Lp(a) is a cholesterol-carrying particle whose level is mostly inherited, and the 2026 ACC/AHA guideline says every adult should have it measured at least once. A level of 125 nmol/L (50 mg/dL) or more raises heart risk by about 40%, and it isn't part of a standard cholesterol test, so most people have to ask for it.
The short version
Lp(a) is an LDL-like particle set mostly by your genes. One test is usually enough. Under the 2026 US guideline, 125 nmol/L (50 mg/dL) or more is a risk enhancer and 250 nmol/L (100 mg/dL) or more roughly doubles risk. Diet doesn't change it much, but a high result is a reason to push harder on LDL and other risk factors, and for close relatives to get tested. Ask your doctor or GP to add it to your next blood test.
This is general information, not medical advice
A high Lp(a) doesn't mean you have heart disease. What it means for you depends on the rest of your risk profile, which your doctor will look at. Don't start or change any medicine because of a single result.
What Lp(a) is
Lipoprotein(a), usually written Lp(a) and said "L-P-little-a", is a particle that looks like LDL with an extra protein called apolipoprotein(a) attached. Like LDL, it can lodge in artery walls and contribute to plaque. The 2026 guideline also notes it has pro-inflammatory effects, and high levels are linked to calcific aortic valve disease, where the valve leading out of the heart stiffens and narrows.
What makes Lp(a) different from LDL is that your level is mostly decided by your genes. It's fairly stable through adult life, and food and exercise barely move it. That's why a single test gives you most of the information you need, and why it often runs in families.
Because standard cholesterol tests don't measure it, someone can have a healthy LDL, a good HDL and still carry a high Lp(a) without knowing. That's one reason heart disease sometimes appears in people whose cholesterol looked fine. (If your LDL is high but HDL is good, see what that combination means.)
The 2026 recommendation: test every adult once
The 2026 ACC/AHA dyslipidemia guideline gives its strongest level of recommendation to measuring Lp(a) at least once in every adult to identify people at higher risk. It also supports cascade testing: when someone has a high result, their parents, siblings and children are tested too, especially where there's a personal or family history of early heart disease.
The guideline isn't alone. The European Atherosclerosis Society recommended testing Lp(a) at least once in adults in 2022, and the US National Lipid Association also recommends testing in all adults.
What your result means
Risk rises steadily with Lp(a): there's no single cut-off where it suddenly becomes dangerous. The guideline gives this table, compared with a typical (median) level of about 20 nmol/L (7 mg/dL):
| Lp(a) level | Approximate risk vs typical | How common |
|---|---|---|
| Under 75 nmol/L (under 30 mg/dL) | Reference level | Most people |
| 75 to 124 nmol/L (30 to 49 mg/dL) | About 1.2 times | |
| 125 nmol/L (50 mg/dL) | About 1.4 times: counts as a risk-enhancing factor | About 1 in 5 people are at or above this |
| 250 nmol/L (100 mg/dL) | About 2 times | About 1 in 20 |
| 350 nmol/L (150 mg/dL) | About 3 times | |
| 430 nmol/L (180 mg/dL) | About 4 times, similar to inherited high cholesterol (familial hypercholesterolaemia) | About 1 in 100 |
The "how common" column comes from the percentiles the guideline gives (about the 80th, 95th and 99th). The guideline says these figures are a general guide and may differ between populations; in some, twice the risk has been seen at 200 nmol/L. It also suggests a repeat test can be considered if your result is close to a threshold.
nmol/L or mg/dL?
Labs report Lp(a) in one of two units. nmol/L counts the number of particles. mg/dL measures their weight. Lp(a) particles vary in size from person to person, so there's no exact conversion between the two. The guideline pairs 125 nmol/L with 50 mg/dL and 250 nmol/L with 100 mg/dL, but describes these as approximate. The practical rule: compare your result with the threshold in the same unit your lab used, and don't run it through a standard cholesterol converter. (Our unit converter is for LDL, HDL, total cholesterol and triglycerides, which do convert exactly.)
What you can and can't change
What you can't easily change
The Lp(a) level itself. Diet and exercise barely affect it, and the guideline doesn't recommend supplements for lowering cholesterol. As of October 2026, no medicine is approved specifically to lower Lp(a). In September 2026, the first large heart-outcome trial of a drug designed to lower Lp(a) to report (pelacarsen, in the Lp(a)HORIZON trial) found that it lowered Lp(a) but didn't reduce heart attacks and strokes, according to the top-line results; the full results hadn't been published at the time of writing. Other drugs, including olpasiran, lepodisiran and muvalaplin, are still in trials.
What you can change
Your overall risk. For anyone with Lp(a) of 125 nmol/L (50 mg/dL) or more, the 2026 guideline recommends early, thorough control of every risk factor you can change. Its take-home message is that a high Lp(a) should mean more intensive LDL lowering. In practice that means:
- LDL and non-HDL cholesterol: aim lower than you otherwise might. HEART UK suggests a non-HDL below 2.5 mmol/L (about 100 mg/dL) for people with raised Lp(a). Diet helps here: see how much each diet change lowers LDL and the Portfolio Diet.
