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Lipoprotein(a): The Often Overlooked Risk Factor in Blood
In this article, you will learn what lipoprotein(a) (Lp(a)) is, why this blood value can be important for your heart health, and why a single measurement makes sense. We will also show you what role diet, cholesterol levels, and a heart-healthy lifestyle can play despite elevated Lp(a) levels.
- Introduction
- Lipoproteins explained simply
- Overview of different lipoproteins
- Special feature Lipoprotein (a)
- Relevance of Lipoprotein (a)
- Why many don't know the value
- Measurement & values
- Can Lipoprotein (a) be influenced?
- What can you do if your value is high?
- Practical tips
- LDL cholesterol
- Blood pressure, blood sugar, exercise & weight
- Eating for heart health
- Non-HDL and ApoB
- Overview of blood values
- Sources & bibliography
Themen dieses Blogartikels:
Lipoprotein(a): The blood value many don't know – and why it's important
When cholesterol is mentioned, most people think of LDL or HDL. Another blood value, however, often remains unnoticed: Lipoprotein(a), or Lp(a) for short. This marker is increasingly becoming a focus of cardiovascular research because it can provide additional information about individual cardiovascular risk.¹
Many people know their cholesterol levels. LDL, HDL, or triglycerides are now almost standard in health check-ups. However, one blood value often remains unnoticed: Lipoprotein(a), or Lp(a) for short. Professional societies now recommend having this value determined at least once in a lifetime, as it is largely genetically determined. Since the Lp(a) value itself can hardly be changed, it is all the more important to keep modifiable risk factors – e.g., blood pressure, blood sugar, smoking, and weight – under control, as they additively determine how high a personal cardiovascular risk can be. Accordingly, lifestyle becomes extremely important with elevated Lp(a) levels to avoid further additive factors.
To understand what Lipoprotein(a) is, it helps to first look at the function of lipoproteins.
Lipoproteins are like delivery services
Cholesterol and other fats are vital components of our body. Among other things, they are needed for the formation of cell membranes, the production of hormones and thus also vitamin D, as well as for the production of bile acids, which in turn play an important role in fat digestion. However, since fats do not dissolve in water, they cannot simply be transported freely through the blood.
This task is taken over by lipoproteins. You can imagine them as small transport vehicles: They safely carry cholesterol and triglycerides through the bloodstream to the cells that need them.
The transport systems, i.e. the lipoproteins, can be imagined as parcel services.
- 📦 The parcel is the cholesterol.
- 🚚 The delivery van is the lipoprotein.
- 🏡 The address is the body cells.
The delivery van ensures that the cholesterol arrives exactly where it is needed – for example, for the formation of cell membranes.
Good to know: Cholesterol is not a "bad" substance. Your body needs it daily for numerous vital processes. What is crucial, however, is how cholesterol is transported and how many lipoprotein particles circulate in the blood.
You can find out more in our article "Cholesterol too high? How to strengthen your heart through the right diet"
Overview of the function of the various lipoproteins – our body's "delivery trucks":
| Lipoprotein | Function |
|---|---|
| Chylomicrons | Transport fats from food from the intestine to the tissues. |
| VLDL | Primarily deliver triglycerides from the liver to the body. |
| LDL | Transports cholesterol to the body cells. |
| HDL | Returns excess cholesterol to the liver. |
The individual lipoproteins perform different functions in the transport of fats and cholesterol in the body.
What makes Lipoprotein(a) special?
Lp(a) is also initially such a delivery vehicle and resembles a normal LDL particle, which transports cholesterol through the body. The decisive difference is that Lp(a) additionally carries the protein apolipoprotein(a), or Apo(a) for short. This is connected to the LDL particle via a disulfide bridge and alters its properties. As a result, lipoprotein(a) differs both structurally and functionally from ordinary LDL.¹
You can imagine it simply like this:
- LDL is a delivery van that transports cholesterol to the body's cells.
- Lp(a) is the same delivery van – but with an additional trailer in the form of apolipoprotein(a). This trailer changes the properties of the entire particle.
That's why Lipoprotein(a) is no longer considered just another cholesterol but rather a distinct blood value that can provide additional information about an individual's cardiovascular risk.¹
Why is Lipoprotein(a) important?
Lipoprotein(a) not only transports cholesterol but can also transport oxidized phospholipids. According to current research, Lp(a) has proatherogenic and pro-inflammatory properties. Scientists therefore assume that elevated concentrations can contribute, among other things, to the formation of deposits in the vessel walls and calcification of the aortic valve.¹'²
For this reason, an elevated Lp(a) value is now considered an independent risk factor for cardiovascular diseases – regardless of LDL cholesterol.¹
It is estimated that about 20 to 25% of the population have elevated Lp(a) levels. This makes Lipoprotein(a) one of the most common genetically determined risk factors for cardiovascular diseases.³'⁴
Why many people don't even know their Lp(a) level
Lipoprotein(a) is nowhere near as well-known as LDL or HDL cholesterol. One reason for this is that its level is usually not automatically determined during a routine blood test. Instead, often only total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides are measured. Therefore, anyone who wants to know their Lp(a) level usually has to specifically request its determination.¹
The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) recommend determining the Lp(a) level at least once in adulthood.¹⁰ This allows a genetically elevated cardiovascular risk to be identified early and considered in the individual risk assessment.
