Genetic cardiovascular risk factor
13 of 22 providers
Lipid Panel / Cardiovascular Health
Desirable:<30 mg/dL, Borderline:30-50 mg/dL, High:>50 mg/dL
Lipoprotein (a), abbreviated as Lp(a), is a unique cholesterol particle consisting of an LDL-like particle with an additional protein called apolipoprotein(a) attached to it. Often called "the forgotten cholesterol,"Lp(a) is a powerful independent risk factor for cardiovascular disease, stroke, and aortic valve stenosis. What makes Lp(a) particularly challenging is that your levels are 70-90% genetically determined and largely unresponsive to diet and lifestyle changes.
Lp(a) is highly atherogenic and prothrombotic, meaning it both promotes plaque formation and increases blood clotting tendency. The apolipoprotein(a) component has structural similarity to plasminogen, interfering with the body's clot-dissolving mechanisms. Lp(a) particles are smaller and more easily oxidized than regular LDL, making them particularly damaging to arterial walls. Approximately 20-30% of the population has elevated Lp(a) levels, often without knowing it.
Despite being discovered in 1963, Lp(a) has only recently gained widespread clinical attention as a critical cardiovascular risk factor. Elevated Lp(a) can explain premature heart disease in people with otherwise healthy lipid profiles and may account for much of the "residual risk"in statin-treated patients. Major cardiology societies now recommend at least one Lp(a) measurement in every adult's lifetime for risk stratification, as knowing your Lp(a) level can significantly impact cardiovascular prevention strategies.
| Range Type | Level | Significance |
|---|---|---|
| Explains premature heart disease and "familial"patterns | Highly atherogenic and prothrombotic properties | Undetectable by standard cholesterol tests |
| Optimal Lp(a) Ranges | Standard:<30 mg/dL or <75 nmol/L | Functional/Optimal:<14 mg/dL or <35 nmol/L |
| Clinical Concern:>50 mg/dL or >125 nmol/L | Lp(a) can be measured in mg/dL or nmol/L;nmol/L is preferred as it accounts for particle size variations. Conversion varies by isoform. Levels >50 mg/dL (>125 nmol/L) confer 2-4x increased cardiovascular risk. Levels >180 nmol/L are considered very high risk. Note:Lp(a) levels remain relatively stable throughout life after age 5. | Aggressive LDL-C and ApoB Lowering |
| Since Lp(a) itself is difficult to lower, compensate by aggressively reducing other atherogenic particles. Target LDL-C <70 mg/dL (or <55 mg/dL if very high Lp(a)) using statins, ezetimibe, or PCSK9 inhibitors. This "treat the company it keeps"approach reduces overall cardiovascular risk. | PCSK9 Inhibitors | PCSK9 inhibitors (evolocumab, alirocumab) can reduce Lp(a) by 20-30%, the most effective currently available therapy. While modest, this reduction may be clinically meaningful in very high-risk patients. These medications also substantially lower LDL-C and ApoB. |
Low-dose aspirin (81mg daily) may be particularly beneficial in patients with elevated Lp(a) due to its prothrombotic effects. Discuss with your physician, weighing bleeding risks against cardiovascular benefits. Evidence suggests aspirin may be more effective in high Lp(a) individuals.
High-dose niacin (1-3g daily) can lower Lp(a) by 20-30%, but cardiovascular outcome benefits remain unproven and side effects are common. Generally not recommended as first-line therapy. Newer therapies are in development. Use only under physician supervision.
Novel RNA-based therapies (antisense oligonucleotides, siRNA) can reduce Lp(a) by 80-90% and are currently in phase 3 trials. Consider enrolling in clinical trials if you have very high Lp(a) (>200 nmol/L). These therapies may be available commercially by 2025-2026.
Low Lp(a) (<10 mg/dL) is beneficial and protective against cardiovascular disease;no adverse effects
Genetic factors;low Lp(a) is associated with reduced cardiovascular risk and is considered protective
Clinical trials showing that PCSK9 inhibitors reduce Lp(a) by 20-30% and that this reduction may contribute to cardiovascular benefit, suggesting therapeutic value even with modest Lp(a) lowering.
Source:Tsimikas et al., "PCSK9 Inhibitors Reduce Lipoprotein(a),"Journal of the American College of Cardiology, 2020
Expert consensus statement from major cardiology societies recommending at least one Lp(a) measurement in all adults for cardiovascular risk stratification, particularly those with premature CVD or strong family history.
Source:Wilson et al., "Use of Lipoprotein(a) in Clinical Practice,"Circulation, 2019
Phase 2 trial results demonstrating that antisense oligonucleotide therapy targeting Lp(a) production reduces levels by up to 90%, with phase 3 outcomes trials underway to determine cardiovascular benefits.
Source:Tsimikas et al., "Antisense Therapy Targeting Lipoprotein(a),"New England Journal of Medicine, 2020
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Source:None
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | — | $398 | 30+ |
| — | $486 | 40+ | |
| — | $468 | 83 | |
| ✓ | $349 | 100+ | |
 InsideTracker | — | $680 | 54 |
 Function Health | ✓ | $365 | 100+ |
| — | $250 | 65 | |
| — | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| — | $399 | 100+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| ✓ | $125 | 60 | |
| — | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 80+ | |
| — | $375 | 85 | |
| ✓ | $700 | 129 |
13 providers include this biomarker in their panels
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
