Lp(a): the cholesterol test you take once, and what a high value means

You can have perfectly good cholesterol results and still be missing an important piece of the picture.

That is because a standard cholesterol test does not measure Lp(a), or lipoprotein(a). Lp(a) is a cholesterol-carrying particle that is similar to LDL and is associated with cardiovascular disease. The important difference is that your Lp(a) level is largely genetic. Unlike LDL cholesterol, you cannot substantially lower Lipoprotein (a) with diet, exercise, or weight loss.

This is also why Lp(a) is usually a once-in-a-lifetime test. Your level tends to stay fairly stable over time, so if it is low, there is generally no reason to keep checking it. If it is high, however, it gives you useful information about your cardiovascular risk that you would not get from a standard cholesterol panel.

What do we know about the risk?

A recent systematic review and meta-analysis looked at 22 cohort and registry studies published between 2016 and 2026, involving more than 580,000 people. Thirteen of the studies had data that could be combined.

Overall, people with the highest Lp(a) levels had around a 61% higher risk of a major cardiovascular event than people in the comparison groups. The outcomes included heart attack, ischaemic stroke, heart failure, peripheral artery disease, aortic valve stenosis and cardiovascular death.

That number needs some context. A 61% increase is a relative increase, not a 61% chance of having a cardiovascular event. The actual difference in risk depends on your starting risk and on other factors such as your age, blood pressure, LDL cholesterol, diabetes, and smoking history.

The study also cannot prove that Lp(a) itself caused these events. The researchers used observational studies, which can show an association but cannot establish cause and effect on their own. They noted that separate genetic evidence supports a causal role for Lp(a) and these study results.

So what do you do if yours is high?

There is not much you can do to lower Lp(a) through lifestyle. The result is still useful information. If you know that your Lp(a) is high, you and your doctor can take the rest of your cardiovascular risk factors into account more carefully.

That might mean paying particular attention to LDL cholesterol and blood pressure, as well as blood sugar, smoking, physical activity, and family history. A high Lp(a) result does not mean you have heart disease or that you will develop it. It is simply another factor to consider when looking at your overall risk.

Family history can be particularly relevant. If close relatives have had cardiovascular disease at a young age, knowing your Lp(a) level may provide useful additional information.

One number, but not the whole story

The study had some limitations. The studies included in the review differed considerably in how they defined high Lp(a), which units they used and which cardiovascular outcomes they measured. Results also varied between studies, and three of the 22 studies were considered to be low quality.

For these reasons, the 61% figure should not be interpreted as a precise increase in risk that applies to everyone with a high Lp(a). The review also does not establish one universal cut-off or tell us which treatment should be used when Lp(a) is elevated.

What it does reinforce is something fairly simple: a normal cholesterol panel does not tell you everything about cardiovascular risk. For Lp(a), one blood test can be enough to find out whether you have an inherited risk factor that you otherwise might never know about.

At Wellth, you can select the tests you want to order - and order them yourself. Our recommendation is still: you probably only need to test lipoprotein (a) once.

Source: Shiha JK et al., Lipoprotein(a) as a Predictor of Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies (2016–2026), Cureus, 2026. pubmed.ncbi.nlm.nih.gov/42764843/