Lipoprotein(a) is an inherited blood fat that can raise your risk of heart attack and stroke, and a standard cholesterol test misses it. Here is who should get checked.
You walk the dog, you have cut back on the bacon and your last cholesterol result was fine. Then you remember your dad had his heart attack at 52, and you wonder whether any of the effort counts for much.
It does count. But there may also be a blood fat called lipoprotein(a), or Lp(a), that runs in your family and that your routine tests never measured. It is worth knowing about, mainly because what you do with the answer can change.
Lp(a) is a lipoprotein, one of the particles your liver makes to carry fats around the bloodstream. It is closely related to LDL, the so-called bad cholesterol, but it has an extra protein attached that seems to make it worse company for your arteries.
The British Heart Foundation says high levels of Lp(a) can raise your risk of cardiovascular disease, including heart attack and stroke. High Lp(a) is also linked to narrowing of the aortic valve, the main exit door from the heart, which matters more the older you get.
The awkward part is that your level is mostly set by your genes. You inherit it from your parents, and it stays fairly stable through adult life. Around one in five people are thought to have raised levels, and most have no idea, because high Lp(a) causes no symptoms.
So the lean marathon runner can have a high level and the bloke who lives on pies can have a low one. Lp(a) doesn’t care how virtuous you are.
A standard NHS lipid test measures total cholesterol, HDL, LDL (or non-HDL) and triglycerides. Lp(a) needs its own test. It is still an ordinary blood sample taken from a vein in your arm, but the lab has to be asked to run it.
The NHS Health Check, offered free to adults aged 40 to 74 in England every five years, checks your cholesterol but not Lp(a). Scotland, Wales and Northern Ireland don’t run the same programme, so if you live there, your GP practice is the place to ask about heart risk checks. The QRISK3 score your GP uses to estimate your 10-year risk of heart disease doesn’t include Lp(a) either.
There is also the question of units. HEART UK, the cholesterol charity, recommends that labs report Lp(a) in nanomoles per litre (nmol/L). Some still use milligrams per decilitre (mg/dL). The two can’t be reliably converted, so if you get a result, check which unit it is in before you compare it with anything you read online.
Lp(a) isn’t tested routinely in general practice. Some NHS labs offer it to GPs. Elsewhere it goes through specialist lipid clinics, and HEART UK notes that in England GPs can use an advice and guidance request to a specialist before ordering it.
HEART UK recommends testing adults in these groups:
People who have had heart or circulatory disease at a young age themselves, or who have a close relative who did. Premature usually means before 55 in a man or before 65 in a woman.
People whose parent, sibling or child has been found to have a very high Lp(a), above 200 nmol/L.
People with familial hypercholesterolaemia, the inherited form of very high cholesterol.
People with calcific aortic valve stenosis.
People whose 10-year heart risk sits just below the level where statins would usually be offered. Here an Lp(a) result can help decide whether treatment makes sense.
The UK and Ireland’s National Clinical Guideline for Stroke also says doctors should consider testing people under 60 who have had a stroke or mini-stroke caused by furred arteries.
NICE’s main guideline on assessing and reducing heart risk, NG238, doesn’t yet include specific recommendations on Lp(a), and specialists are campaigning for that to change. In practice, whether you get tested depends on your history and your GP. The family history is your best argument, so go armed with details: who it was, what happened and how old they were.
You can’t change the hand you were dealt, but a high Lp(a) result tells you to play the rest of your cards much more carefully.
This is where people get deflated, because there is currently no licensed medicine designed specifically to lower Lp(a). Diet and exercise barely move it, and statins don’t bring it down in any meaningful way.
That doesn’t make the result useless. Specialists writing in the British Journal of Cardiology say the main response to high Lp(a) is to tackle every other risk factor more firmly. Your overall risk is what counts, and you can do plenty about most of it.
In practice, that can mean:
Lowering LDL harder. Your GP may weigh up a statin or other cholesterol-lowering treatment sooner than they otherwise would. That is a conversation to have with them, not a decision to make from an article.
Getting your blood pressure right. Check it regularly, at a pharmacy or with a validated home monitor.
Stopping smoking, if you still do. Free NHS stop smoking services are available across the UK.
Keeping your weight and waist in check. Even losing half a stone (about 3kg) can help your blood pressure and blood sugar.
Moving most days and keeping alcohol within the UK Chief Medical Officers’ guideline of no more than 14 units a week.
There is a family angle too. Lp(a) is inherited, so a high result in you means your brothers, sisters and children may be worth testing. That might be the most useful thing to come out of your blood test.
If you ever get chest pain, sudden breathlessness or signs of a stroke, such as a drooping face, a weak arm or slurred speech, call 999. For anything worrying that is less urgent, contact NHS 111 or your GP.
There are several, and they lower Lp(a) dramatically in trials. The harder question is whether that prevents heart attacks and strokes.
The first large outcome trial, Lp(a)HORIZON, tested a drug called pelacarsen in more than 8,000 people with existing heart disease and high Lp(a). The early headline results showed it cut Lp(a) levels but did not significantly reduce major heart events across the whole trial group. Researchers are still working through the full data. Other drugs that work in different ways are still in their own trials.
Put plainly, an Lp(a) pill or jab is not around the corner for most people, and it isn’t certain one will work. What you can act on today is knowing your number and managing the risks you can control.
Lp(a) is an inherited blood fat that raises your risk of heart attack, stroke and aortic valve disease. A routine cholesterol test or NHS Health Check won’t measure it. If heart disease struck someone in your family early, ask your GP whether an Lp(a) test is right for you. There is no specific treatment yet, but a high result is a strong reason to work harder on your cholesterol, blood pressure and lifestyle, and to tell your relatives.
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