Cholesterol: Lp(a), the inherited risk factor

This is general information, not medical advice. Always discuss your blood values with your doctor.

1. 1

   What is it?

   Lp(a) is an LDL-like particle with an extra protein (apo(a)) attached. Its level is more than 90% determined by your genes, stays fairly stable throughout life and barely changes with lifestyle.

2. 2

   Why measure it?

   A high Lp(a) raises cardiovascular risk independently of your LDL, even when that is well controlled. European guidelines recommend having Lp(a) measured at least once in your life, preferably with your first lipid profile. A 2026 American guideline also recommends universal testing.

3. 3

   Which values?

   Below 30 mg/dL (75 nmol/L): lower risk. Between 30 and 50 mg/dL (75 to 125 nmol/L): intermediate. Above 50 mg/dL (about 105 to 125 nmol/L, depending on the conversion): higher risk. The relationship is continuous, there is no magic cut-off. Note: mg/dL and nmol/L are not interchangeable, the guideline prefers nmol/L.

4. 4

   What can you do about it?

   Diet, exercise and weight loss have little or no effect on Lp(a). Neither do statins, ezetimibe and bempedoic acid, and statins may even raise it slightly. PCSK9 inhibitors and inclisiran lower it by about 20 to 30%, but that is secondary to their LDL effect. With a high Lp(a), you tackle the other risk factors more strictly (LDL, blood pressure, smoking), together with your doctor.

5. 5

   New drugs: no proof yet

   Drugs that specifically lower Lp(a) are being tested. In September 2026 the manufacturer reported that pelacarsen, the first with an outcomes trial, did lower Lp(a) but did not significantly reduce cardiovascular events (8,323 patients with cardiovascular disease, topline results, full data to follow). Other trials are still running. Testing remains recommended, but there is no proven treatment yet.

Updated in October 2026