blood pressure, blood sugar, and cholesterol levels.
- Manage your blood pressure: As hypertension compounds cardiovascular risk, keeping it in check is essential.
- Work with a provider on a personalized prevention plan. This might include more frequent monitoring, earlier intervention with medications, or additional testing like a coronary calcium score.
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The benefits of widespread testing
The benefits of widespread testing
Knowing your Lp(a) level allows for earlier, more targeted intervention. It helps you and your healthcare provider make more informed decisions about prevention strategies, medication timing, and monitoring frequency.
This is a very proactive approach to healthcare and better than the alternative of waiting for a cardiovascular event to reveal hidden risk.
The takeaway
Knowing your level gives you valuable information about your baseline cardiovascular risk, helping you take smarter, earlier action on the things that are within your control.
If you've never had your Lp(a) tested, consider asking your doctor about it at your next visit. It's an easy blood test that could reveal an important piece of your heart health puzzle, and help you build a more personalized prevention plan for the years ahead.