What it means
Lipoprotein(a) is an LDL particle with an extra protein, apolipoprotein(a), bolted on. The apo(a) protein resembles plasminogen, so Lp(a) is both atherogenic (it carries ApoB and cholesterol into the artery wall) and pro-thrombotic and pro-inflammatory. Its level is more than 90% genetic, set by the LPA gene, and stable across life.
About 20% of people have levels above 50 mg/dL (roughly 125 nmol/L), the threshold at which risk rises clearly.
Why it matters for longevity
High Lp(a) roughly doubles heart-attack risk and is the main cause of calcific aortic stenosis — independently of LDL cholesterol. Because it is inherited, it explains many of the heart attacks in fit, lean people with "good cholesterol" and a family history. Knowing it changes how aggressively everything else should be managed.
What the evidence says
Mendelian randomisation and large cohorts (Copenhagen General Population Study, UK Biobank) show a continuous, causal relationship between Lp(a) and coronary disease, stroke and aortic stenosis. The 2022 European Atherosclerosis Society consensus recommends every adult be tested at least once.
Statins do not lower Lp(a) (they may raise it slightly); PCSK9 inhibitors lower it by 20–25%; niacin lowers it but without outcome benefit. Dedicated drugs — the antisense oligonucleotide pelacarsen and the siRNAs olpasiran and lepodisiran — lower it by 80–95%, and the first outcome trial (HORIZON) is expected to report in 2025–2026.
How to measure or use it
- A single blood test, ideally reported in nmol/L (the particle count); above 125 nmol/L or 50 mg/dL is high.
- Because it is genetic, one test is enough unless a drug is started; children of a high-Lp(a) parent should be tested too.
- If high: lower every other risk factor harder — ApoB, blood pressure, HbA1c, hs-CRP — and discuss a coronary calcium score and the new drugs with a physician.
Related
- Biomarkers of ageing — where Lp(a) sits in the panel
- Baseline labs — the once-only tests
- Metabolic health — the modifiable risk factors to lower instead
Frequently asked questions
Can I lower Lp(a) with diet or exercise?
Barely. It is more than 90% genetic. Lifestyle lowers the other risk factors, which is the current strategy.
How often should I test it?
Once. It is stable across life unless a drug that affects it is started.
What drugs lower Lp(a)?
PCSK9 inhibitors by 20–25%; the new antisense and siRNA drugs by 80–95%, with outcome trials reporting from 2025.
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