Lipoprotein(a): an inherited cardiovascular risk factor worth knowing

When people talk about cholesterol, they usually think of LDL, the so-called “bad cholesterol”. There is, however, another much lesser-known particle, lipoprotein(a) or Lp(a), which also affects the health of the heart and arteries. Its level is determined almost entirely by inheritance, so it can be high in people with healthy habits and an otherwise normal blood test.

A particle similar to LDL cholesterol, with a component of its own

Lipoprotein(a) has a structure very similar to that of LDL cholesterol, but it carries an additional protein, apolipoprotein(a). This difference gives it a particular behaviour: it promotes the deposit of cholesterol in the artery wall, tends to favour the formation of blood clots and is linked to calcification of the aortic valve. For this reason, the European societies of Cardiology and Atherosclerosis regard it as a causal factor in cardiovascular disease and aortic stenosis.

A level that is inherited and stays stable

More than 90% of the Lp(a) level depends on genetics. It is inherited from the parents, is reached in childhood and hardly changes throughout life. Unlike LDL cholesterol, it is not significantly modified by diet or exercise. It is estimated that roughly one in five people has raised values, in most cases without knowing it.

Why measuring it once is enough

As it is a stable value, the European dyslipidaemia guidelines, updated in 2025, recommend measuring Lp(a) at least once in every adult’s lifetime. It is determined with a standard blood test. Above 50 mg/dL (about 105 nmol/L), cardiovascular risk increases, and it does so progressively the higher the value is. Bear in mind that each laboratory may report the result in one of these two units, which are not directly interchangeable.

Measurement is especially useful in these situations:

• a family history of heart attack or stroke at an early age;
• familial hypercholesterolaemia;
• cardiovascular disease with no clear cause to explain it;
• close relatives with raised Lp(a).

What can be done if it is raised

At present there is no drug specifically approved to lower lipoprotein(a). Knowing the value, however, changes how each person’s risk is approached. When Lp(a) is high, the aim becomes to reduce overall cardiovascular risk more rigorously:

• stricter control of LDL cholesterol;
• monitoring blood pressure and glucose;
• maintaining a healthy weight and regular physical activity;
• avoiding tobacco entirely.

Healthy habits do not lower Lp(a), but they do reduce total risk, which is what ultimately matters. Given its hereditary nature, it may also be advisable for first-degree relatives to have it measured.

A line of research still evolving

Several drugs capable of reducing Lp(a) by more than 80% are in development. In September 2026 the first results were announced of the large trial of pelacarsen, the most advanced of them. The drug lowered Lp(a) but did not reduce the combined rate of cardiovascular death, heart attack, stroke and urgent revascularisation compared with placebo. Results from other ongoing trials are still to come.

In the meantime, the most effective step remains identifying people with raised Lp(a) and rigorously controlling the other risk factors.

The assessment at UMA

In the Cardiology and Cardiovascular Prevention consultation at Unidad Médica Angloamericana, the Lp(a) result is not interpreted in isolation. It is assessed together with family history, lipid profile and each patient’s other risk factors, in order to define the most appropriate follow-up precisely.

Article written by Dr. Leopoldo Pérez de Isla and Dr. Adriana Saltijeral Cerezo, Cardiology specialists at Unidad Médica Angloamericana.