Most adults should discuss a lipoprotein(a), or Lp(a), blood test with a healthcare professional at least once in adulthood. Current U.S. guidance recommends testing at least once because levels are largely inherited and can add information about heart and stroke risk that a routine cholesterol panel may miss. Testing may be especially useful when cardiovascular disease runs in the family or occurs earlier than expected.
Why is lipoprotein(a) testing important?
Lipoprotein(a), often written as Lp(a), is a cholesterol-carrying particle in the blood. It resembles low-density lipoprotein (LDL), commonly called bad cholesterol, but contains an additional protein called apolipoprotein(a). A higher Lp(a) level is associated with an increased risk of cardiovascular conditions, including coronary artery disease, heart attack, stroke, and aortic valve stenosis.
Unlike LDL cholesterol, which can change substantially with diet, exercise, and medication, Lp(a) levels are largely determined by inherited genetic factors. A standard cholesterol panel does not usually measure Lp(a), so someone can have an LDL cholesterol result that looks favorable while still having an additional inherited cardiovascular risk factor. According to the American Heart Association, a specific Lp(a) blood test is the way to find out the level.
When should adults get an Lp(a) test?
The 2026 American College of Cardiology and American Heart Association dyslipidemia guideline recommends measuring Lp(a) at least once in all adults to improve cardiovascular risk assessment. This means testing is not limited to people who already have high cholesterol or a diagnosed heart condition. It can be considered as part of preventive cardiovascular care, including during an initial cholesterol assessment. The American Heart Association's summary of the 2026 guideline identifies Lp(a) measurement as an important way to identify additional cardiovascular risk.
There are also situations in which the result may be particularly useful to clinical decision-making. A healthcare professional may give greater attention to Lp(a) testing when someone has a family history of early cardiovascular disease, inherited high cholesterol, or cardiovascular disease that seems disproportionate to their usual cholesterol results.
Should you get tested if heart disease runs in your family?
Yes, family history is an important reason to discuss Lp(a) testing. Consider bringing it up if a close relative developed heart disease or had a stroke at a relatively young age, particularly if several relatives have been affected. An inherited tendency toward higher Lp(a) can run through families, even when relatives have different cholesterol results or lifestyles.
The MedlinePlus Lipoprotein(a) Blood Test guide identifies early cardiovascular disease in close relatives, familial hypercholesterolemia, and cardiovascular disease despite otherwise unremarkable cholesterol measurements as situations in which a clinician may consider the test. Family history does not establish that a person has elevated Lp(a), but it can help determine whether testing would add useful information.
Should you get tested if you already have heart disease?
Lp(a) testing may also be useful for people who have already experienced a heart attack, stroke, or other cardiovascular condition. It can help explain an additional inherited risk factor and inform decisions about preventing future events. This may be especially relevant when cardiovascular disease occurs earlier than expected or when LDL cholesterol and triglyceride results do not fully explain the overall risk.
The result is considered alongside the person's medical history, previous cardiovascular events, other cholesterol measurements, blood pressure, diabetes status, smoking history, and current treatment. It does not replace these assessments. Instead, it adds another piece of information that may help a healthcare professional decide how intensively to manage established cardiovascular risk factors.
At what age should you test lipoprotein(a)?
For most people, the key recommendation is to have Lp(a) measured at least once during adulthood. Because the level is largely inherited and usually remains relatively stable, testing does not generally need to be repeated every year. Adults who have never had the test can ask whether it should be included in their next cardiovascular risk assessment.
Testing in children and adolescents is more selective. A clinician may consider it when a parent has premature atherosclerotic cardiovascular disease or when a young person has a personal history of ischemic stroke. The European Atherosclerosis Society consensus statement discusses these specific circumstances for testing younger people. The decision should account for the family history and the child's individual medical circumstances rather than automatically applying adult screening decisions to every child.
How often should Lp(a) testing be repeated?
For most adults, a single measurement is sufficient for routine risk assessment because genetic factors largely determine the Lp(a) level. Repeated testing is not usually necessary simply to monitor the number each year. This differs from tests such as LDL cholesterol, which may be checked more frequently to assess changes associated with treatment or lifestyle adjustments.
There are exceptions. Certain health conditions and life stages can affect Lp(a) measurements, including kidney or liver disease and pregnancy-related hormonal changes. A healthcare professional may therefore recommend another measurement if the original result was obtained under circumstances that could affect interpretation or if a relevant medical condition has changed. The National Lipid Association's focused update on Lp(a) also recommends testing first-degree relatives of people with elevated Lp(a) to identify others who may benefit from cardiovascular risk assessment.
What should you know before the blood test?
An Lp(a) test requires a blood sample, usually collected from a vein in the arm. The collection itself is similar to other routine blood tests. Some people experience brief discomfort or minor bruising where the needle enters the skin, but serious complications from the blood draw are uncommon.
Preparation instructions can differ by laboratory and by the other tests ordered at the same appointment. Some laboratories request fasting for a specified period, while other testing arrangements may not require it. Follow the instructions provided by the healthcare professional or laboratory rather than assuming you need to fast. Tell your clinician about relevant medicines, supplements, hormone treatments, and health conditions so the result can be interpreted appropriately.
You can often arrange Lp(a) testing alongside a routine cholesterol assessment, but it is a separate measurement. Confirm that the order specifically includes lipoprotein(a), because a standard lipid panel does not ordinarily provide an Lp(a) result.
How are Lp(a) results used in cardiovascular risk assessment?
Results are commonly reported in either milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). These units measure different aspects of the particle concentration, and there is no universally reliable conversion that applies to every individual result. When comparing past and current measurements, it is helpful to note which unit and testing method the laboratory used.
Under the 2026 U.S. dyslipidemia guideline, an Lp(a) level of at least 125 nmol/L or 50 mg/dL is considered a cardiovascular risk-enhancing factor. This is a point for clinical risk assessment, not a diagnosis of heart disease or a prediction that a cardiovascular event will occur. The risk associated with Lp(a) depends on the broader clinical picture, including other cardiovascular risk factors and whether cardiovascular disease is already present.
An elevated result may lead a healthcare professional to review LDL cholesterol management, blood pressure, blood sugar, smoking, physical activity, and other factors more carefully. The purpose is to use the additional information to guide prevention decisions. A result should not be interpreted in isolation, and treatment decisions depend on the person's overall risk and medical circumstances.
What if your Lp(a) level is higher than expected?
A higher-than-expected result is a reason to discuss cardiovascular risk with a healthcare professional, not a reason to assume that heart disease is present. Lp(a) is largely inherited, so eating differently or exercising more is not expected to substantially lower the Lp(a) number itself. Nevertheless, heart-healthy habits remain important because they can improve other aspects of cardiovascular health.
Depending on the overall assessment, a clinician may recommend closer attention to LDL cholesterol, appropriate cholesterol-lowering medication, blood pressure control, diabetes management, smoking cessation, and regular physical activity. The objective is to reduce the person's overall cardiovascular risk rather than relying on the Lp(a) result alone.
There is currently no medication approved specifically for routine treatment of elevated Lp(a) alone in the United States. Some existing lipid-lowering treatments can reduce Lp(a) to varying degrees, but their use depends on the person's clinical situation and broader treatment goals. Discuss the meaning of the result and the available prevention strategies with a healthcare professional who can consider the complete risk profile.