For years, lowering LDL cholesterol—often called “bad cholesterol”—has been one of the main ways to reduce the risk of heart attack and stroke. While LDL cholesterol is still very important, researchers now know that it is not the only cholesterol-related factor that affects heart health.
One blood marker that is receiving much more attention is lipoprotein(a), or Lp(a). Many people have never heard of it, yet about 1 in 5 people worldwide have elevated Lp(a) levels. Unlike traditional cholesterol, Lp(a) is mostly inherited, meaning healthy eating and exercise have very little effect on it.
Because growing research has shown that elevated Lp(a) increases the risk of cardiovascular disease, the new American College of Cardiology (ACC) and American Heart Association (AHA) cholesterol guidelines now recommend that every adult have their Lp(a) level measured at least once during their lifetime.
What Is Lipoprotein(a)?
Lp(a) is a type of cholesterol particle that is similar to LDL cholesterol but contains an extra protein called apolipoprotein(a). This extra protein makes it more likely to contribute to plaque buildup inside the arteries.
Over time, this plaque can narrow blood vessels and increase the risk of:
- Heart attack
- Stroke
- Peripheral artery disease
- Aortic valve disease
Unlike LDL cholesterol, which can often be lowered through diet, exercise, and medications, Lp(a) levels are determined mainly by your genes. If one or both of your parents have high Lp(a), there is a good chance you may have it as well.
Why Does Lp(a) Matter?
For some people, high Lp(a) may explain why they develop heart disease even though their LDL cholesterol appears well controlled.
A large study involving nearly 2.9 million adults found that people with elevated Lp(a) were more likely to have early signs of plaque buildup throughout the body. Higher Lp(a) levels were linked to narrowing of the arteries, calcium buildup in the heart’s arteries, and other signs of atherosclerosis before symptoms developed.
Researchers also found that the risk increased as Lp(a) levels increased, suggesting that even moderately elevated levels may contribute to cardiovascular disease over many years.
These findings continue to strengthen the evidence that Lp(a) is an independent risk factor for heart disease and should be considered alongside traditional cholesterol testing.
What Do the New Cholesterol Guidelines Say?
One of the biggest updates in the new ACC/AHA cholesterol guidelines is the recommendation that all adults have Lp(a) measured at least once in their lifetime.
Doctors may especially recommend testing if you have:
- A family history of early heart disease.
- A personal or family history of high cholesterol.
- A heart attack or stroke at a younger age.
- High cholesterol despite treatment.
- A family member known to have elevated Lp(a).
Because Lp(a) stays relatively stable throughout life, most people only need to be tested once.
The guidelines also recognize Lp(a) as a risk-enhancing factor, meaning it can help doctors better estimate a person’s overall cardiovascular risk and decide whether more aggressive cholesterol-lowering treatment is needed.
Can High Lp(a) Be Treated?
Right now, there are no FDA-approved medications that specifically lower Lp(a).
Healthy habits such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight, and not smoking remain extremely important because they lower overall cardiovascular risk. However, these lifestyle changes usually do not significantly reduce Lp(a) itself.
Current cholesterol medications, including statins, are still recommended when appropriate because they lower LDL cholesterol and reduce the overall risk of heart attack and stroke, even if they do not substantially lower Lp(a).
New Treatments Are on the Horizon
Researchers are now developing medications designed specifically to lower Lp(a).
Two of the most closely watched clinical trials are studying:
- Pelacarsen, an antisense therapy being evaluated in the Lp(a)HORIZON trial.
- Lepodisiran, an RNA interference therapy being studied in the ACCLAIM-Lp(a) trial.
Earlier studies have shown these medications can lower Lp(a) levels by more than 80%, and researchers are now studying whether that translates into fewer heart attacks, strokes, and other cardiovascular events.
If successful, these therapies could become the first treatments developed specifically for people with inherited high Lp(a).
What This Means for You
Most people know their LDL cholesterol number, but far fewer know their Lp(a) level. As research continues to show that inherited Lp(a) plays an important role in cardiovascular disease, testing for it is becoming an important part of personalized heart care.
If you have a family history of heart disease or have developed cardiovascular disease despite having otherwise healthy cholesterol levels, ask your healthcare provider whether an Lp(a) blood test is right for you. Knowing your Lp(a) level can provide valuable information about your long-term heart health and may help guide future treatment decisions as new therapies become available.
Source
Man S, Zhang Y, Wang X, et al. Prevalence of Elevated Lipoprotein(a) and Its Association With Subclinical Atherosclerosis in 2.9 Million Chinese Adults. J Am Coll Cardiol. 2025. Available from: https://www.jacc.org/doi/epdf/10.1016/j.jacc.2025.02.032. Accessed August 17, 2026.
ClinicalTrials.gov. A Study of Pelacarsen (TQJ230) in Participants With Established Cardiovascular Disease (Lp(a)HORIZON). Identifier: NCT04023552. Available from: https://clinicaltrials.gov/study/NCT04023552. Accessed August 17, 2026.
ClinicalTrials.gov. A Study of Lepodisiran in Participants With Elevated Lipoprotein(a) (ACCLAIM-Lp(a)). Identifier: NCT06292013. Available from: https://clinicaltrials.gov/study/NCT06292013. Accessed August 17, 2026.
American Heart Association. ACC/AHA Issue Updated Guideline for Managing Lipids, Cholesterol. Available from: https://newsroom.heart.org/news/accaha-issue-updated-guideline-for-managing-lipids-cholesterol. Accessed August 17, 2026.
