Lipoprotein(a) Levels Explained: Lp(a) and Heart Risk

Lipoprotein(a), usually shortened to Lp(a) and said "L-P-little-a", is a particle that carries cholesterol in your blood. It is similar to LDL cholesterol but has an extra protein attached. A raised Lp(a) level is linked with a higher risk of heart attack, stroke and narrowing of the aortic valve, and it is set mainly by the genes you inherit.

Because it is not part of a standard cholesterol test, many people with a raised level never find out. This guide explains the risk bands HEART UK uses, why most people only need one test in their lifetime, who should consider testing, and what you can do if your level is high.

Test it in Chiswick: our Lipoprotein (a) blood test costs £69, with your result explained in person by a practitioner. No GP referral needed. Book this test or call 020 4515 0000. Prefer to test at home? A home finger-prick kit is also available, ask us when you enquire.

Quick answer

HEART UK measures Lp(a) in nmol/L and groups the risk as: 32 to 90 nmol/L minor, 90 to 200 moderate, 200 to 400 high, and above 400 very high. A level above 90 nmol/L is considered raised, and NHS laboratory guidance puts this at about the top 20% of the population. Lp(a) is mainly inherited and stays fairly stable through life, so most people only need it checked once. Statins and lifestyle changes do not lower Lp(a) much, but they reduce your overall heart risk.

What is lipoprotein(a)?

Lp(a) is a type of lipoprotein, a package that carries fats such as cholesterol around the body. HEART UK explains that the amount of Lp(a) in your blood is determined by your genes, and that ethnic background can affect levels. Unlike LDL cholesterol, diet and exercise usually make little difference to it.

A raised Lp(a) adds to your risk from other factors such as high LDL cholesterol, smoking, high blood pressure and diabetes. That is why a high result is a reason to look carefully at your whole heart health rather than a cause for alarm on its own.

What your Lp(a) result means

Lp(a) can be reported in nmol/L, mg/dL or mg/L, and the same number means very different things in different units. Always check the unit and range on your report. Using the HEART UK bands in nmol/L:

• Below 90 nmol/L (minor): little extra risk from Lp(a). HEART UK describes 32 to 90 nmol/L as minor risk.
• 90 to 200 nmol/L (moderate): raised. Worth reviewing your other heart risk factors with your GP or practitioner.
• 200 to 400 nmol/L (high): a significant extra risk. NHS guidance suggests tighter control of LDL cholesterol for many people at this level.
• Above 400 nmol/L (very high): NHS laboratory guidance notes the heart risk is similar to that seen in inherited familial hypercholesterolaemia.

Converting mg/dL to nmol/L

If your result is in mg/dL, you cannot convert it exactly, because Lp(a) particles vary in size between people. NHS laboratory guidance from University Hospitals Bristol and Weston notes that results in nmol/L are roughly 2.4 times higher than in mg/dL. HEART UK recommends that Lp(a) is measured in nmol/L.

Symptoms

A high Lp(a) level does not cause symptoms. Many people only find out after a heart attack or stroke, or when a relative is diagnosed. The only way to know your level is a blood test.

Who should have an Lp(a) test?

HEART UK suggests Lp(a) testing for:

• people with heart or circulation disease that started before the age of 60, or a family history of it
• parents, brothers, sisters and children of someone with an Lp(a) above 200 nmol/L
• people with familial hypercholesterolaemia or another inherited cholesterol condition
• people with calcific aortic valve disease, or a family history of it
• people whose heart risk score is borderline, where knowing Lp(a) could change treatment

Some NHS lipid guidance goes further and suggests measuring Lp(a) at least once in all adults, usually with their first full cholesterol test.

Why you usually only need one test

Because Lp(a) is mainly set by your genes, levels stay largely stable through adult life. HEART UK says most people will not need to have it checked again. Your practitioner will tell you if a repeat test would be useful in your case.

What to do if your Lp(a) is high

HEART UK describes medicines that specifically target Lp(a) as still being studied, so for now the focus is on reducing your overall risk of heart disease and stroke:

• Know your other numbers: check your full cholesterol profile, blood pressure and blood sugar.
• Lower LDL and non-HDL cholesterol: HEART UK suggests targets of LDL below 1.8 mmol/L and non-HDL below 2.5 mmol/L for higher risk people. Statins do not lower Lp(a), but they lower LDL cholesterol and overall risk.
• Healthy lifestyle: stop smoking, stay active, eat a balanced diet and keep a healthy weight.
• Tell your family: close relatives may wish to be tested, because raised Lp(a) runs in families.

HEART UK notes that some specialist treatments, such as lipoprotein apheresis, are used for a small number of people with recurring heart disease, and that new medicines that lower Lp(a) are being studied in clinical trials.

When to see a GP or get urgent help

See your GP if your Lp(a) is above 90 nmol/L, especially if you also have high cholesterol, high blood pressure, diabetes, or a family history of early heart disease or stroke. Your GP can assess your overall risk and discuss treatment.

Call 999 if you have chest pain that feels tight or squeezing, chest pain spreading to your arms, neck or jaw, or severe difficulty breathing. These can be signs of a heart attack. Do not drive yourself to A&E.

Preparing for your test

Lp(a) is a simple blood test. Because it is mostly inherited and stable, the timing of the test matters less than for many other markers. If you are having Lp(a) checked at the same time as other tests that need fasting, we will let you know when you book. Tell your practitioner about any cholesterol medicines you take.

Frequently asked questions

Is an Lp(a) of 100 nmol/L high?

Yes, it is raised. HEART UK places 90 to 200 nmol/L in the moderate risk band. It is a good reason to review your cholesterol, blood pressure and other risk factors with a practitioner or GP.

What is a normal Lp(a) level?

Below 90 nmol/L is generally regarded as minor risk, with HEART UK describing 32 to 90 nmol/L as minor. About 4 in 5 people have a level below 90 nmol/L.

Can I lower my Lp(a) naturally?

Diet and lifestyle usually make little difference to Lp(a) itself. They are still important, because they lower your overall risk of heart disease and stroke.

Is Lp(a) included in a standard cholesterol test?

No. A standard cholesterol test measures total, LDL and HDL cholesterol and triglycerides. Lp(a) needs to be requested separately or as part of a wider heart panel.

Should my children be tested?

HEART UK suggests testing the children, parents, brothers and sisters of people with an Lp(a) above 200 nmol/L. Talk to your GP about the right time to test children.

Lp(a) testing in Chiswick

We take your blood sample at our clinic at 8 to 9 Bedford Corner, The Avenue, Chiswick, London W4 1LZ, a short walk from Turnham Green station on the District line (Piccadilly line trains stop there early morning and late evening only), and on the 94, E3 and 272 bus routes. Limited parking is available on request when you book. Your sample is analysed at the Randox accredited laboratory, most results are back within a few working days, and a practitioner talks you through what your result means. No GP referral is needed, and we can send a GP feedback report on request.

Book a single Lipoprotein (a) blood test, or see Lp(a) alongside your cholesterol, apolipoproteins and inflammation markers in our Metabolic Health Extended panel. You can also explore our heart health blood tests, compare every blood test and price, or read our guides to cholesterol levels and triglyceride levels.

This article is general information, not medical advice. Discuss your results with your GP or practitioner.