Should you test your Lp(a)? What the new US guidelines mean for you

Lipoprotein(a) is a specific type of lipoprotein found in your blood plasma that helps carry fats around your body.

While LDL and HDL cholesterol get plenty of coverage in health news, they're not the only markers of fats in the blood with a bearing on your health.

In fact, some experts now believe that metrics like Lp(a) could give you unrivalled insight into your cardiovascular health. The clinical team at Thriva echoes this, which is why we offer Lp(a) as a home test to understand your risk factors.

What is Lp(a) and why does it matter?

Lipoprotein(a), or Lp(a), is a type of lipoprotein your liver makes that helps transport fat around your body.

Each Lp(a) particle is made up of a lipoprotein that is similar to LDL cholesterol, as well as two proteins, known as ApoB and Apo(a).

The Apo(a) is important here as it gives Lp(a) a level of "stickiness." Some describe its effects as being similar to adding velcro to an LDL particle.

Being "sticky" could quicken the narrowing of arteries, as it may be more likely to adhere to artery walls compared to LDL cholesterol. Some scientists also believe that Lp(a) could increase the occurrence of blood clots.

Due to these properties, experts agree that high levels of Lp(a) in your blood are a risk factor for cardiovascular disease.

What makes Lp(a) different from many other biomarkers, however, is that your levels are determined by genetics. They aren't affected by your age or sex, and you can't change them through lifestyle factors. Knowing your levels can be helpful, but it's a very personal choice.

What do the new US guidelines recommend and why?

A new 2026 set of guidelines from the American College of Cardiology and American Heart Association, published in Circulation, recommends that all adults receive Lp(a) testing at least once in their life.

Lp(a) levels in your blood are typically measured in nanomoles per litre (nmol/L), but you may also see some people using milligrams per decilitre (mg/dL).

The committee behind the recommendations stated that having a high concentration of 125 nmol/L (50 mg/dL) is associated with a 40% greater risk of plaque-related cardiovascular disease compared with people with low Lp(a) levels.

As the concentration of Lp(a) in your blood is typically stable over time, the committee wrote that having just one test should be enough to give a good idea of your cardiovascular disease risk.

The association between Lp(a) and cardiovascular disease holds even when adjusting for other risk factors, such as LDL cholesterol levels. So, even if someone has low levels of LDL, a high Lp(a) level could still increase their risk of cardiovascular disease.

The committee said that early identification of high Lp(a) levels could help people to start taking heart-healthy actions sooner.

Where do we stand with routine checking of Lp(a) in the UK?

In the UK, doctors don't routinely test for Lp(a), and they'll only request testing in specific circumstances.

One reason Lp(a) hasn't been more widely recognised as an important risk factor for cardiovascular disease is the inconsistency within the studies investigating it. There's also a lack of consistency in the tests used to measure it.

Heart UK recommend that people with one of the following conditions should receive Lp(a) testing:

• a personal or family history of cardiovascular disease before the age of 60
• first-degree relatives with Lp(a) levels above 200 nmol/L
• familial hypercholesterolaemia, an inherited disorder causing high LDL from birth
• calcific aortic valve disease, or a family history of it, a disease affecting a heart valve
• a raised 10-year risk of developing cardiovascular disease

However, more in line with the American College of Cardiology and American Heart Association, the European Atherosclerosis Society say that Lp(a) measurement is recommended in all adults at least once.

While Lp(a) levels remain relatively stable over time, there are some things that can affect them. These include the transition to menopause, pregnancy, certain medications, and some diseases affecting your kidney, liver, or thyroid.

Having raised Lp(a) is also relatively common, affecting around 1 in 5 people. It's also worth knowing that not everyone will want to know their Lp(a). Because you can't do much about it, it can cause unnecessary worry, and this might be detrimental to some people.

Because of this, the general advice for people with raised Lp(a) is to focus as much as possible on risk factors that they can control, like eating well and exercising regularly.

What you can do to better understand your cardiovascular health

One thing the new recommendations from the American College of Cardiology and American Heart Association make clear is that there are several factors influencing heart health that go under the radar.

We're very familiar with cholesterol being a measure of our blood fats are, but just focusing on this means missing out on a potentially bigger picture.

An Lp(a) measurement gives you a marker of potential cardiovascular health that's likely to remain unchanged throughout life.

Another lesser-known metric is ApoB, one of the proteins that make up Lp(a) particles. This protein is present in a range of other lipoproteins, including LDL, that can all contribute to buildups of plaque that can lead to heart attacks and strokes.

Measuring ApoB levels can give you insight into your cardiovascular risk, and the National Lipid Association has stated that it's a more reliable indicator than looking at LDL alone.

If you're curious about your Lp(a) and ApoB levels, you can measure and track both with a Thriva at-home blood test.

While some factors influencing your cardiovascular health risk aren't within your control, many of them are. Testing gives you extra context to support the decisions you make about your health.

Learn more about taking an at-home Lp(a) test.

Takeaway

Recent guidelines from the US recommend that all adults should measure their Lp(a) levels at least once, given that high levels are a strong risk factor for cardiovascular disease that is unaffected by lifestyle changes.

You can measure your Lp(a) levels, as well as other metrics like ApoB and LDL, with Thriva at-home blood testing to give you a fuller picture of your cardiovascular health.

Frequently asked questions

Is Lp(a) the same as LDL cholesterol?

No. Lp(a) is a separate lipoprotein particle, but it contains a structure similar to LDL with an extra protein called Apo(a) attached. You can have normal LDL but still have high Lp(a).

Can you lower Lp(a) naturally?

Your Lp(a) level is largely determined by genetics and stays relatively stable throughout life. You can focus on managing the cardiovascular risk factors you can change through diet, exercise, and medication if needed.

What is a normal Lp(a) level?

Guidance from the American College of Cardiology and American Heart Association says 125 nmol/L (around 50 mg/dL) is the threshold linked with a 40% greater risk of plaque-related cardiovascular disease. Levels below this are generally considered lower risk.

Does the NHS test for Lp(a)?

The NHS doesn't routinely test Lp(a). If you want to know your level, you can try an at-home Lp(a) test.

Disclaimer: This information is for general educational purposes only and isn’t a substitute for professional medical advice, diagnosis, or treatment. Always speak with a qualified healthcare professional first if you have concerns about your health.