Heart and vessels
Lipoproteïne(a)
An inherited cholesterol particle that raises the risk of cardiovascular disease independently of LDL; one measurement is usually enough.
Everything about this testWhat it measures
Lipoprotein(a), Lp(a) for short, is an LDL particle with an extra protein attached to it: apolipoprotein(a). Like LDL, it can deposit cholesterol in the blood vessel wall and so contribute to hardening of the arteries (atherosclerosis). About 90 percent of the amount of Lp(a) in the blood is fixed by your genes, and it barely changes from adulthood onward. Lifestyle has little influence on it, and the standard lipid profile does not measure Lp(a) separately.
- Inherited raised Lp(a), a risk factor for cardiovascular disease that is independent of LDL cholesterol
- A possible explanation for cardiovascular disease at a young age in yourself or in your family
- An extra risk factor in familial hypercholesterolemia (inherited high cholesterol)
High
A raised Lp(a) fits a higher risk of a heart attack, a stroke and narrowing of the arteries. The Dutch guidelines consider a value above 50 mg/dl raised; this applies to about 1 in 5 people. How large the extra risk is exactly is hard to say for one person and depends strongly on the other risk factors, such as smoking, blood pressure and LDL cholesterol. A high value is almost always inborn; kidney disease can also raise the value. A high Lp(a) does not cause symptoms.
Low
A low Lp(a) is favorable and common; it means this particle contributes little to your risk. It says nothing about the other risk factors: a high LDL cholesterol, smoking or high blood pressure weigh just as heavily. A low value has no downsides and causes no symptoms.
If your result is abnormal
With a raised value, the GP assesses the full risk profile (blood pressure, smoking, LDL cholesterol, diabetes), and the approach focuses on lifestyle and, if needed, on a lower LDL cholesterol. With cardiovascular disease at a young age or inherited high cholesterol in the family, referral to an internist (specialist in internal medicine) may follow, who can take Lp(a) into account in treatment according to the guideline on hereditary dyslipidemia.
Reliability
Lp(a) is a risk marker, not a test that shows a disease. According to the guideline on laboratory diagnostics, one measurement is enough because the value stays virtually the same for life, and you do not need to be fasting. According to the Dutch guideline on hereditary dyslipidemia, Lp(a) is most informative with unexplained cardiovascular disease at a young age, in yourself or in your family, with inherited high cholesterol and with recurring cardiovascular disease despite treatment. Lp(a) is not part of the SCORE2 risk estimate in the Dutch GP guideline (NHG) on cardiovascular risk management. A recent European guideline (ESC/EAS 2025) advises measuring Lp(a) at least once in your life.
Limitations
- Laboratories report Lp(a) in mg/dl or in nmol/l; converting between these units is unreliable, so only compare results in the same unit and preferably from the same laboratory.
- The cutoff of 50 mg/dl is based on research in people of European descent; there are no good normal values for people of other descent.
- In kidney disease the value can come out higher; the laboratory and the doctor take this into account when assessing it.
- There is no research yet showing that specifically lowering Lp(a) prevents cardiovascular disease; the result therefore mainly directs attention to the other risk factors.
How common is this
Because 50 mg/dl roughly corresponds to the highest 20 percent of the population, about 1 in 5 adults has a raised Lp(a). It is passed on through families: children, brothers and sisters of someone with a high Lp(a) are more likely to have a high value. In 2024, more than 1.7 million people in the Netherlands were known to have a cardiovascular disease.
Who is this useful for
According to the Dutch guideline, mainly useful after a heart attack, stroke or narrowing of the arteries at a young age without a clear cause, in yourself or in close relatives, with inherited high cholesterol and with a known high Lp(a) in the family. Once you have been measured, you do not need to repeat the test. In people without symptoms and without a family history, the result usually does not change the advice, because there is no targeted treatment yet and the approach focuses on the other risk factors.
Downsides and risks
- A high value cannot be changed with lifestyle and there is no targeted treatment yet; this can cause worry without anything that can be done about it directly.
- There is no uniform Dutch advice on what to do with a raised Lp(a); the advice can therefore differ between healthcare providers.
Sources
- FMS Richtlijnendatabase, richtlijn Erfelijke dyslipidemie in de 2e en 3e lijn: Meten Lp(a)
- FMS Richtlijnendatabase, richtlijn Erfelijke dyslipidemie in de 2e en 3e lijn: Behandeling patiënten met verhoogd Lp(a)
- FMS Richtlijnendatabase, richtlijn Laboratoriumtechnische aspecten bij lipidendiagnostiek: Pre-analytische aspecten
- FMS Richtlijnendatabase, richtlijn CVRM: Nuchter bloedprikken bij CVRM
- NHG-Standaard Cardiovasculair risicomanagement (M84)
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results