Lipoprotein(a)
Lipoprotein(a), or Lp(a), is a genetically determined variant of LDL that independently increases cardiovascular risk. Levels are 90%+ heritable and largely resistant to lifestyle changes.
Elevated Lp(a) promotes atherosclerosis, thrombosis, and inflammation. It is now recognized as a causal risk factor for coronary artery disease and aortic stenosis.
What It Measures
Concentration of Lp(a) particles in blood, reflecting genetic cardiovascular risk.
Reference Ranges
| Status | Range (nmol/L) |
|---|---|
| Optimal | < 30 nmol/L |
| Normal | 30–50 nmol/L |
| Borderline | 50–75 nmol/L |
| Out of Range | > 75 nmol/L |
Optimal Ranges
| Group | Range | Unit | Source |
|---|---|---|---|
| Low risk | 0–30 | mg/dL | EAS guidelines |
| Borderline | 30–50 | mg/dL | EAS guidelines |
| High risk | 50–999 | mg/dL | EAS guidelines |
When Values Are High
Lp(a) is 90% genetically determined and is an independent cardiovascular risk factor. Elevated Lp(a) increases risk of heart attack, stroke, and aortic stenosis. Unlike LDL-C, Lp(a) is minimally responsive to lifestyle changes.
When Values Are Low
Low Lp(a) is protective. There is no known downside to low Lp(a) levels.
What To Do
Lifestyle
- •Lp(a) is largely genetic — lifestyle has minimal effect
- •Focus on reducing all other modifiable risk factors (LDL, blood pressure, inflammation)
- •Aggressive LDL/ApoB reduction is especially important when Lp(a) is elevated
Supplements
- •Niacin (1–3g/day) can lower Lp(a) by 20–30% but has side effects
- •PCSK9 inhibitors reduce Lp(a) by 20–30%
- •Novel antisense oligonucleotide therapies (pelacarsen) in clinical trials
When to Retest
Test once — Lp(a) is genetically determined and rarely changes. Retest only if starting Lp(a)-targeted therapy.
How GATOR Tracks This
Lab Providers
Related Clinical Ratios
Related Biomarkers
This content is for informational purposes only and does not constitute medical advice. Reference ranges may vary by laboratory and individual factors. Consult a qualified healthcare provider for interpretation of your results and treatment decisions.
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