Lipoprotein (a) Test - More Information

The lipoprotein (a) test, also known as an Lp(a) test, Lp(a) blood test and lipoprotein (a) lab test, measures the Lp(a) blood level. Through Accesa Labs, people can order a lipoprotein (a) test online, get tested at a local lab, and get electronic results, typically within a few business days.

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What Is Lipoprotein(a)?

Lipoprotein(a), sometimes abbreviated as Lp(a), is a type of lipoprotein particle that carries cholesterol through the bloodstream. It is structurally similar to LDL cholesterol (the so-called "bad cholesterol") but has an additional protein called apolipoprotein(a), or apo(a), attached to it. This extra protein is thought to make Lp(a) more likely to promote the build up of plaque in arterial walls and to contribute to blood clot formation. Elevated Lp(a) is thought to be an independent risk factor for cardiovascular disease meaning that it raises the risk of heart attack, stroke, and aortic valve disease. This can be true even for people whose other standard lipid panel values are in the normal range. As such, lipoprotein (a) might help identify a cardiovascular risk profile that is distinct from LDL cholesterol.

What makes Lp(a) particularly important is its genetic basis. Unlike LDL cholesterol, which responds meaningfully to diet, exercise, and some medications, Lp(a) levels are determined largely by genetics. Lp(a) levels are thought to be largely fixed, do not respond significantly to lifestyle modification, and are not lowered by statins. This means that measuring Lp(a) provides cardiovascular risk information that adds to the information provided by a standard lipid panel.

Who Should Get an Lp(a) Test?

Major cardiovascular organizations generally recommend that every adult have their Lp(a) measured at least once. Specific groups for whom Lp(a) testing is particularly important include:

Adults with a personal or family history of premature cardiovascular disease. Premature cardiovascular disease, sometimes defined as a heart attack, stroke, or coronary artery disease diagnosis before age 55 in men or age 65 in women, is a strong indicator that inherited factors such as elevated Lp(a) may be involved. People with a first-degree relative who experienced a premature cardiovascular event should consider Lp(a) testing regardless of their own cholesterol levels.

People with high LDL cholesterol or a family history of it. Elevated Lp(a) is particularly common among people with familial hypercholesterolemia (FH) - an inherited condition that causes very high LDL cholesterol. Lp(a) testing is recommended as part of the workup for anyone diagnosed with FH.

People who have had a heart attack, stroke, or aortic valve disease without an obvious cause. People who have experienced cardiovascular events despite well-managed cholesterol levels should be evaluated for elevated Lp(a) as a potential explanation.

People who want a more complete cardiovascular risk picture. Many people with "normal" lipid panels carry elevated Lp(a) and are unaware of it. Because Lp(a) is not included in a standard lipid panel, anyone who wants a complete assessment of their cardiovascular risk should consider adding an Lp(a) test.

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Getting a Lipoprotein (a) Test

General Lp(a) blood testing is recommended for anyone who wants to check one marker correlated with cardiac disease risk. Additionally, people who have a family history of cardiovascular disease, high cholesterol, a history of heart surgery or stents, or early heart disease should be checked. For a more detailed look at their cardiovascular risk profile, the Lp(a) testing is often ordered with the CRP test, homocysteine test and either the lipid panel test or the more detailed Cardio IQ test panel.

To get an lipoprotein (a) test near you, simply order online and get tested at a local lab. Once you get your blood drawn at the Quest Diagnostics lab location, your Lp(a) lab results will be available electronically relatively quickly. As can be seen on the lipoprotein(a) sample report link above, your Lp(a) results will be reported as a numerical result in nmol/L. The lab will also report a reference range based on the lab equipment used for processing the sample. In this sample report, the range is <75 nmol/L which is a fairly standard target for Lp(a) levels.

Understanding Lp(a) Test Results

Lp(a) can be reported in two different units - nmol/L (nanomoles per liter) and mg/dL (milligrams per deciliter). Most current cardiovascular guidelines prefer nmol/L as it measures particle number directly and is less affected by particle size variation. Testing through Accesa Labs reports Lp(a) test results in nmol/L.

*Adapted from Curr Cardiovasc Risk Rep. 2025 Feb 18;19(1):8

The threshold of 125 nmol/L is widely used in clinical guidelines from multiple medical societies as the level at which Lp(a) is considered a significant, actionable cardiovascular risk factor.

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The Genetics of Lp(a)

Lp(a) levels are thought to be almost entirely genetically determined. The gene encoding apolipoprotein(a) is inherited from both parents and an individual's Lp(a) level is determined by which variants of this gene they carry. Unlike most cardiovascular risk factors, Lp(a) cannot be meaningfully changed through diet, exercise, weight loss, or most existing medications.

This genetic basis has several important implications:

Lp(a) does not require repeated monitoring. Because levels are thought to change little over a lifetime in the absence of specific Lp(a)-lowering therapy, major cardiovascular societies recommend measuring Lp(a) once to establish a person's Lp(a) risk category.

Family members share risk. If one person in a family is found to have a significantly elevated Lp(a) level, first-degree relatives have a higher chance of also having elevated levels. Cascade testing of family members is a standard recommendation when markedly elevated Lp(a) is discovered.

Elevated Lp(a) is common. Approximately 1 in 5 people globally have Lp(a) levels elevated enough to increase their cardiovascular risk. Many of these people are unaware because Lp(a) is not part of a standard lipid panel and has historically not been checked as part of routine lab testing.

Lp(a) vs. LDL Cholesterol - What Is the Difference?

LDL cholesterol and Lp(a) are both lipoproteins that carry cholesterol and both contribute to cardiovascular disease risk. However, they differ in important ways.

LDL cholesterol is influenced substantially by diet and lifestyle. Most people with high LDL can bring their levels into a healthier range through a combination of diet, exercise, and medication if needed. Lp(a), by contrast, is largely unresponsive to lifestyle changes and most existing lipid-lowering medications. Statins can even paradoxically raise Lp(a) slightly in some patients. This means that a standard lipid profile does not capture Lp(a) risk. A person with well-controlled LDL and a favorable lipid panel can still have an elevated cardiovascular risk profile if their Lp(a) is high.