- Blood pressure, blood sugar, weight and smoking: each adds to the risk Lp(a) brings, and each can be improved.
- Medicine where appropriate: a high Lp(a) can tip the decision towards starting a statin. For people who already have heart or artery disease, a high Lp(a) and an LDL still above goal on a statin, the guideline recommends adding a PCSK9 inhibitor. In rare cases of very high Lp(a) with worsening heart disease, a specialist blood-filtering treatment called lipoprotein apheresis is an option.
How to ask for the test
In the US
- Ask your doctor to add "lipoprotein(a)" to your next blood test order. It's a separate test from the standard lipid panel, but it's an ordinary blood test.
- You can mention that the 2026 ACC/AHA guideline recommends it once for every adult.
- Check with your insurer about cover if you're unsure.
- When you get the result, note the unit (nmol/L or mg/dL) and compare it with the matching threshold.
In the UK (NHS)
- Lp(a) isn't part of a standard NHS cholesterol check, and NICE's lipid guideline (NG238) doesn't cover it, so availability varies.
- HEART UK recommends testing adults who have a personal or family history of early heart disease, a close relative with Lp(a) over 200 nmol/L, familial hypercholesterolaemia, narrowing of the aortic valve, or a borderline 10-year risk score (under 15%). If any of these apply, tell your GP.
- Ask whether a referral to a lipid clinic would be useful if your result is high or your family history is strong.
If your result is high
- Don't panic. About one in five people have a level above the risk-enhancer threshold. It's a risk factor, not a diagnosis.
- Tell your close relatives. Parents, brothers, sisters and children have a good chance of sharing it, and the guideline supports testing them.
- Work on what you can change. Ask your doctor what LDL or non-HDL goal makes sense for you now, and how often to re-check it.
- Keep the result. Because it rarely changes, this one number will matter for years. Store it with your other results.
Questions to take to your appointment
- Have I ever had Lp(a) measured? Can it be added to my next blood test?
- Was my result in nmol/L or mg/dL, and where does it sit against the guideline thresholds?
- Given my Lp(a), should my LDL or non-HDL goal be lower?
- Should my family members be tested?
- Would a referral to a lipid specialist help?
Sources
- Blumenthal RS, Morris PB, et al. 2026 ACC/AHA Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026;87(19). Also in Circulation, doi:10.1161/CIR.0000000000001423. Sections 3.4 and 4.2.10, Table 4.
- Kronenberg F, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43:3925–3946.
- Cegla J, et al. HEART UK consensus statement on Lipoprotein(a): a call to action. Atherosclerosis. 2019;291:62–70.
- National Lipid Association: Top-line results from the phase 3 Lp(a)HORIZON trial (September 2026).
- NICE NG238: Cardiovascular disease risk assessment and reduction, including lipid modification
Frequently asked questions
What is Lp(a)?
Lp(a), or lipoprotein(a), is an LDL-like particle with an extra protein, apolipoprotein(a), attached. Like LDL, it can build up in artery walls, and it's also linked to narrowing of the aortic heart valve. Its level is mostly set by your genes, so it stays fairly stable through life.
Should everyone get an Lp(a) test?
The 2026 ACC/AHA guideline recommends measuring Lp(a) at least once in every adult, and the European Atherosclerosis Society made the same recommendation in 2022. In the UK, HEART UK recommends testing people with a personal or family history of early heart disease, familial hypercholesterolaemia, a close relative with high Lp(a), aortic valve narrowing, or a borderline heart-risk score.
What is a high Lp(a) level?
Under the 2026 ACC/AHA guideline, 125 nmol/L (50 mg/dL) or more is a risk-enhancing factor, linked to about 1.4 times the risk of heart attack and stroke compared with the typical level of about 20 nmol/L. 250 nmol/L (100 mg/dL) or more is linked to about twice the risk, and 430 nmol/L (180 mg/dL) to about four times.
How do I convert Lp(a) from mg/dL to nmol/L?
There's no exact conversion. nmol/L counts particles and mg/dL weighs them, and Lp(a) particles vary in size from person to person. The guideline pairs 125 nmol/L with 50 mg/dL and 250 nmol/L with 100 mg/dL, but calls these equivalences approximate. Compare your result with a threshold in the same unit your lab used.
Can you lower Lp(a) with diet or exercise?
Not meaningfully. Lp(a) is mostly inherited, and diet and exercise barely change it. What you can change is your overall risk: the 2026 guideline recommends early, thorough control of LDL, blood pressure, blood sugar, smoking and weight in anyone with high Lp(a). As of October 2026, no medicine is approved specifically to lower Lp(a); several are being tested in large trials.
Does the NHS test for Lp(a)?
It isn't part of a standard NHS cholesterol check, and NICE's lipid guidance doesn't cover it. You can ask your GP, especially if you have a family history of early heart disease or very high cholesterol, which are among the groups HEART UK says should be tested.
Keep your Lp(a) result with the rest of your numbers
Lp(a) rarely changes, so the one result you get will matter for years. Heart Tracker charts your total cholesterol, LDL, HDL and triglycerides over time, so you can see whether you're bringing LDL down to a goal set with your Lp(a) in mind. Free, with no account needed.
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