You keep an eye on your blood lipids, your LDL cholesterol is within target, and yet someone in your family had a heart attack at an early age. In that case it is worth looking at a value that is still missing from most routine panels: lipoprotein(a), or Lp(a) for short. It is almost entirely determined by your genes and barely moves with exercise or diet. A single blood test in your lifetime is enough to know where you stand.
What you should know about lipoprotein(a)
Lipoprotein(a) is a particle similar to LDL that additionally carries apolipoprotein(a). This feature makes it doubly unfavourable: it promotes calcification of the arteries and encourages clot formation. An elevated Lp(a) level is regarded as a causal, genetically determined risk factor for atherosclerosis and for calcification of the aortic valve, independent of sex and ethnic origin [EAS 2022]. Around 20 percent of the population carry elevated levels, often without knowing it. The level is more than 90 percent hereditary, which is why a single measurement in a lifetime is usually sufficient [Swiss Heart Foundation 2025]. Levels from 50 mg/dl, or 125 nmol/l, are considered clinically relevant; below 30 mg/dl the value counts as unremarkable. There is currently no approved therapy that specifically targets Lp(a). That makes it all the more important to treat the remaining risk factors consistently, above all by keeping LDL low.
Why Lp(a) in particular is so easily overlooked
In everyday practice attention usually goes to total cholesterol, LDL and HDL. Lp(a) rarely appears on the standard laboratory form, even though it carries a risk of its own. The insidious part: your LDL can sit neatly within target while Lp(a) still pushes your cardiovascular risk further up. This exact constellation explains many an early heart attack in which the other values looked unremarkable at first.
There is a historical reason as well. For a long time Lp(a) was regarded as an interesting laboratory value that could hardly be influenced. If a finding led to no treatment anyway, many practices had little incentive to measure it at all. Genetics has turned that picture around: large studies now show that elevated levels actively drive the risk and do not merely accompany it [AHA 2022]. That turns the value into information you and your doctor can act on early, long before anything shows in the arteries.
Three properties make the value special:
- It is almost purely genetic. Lifestyle changes barely shift it.
- It remains largely stable over a lifetime. One measurement is usually enough.
- It is inherited codominantly. An abnormal finding in you often has implications for siblings, parents and children.
When a measurement makes sense
The European professional societies recommend measuring Lp(a) at least once in every adult [EAS 2022]. The Swiss Heart Foundation endorses this one-off measurement [Swiss Heart Foundation 2025]. The test is particularly urgent in these situations:
| Situation | Why it matters |
|---|---|
| Heart attack or stroke in the family before age 55 (men) or 60 (women) | Points to an inherited burden |
| A cardiovascular event of your own despite well-controlled LDL | Lp(a) as the remaining risk driver |
| Known familial hypercholesterolaemia | Frequently combined with elevated Lp(a) |
| Unexplained or early-onset calcification of the aortic valve | Lp(a) as a possible contributing driver |
| Abnormal Lp(a) level in a close relative | Codominant inheritance |
If your value lies between 30 and 50 mg/dl, in the so-called grey zone, the remaining risk factors decide the next steps. At Dein Team Herzzentrum we therefore always place the finding in the overall picture, together with your LDL, your blood pressure and your family history.
What you can do today
Even without a drug aimed directly at Lp(a), you are far from powerless. An elevated value shifts the focus to everything that can be influenced.
- Lower LDL consistently. The higher your Lp(a), the more ambitious your LDL target should be. Statins, supplemented where needed by ezetimibe or a PCSK9 inhibitor, form the basis here.
- Address blood pressure, blood sugar and smoking. With elevated Lp(a), every additional risk factor counts double.
- Inform your family. With an abnormal finding, it makes sense for close relatives to have their own value checked as well [Swiss Heart Foundation 2025].
- Have the course monitored. Because the value stays stable, this is less about repeat measurements and more about a well-considered overall strategy over the years.
In rare, very severe cases with progressive disease, lipoprotein apheresis may be considered, a blood-filtering procedure that lowers the values sharply for a time. That is a case-by-case decision taken in specialised centres.
New therapies are drawing closer
The coming years are likely to change the picture. Several agents that specifically throttle Lp(a) production are well advanced in clinical testing. In phase 2 trials they lowered levels in some cases by more than 90 percent: pelacarsen, an antisense agent, by around 80 percent [Tsimikas 2020], olpasiran and lepodisiran, both siRNA approaches, by more than 90 percent [O'Donoghue 2022; Nissen 2025]. With muvalaplin, an oral inhibitor is also in development.
The decisive open question remains whether the sharp reduction in the laboratory value also means fewer heart attacks and strokes. Large endpoint trials are meant to provide that answer. The outcome trial for pelacarsen is still running, with results expected in the course of 2026. Until then the rule is: those who know their value can lower the remaining risk early and consistently, and stand ready as soon as a targeted therapy is approved.
At Dein Team Herzzentrum we see this as the real benefit of an early measurement. A known value changes the conversation: it explains a burdened family history, it justifies a more ambitious LDL target, and it gives you the opportunity to alert close relatives in good time. Should one of the new therapies clear the hurdle of approval, those who already know their status and have been well managed over the years will benefit most. In that sense, today's measurement is preparation for tomorrow's treatment.
Frequently asked questions about lipoprotein(a)
Do I need to have Lp(a) checked regularly? As a rule, no. The value is genetically determined and remains largely stable over a lifetime. A single measurement is usually enough, unless a particular situation suggests testing again.
Can I lower my Lp(a) level with diet or exercise? Hardly. Unlike LDL, diet, exercise and body weight have only a minor influence. These measures remain valuable for your heart health, but they barely change the Lp(a) value itself.
From what level is Lp(a) considered elevated? Levels from 50 mg/dl, or 125 nmol/l, are considered clinically relevant. Below 30 mg/dl the value counts as unremarkable. In between lies a grey zone in which the remaining risk factors tip the balance [EAS 2022].
I have a high Lp(a) but a normal LDL. Am I at risk? Elevated Lp(a) carries a risk of its own, even if your LDL is within target. That is exactly why the measurement is worthwhile. Your LDL should then be kept low with particular consistency.
Is the test available in Switzerland? Yes. Lp(a) can be determined from a simple blood sample, including here with us in Zürich. It makes sense to have the result interpreted by a physician rather than simply receiving a number.
Should my family be tested too? If your value is elevated, yes. Lp(a) is inherited codominantly, so an abnormal finding in you can point to an increased risk in parents, siblings or children [Swiss Heart Foundation 2025].
Is there already a drug that acts directly on Lp(a)? Not yet approved. Several agents lower the value markedly in trials, but proof of fewer heart attacks and strokes is still outstanding. Until then, treatment of the remaining risk factors takes priority.
This article is intended as guidance and does not replace a personal consultation with your physician. Whether and when an Lp(a) measurement makes sense for you is best clarified directly with your doctor.