Yes. Lipoprotein(a), often called Lp(a), is a type of cholesterol-carrying particle in the blood. Its cholesterol is included in standard LDL cholesterol results, so it can contribute to the number on a lipid panel. More importantly, a high Lp(a) level can raise the risk of heart and blood vessel disease even when total cholesterol or LDL cholesterol appears acceptable on a routine test.
How Is Lipoprotein(a) Different From Regular Cholesterol?
Cholesterol is a waxy substance that your body needs to build cells and make certain hormones. Because cholesterol cannot travel through the bloodstream on its own, it is carried by particles called lipoproteins. Low-density lipoprotein (LDL) carries cholesterol through the blood and is commonly called bad cholesterol because excess LDL can contribute to fatty deposits inside artery walls.
Lipoprotein(a), written as Lp(a), is a cholesterol-carrying particle that resembles LDL but has an additional protein called apolipoprotein(a). This extra protein gives Lp(a) properties that make it an important risk factor for cardiovascular disease. According to Cleveland Clinic, Lp(a) levels are largely determined by inherited genes and can be associated with an increased risk of heart and blood vessel disease.
Although Lp(a) and LDL cholesterol are related, they are not interchangeable measurements. LDL cholesterol measures the amount of cholesterol carried in LDL-related particles, while an Lp(a) test measures the concentration of the Lp(a) particles themselves.
Can Lp(a) Raise Your LDL or Total Cholesterol Results?
Yes. Cholesterol carried inside Lp(a) particles contributes to the cholesterol measured in a standard lipid panel. This means that Lp(a) can contribute to both the reported LDL cholesterol value and total cholesterol value. The usual laboratory tests do not routinely separate the cholesterol carried by Lp(a) from cholesterol carried by other LDL particles.
The European Atherosclerosis Society explains that Lp(a)-related cholesterol is included in reported LDL cholesterol measurements. However, the amount of cholesterol within Lp(a) particles varies between individuals. Therefore, healthcare professionals should not assume that a fixed percentage of an Lp(a) result can accurately be subtracted from LDL cholesterol.
A high Lp(a) level does not necessarily mean that a routine cholesterol panel will show unusually high numbers. Someone may have an LDL cholesterol result that appears satisfactory while still having an elevated Lp(a) level. Conversely, a higher LDL cholesterol result cannot establish whether Lp(a) is responsible for some of the measured cholesterol.
Why Can High Lp(a) Matter When Cholesterol Looks Normal?
Lp(a) is important because it can increase cardiovascular risk independently of the usual cholesterol measurements. Like LDL particles, Lp(a) can contribute to the buildup of plaque inside arteries. It is also associated with processes involving inflammation and blood clotting, which can add to cardiovascular risk.
According to MedlinePlus, a high Lp(a) level may increase the risk of coronary artery disease, heart attack, stroke, and peripheral artery disease, even when other cholesterol results appear normal. Elevated Lp(a) is also associated with calcific aortic valve disease, in which calcium buildup can cause the aortic valve to narrow.
The level of risk depends on more than Lp(a) alone. Healthcare professionals also consider LDL cholesterol, blood pressure, diabetes, smoking, family history, existing cardiovascular disease, and other relevant factors when assessing overall risk. An elevated Lp(a) result adds useful information that a routine lipid panel may not provide.
What Causes High Lipoprotein(a) Levels?
Genes inherited from biological parents are the main factor determining a person's Lp(a) level. Levels often remain relatively stable throughout life, so high Lp(a) is not necessarily a result of eating too much cholesterol, gaining weight, or not exercising enough.
Other health factors may influence Lp(a) levels in certain circumstances. Kidney disease, liver disease, and thyroid disease may be associated with higher levels, while some life stages, including menopause, can affect levels in women. These influences do not change the fact that inherited genetics is the principal determinant for most people.
Because Lp(a) is inherited, a person with an elevated level may have biological relatives with the same risk factor. A family history of cardiovascular disease at a relatively young age can make Lp(a) testing particularly relevant, even when routine cholesterol results do not appear concerning.
When Should You Consider an Lp(a) Blood Test?
A standard lipid panel measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. It does not usually include a separate Lp(a) measurement. A healthcare professional must order the specific blood test to determine the Lp(a) level.
The American Heart Association's 2026 dyslipidemia guidance recommends measuring Lp(a) at least once in adulthood to help assess cardiovascular risk. Testing may be especially relevant when there is a family history of premature cardiovascular disease, familial hypercholesterolemia, or cardiovascular disease that is not fully explained by the usual risk factors.
Results may be reported in milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). These are different units, and a simple universal conversion between them is not reliable. The interpretation should use the laboratory's reporting units and the applicable clinical guidance.
In the 2026 US guidance, an Lp(a) level of 125 nmol/L or 50 mg/dL and above is considered a risk-enhancing factor. This is a clinical decision threshold, not a diagnosis by itself. Healthcare professionals interpret the result alongside the person's medical history, other test results, and overall cardiovascular risk.
Because Lp(a) generally changes little over time, repeated testing is not routinely necessary for everyone. A clinician may recommend another measurement when a health condition or a change in clinical circumstances could affect the result.
What Can You Do if Your Lp(a) Level Is High?
Although lifestyle changes generally do not lower Lp(a) itself, they can still help reduce overall cardiovascular risk. This distinction matters because an inherited risk factor does not mean that other aspects of heart health cannot be improved.
Depending on your health and risk profile, practical steps may include:
- Following a heart-healthy eating pattern that limits saturated and trans fats.
- Getting regular physical activity appropriate for your health and abilities.
- Avoiding tobacco and stopping smoking if you smoke.
- Managing blood pressure and blood glucose when these are elevated.
- Working with a healthcare professional to identify and treat high LDL cholesterol.
According to the American Heart Association's guidance on Lp(a), lifestyle changes do not generally reduce the Lp(a) level, but they remain important for cardiovascular health. There is currently no medication approved specifically to lower Lp(a) alone. Certain cholesterol-lowering medicines, including PCSK9 inhibitors, can reduce both LDL cholesterol and Lp(a) in some people, but whether they are appropriate depends on the person's overall risk and medical circumstances.
If Lp(a) is elevated, a healthcare professional may recommend more intensive LDL cholesterol management or other measures to reduce cardiovascular risk. Do not stop or change prescribed cholesterol medication because of an Lp(a) result. Instead, discuss whether your current treatment goals adequately address your overall risk.
Because Lp(a) is inherited, close biological relatives may also benefit from discussing testing with their healthcare professionals. Identifying an elevated level can help families understand their cardiovascular risk and make informed prevention decisions.
Can You Have High Lp(a) Without High Cholesterol?
Yes. A routine lipid panel can show LDL cholesterol and total cholesterol that appear acceptable while a separate Lp(a) test reveals an elevated level. The two tests provide different information. A satisfactory routine cholesterol result does not automatically rule out the additional cardiovascular risk associated with Lp(a), just as an elevated Lp(a) result does not determine a person's overall risk on its own.
The most useful approach is to consider both measurements together. If you have a strong family history of early heart disease or have developed cardiovascular disease despite apparently acceptable cholesterol results, ask your healthcare professional whether an Lp(a) test would help clarify your risk and guide prevention.