Do You Know Your Lipoprotein(a) Level? A Hidden Cardiovascular Risk Factor You Should Know About

A Hidden Cardiovascular Risk Factor

Lipoprotein(a), commonly called Lp(a), is an inherited cholesterol-related particle that can increase the risk of atherosclerotic cardiovascular disease (ASCVD), including heart attacks, strokes, and aortic valve disease. Unlike traditional cholesterol measurements, Lp(a) levels are primarily determined by genetics and are not significantly changed by lifestyle alone.

Many people with elevated Lp(a) feel healthy and have normal cholesterol levels, yet they may have an increased lifetime risk of cardiovascular disease. Knowing your Lp(a) level provides important information to better understand your overall cardiovascular risk.

Current Guidelines on Lp(a) Testing

Recent guidelines and expert recommendations from the American College of Cardiology (ACC), American Heart Association (AHA), National Lipid Association (NLA), and European Atherosclerosis Society (EAS) support measuring Lp(a) at least once in an adult's lifetime, particularly for individuals with:

• A family history of premature cardiovascular disease
• Cardiovascular disease occurring earlier than expected
• A personal history of ASCVD without clear risk factors
• Severe hypercholesterolemia
• Recurrent cardiovascular events despite optimal treatment

Why LDL-C Management Remains Essential

Although Lp(a) is an important inherited risk factor, LDL cholesterol (LDL-C) remains one of the most important modifiable causes of cardiovascular disease. Elevated LDL-C and Lp(a) contribute to cholesterol buildup in artery walls, accelerating atherosclerosis.

For individuals with elevated Lp(a), controlling all other cardiovascular risk factors becomes even more important — especially LDL-C. Current ACC/AHA and NLA recommendations emphasize aggressive LDL-C lowering based on overall cardiovascular risk.

How Can Cardiovascular Risk Be Reduced?

While there are currently limited medications specifically approved to lower Lp(a), effective strategies include:

1. Optimize LDL-C Lowering

• Statins remain the foundation of LDL-C reduction therapy
• Additional medications such as ezetimibe, PCSK9 inhibitors, bempedoic acid, and other therapies may be considered for patients who require additional LDL-C lowering

2. Address All Cardiovascular Risk Factors

• Control blood pressure
• Manage diabetes
• Maintain a healthy weight
• Exercise regularly
• Follow a heart-healthy diet
• Avoid tobacco exposure

3. Consider Family Screening

Because Lp(a) is largely inherited, first-degree relatives may benefit from testing, especially when there is a family history of premature cardiovascular disease.

The Future of Lp(a) Treatment

Several targeted therapies designed specifically to lower Lp(a) are currently being studied in clinical trials. Until these therapies become widely available, the best approach is to identify elevated Lp(a) early and aggressively manage modifiable cardiovascular risks, especially LDL-C.

Take Control of Your Cardiovascular Health

Knowing your Lp(a) level can provide valuable insight into your lifetime risk of heart disease. Combined with appropriate LDL-C management and comprehensive risk reduction, Lp(a) testing can help guide a personalized approach to preventing cardiovascular disease.

Ask your healthcare provider: "Do I know my Lipoprotein(a) level?"