Good to know: A normal LDL cholesterol level does not automatically mean that your Lp(a) level is also unremarkable. Both blood values provide different information.
Why Measurement Is Not Always Easy
There are several reasons why lipoprotein(a) has been measured relatively infrequently so far. For a long time, this blood value played a subordinate role in clinical practice. Furthermore, it is not part of routine blood lipid analysis, and for a long time, there were no approved therapeutic options specifically targeting Lp(a).
Another special feature is that while cholesterol levels such as LDL or HDL are often given in mmol/l or mg/dl, lipoprotein(a) is usually measured either as mass concentration (mg/dl) or as particle concentration (nmol/l). These two units cannot be directly converted into one another because the size and structure of apolipoprotein(a) vary from person to person. As a result, results from different laboratories can only be compared to a limited extent.¹
Practical Tip
Specifically ask your doctor to determine your lipoprotein(a) level – especially if there is a family history of heart attacks, strokes, coronary heart disease, or other cardiovascular diseases at a young age. A one-time Lp(a) determination may also be useful if there is a family history of elevated cholesterol levels or if you already have other risk factors such as diabetes or high blood pressure. If the value is re-checked later, the measurement should ideally be performed in the same laboratory and with the same unit (mg/dl or nmol/l) so that the results are more comparable.
What is the maximum allowed lipoprotein(a) level & when is a lipoprotein(a) level considered elevated?
Unlike many other laboratory values, there is no sharp cut-off for lipoprotein(a) beyond which a risk suddenly exists. Instead, the cardiovascular risk increases continuously with increasing Lp(a) concentration. For clinical classification, a value of over 50 mg/dL is considered a relevant risk modifier. Laboratories that report the value in nmol/L accordingly use a threshold of 105 nmol/L. However, values between 30 and 50 mg/dL can already be associated with an increased risk, depending on the individual risk profile.¹
Important: The values in mg/dL and nmol/L should not be understood as direct conversions here, as the respective thresholds depend on the measurement method used or the underlying classification. A single Lp(a) value should always be assessed together with other factors such as LDL cholesterol, blood pressure, blood sugar, family history, and overall cardiovascular risk.
Lipoprotein(a) is genetically determined – and what that means for you
Many blood values can be positively influenced by a balanced diet, regular exercise, or weight loss. However, this is only possible to a limited extent with lipoprotein(a).
According to current knowledge, about 70 to over 90% of the Lp(a) concentration is genetically determined. The LPA gene, which controls the structure of apolipoprotein(a), is primarily responsible for this.³'⁵ Let's stick with our comparison to the delivery van: the size of the additional trailer is determined when the vehicle is built. This is why Lp(a) levels can usually only be minimally influenced by diet, exercise, or weight loss.
The good news: an elevated Lp(a) level is not a sign of an unhealthy lifestyle. Instead, current guidelines recommend focusing on the overall cardiovascular risk and specifically optimizing modifiable factors such as LDL cholesterol, blood pressure, blood sugar, and lifestyle.²
What can you do for your heart health despite elevated lipoprotein(a)?
According to current knowledge, an elevated lipoprotein(a) level usually cannot be significantly influenced. However, this does not mean that you are helplessly at the mercy of your heart health.
Cardiovascular diseases such as heart attack and stroke generally do not arise from a single blood value, but from the interaction of various risk factors. An elevated Lp(a) level can increase the risk of heart attack and other cardiovascular diseases. Therefore, current guidelines recommend consistently optimizing modifiable factors in particular.²
These include, among others:
- Reducing elevated cholesterol levels: Keep LDL cholesterol within the individual target range if possible.
- Regularly monitor blood pressure
- Keep an eye on blood sugar levels
- Do not smoke
- Regular exercise
- A healthy body weight
- A balanced, heart-healthy diet
- Keep triglycerides low
Let's start with one of the most important modifiable risk factors: LDL cholesterol.
LDL Cholesterol: The Most Important Modifiable Risk Factor
If lipoprotein(a) is genetically determined, another blood value comes into particular focus: LDL cholesterol. It is one of the most important cholesterol values in the blood and, unlike Lp(a), can be influenced by diet, regular exercise, and, if necessary, medication.
As a reminder: imagine LDL again as a delivery van that transports cholesterol to the body cells. Your body needs a certain amount of these delivery vans. However, if there are consistently too many on the road, the likelihood of cholesterol accumulating in the vessel walls and promoting the development of atherosclerosis increases.²
Therefore, current guidelines recommend that people with elevated lipoprotein(a), in particular, keep their LDL cholesterol within their individual target range as much as possible.
Blood pressure, blood sugar, exercise, weight
Well-managed blood pressure and stable blood sugar levels also contribute to reducing the overall risk of cardiovascular disease. Regular exercise, sufficient sleep, and a balanced diet play an important role in this.
Eating for a Healthy Heart – How to Support Your Blood Vessels
Heart-Healthy Fats: Why Omega-3 is Especially Interesting
Omega-3 fatty acids are among the most thoroughly researched nutrients in the field of cardiovascular health. According to current knowledge, the marine omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) do not affect lipoprotein(a) levels to a relevant extent.
Nevertheless, they play an important role in the cardiovascular system. Studies show that EPA and DHA can, among other things, lower elevated triglyceride levels, influence inflammatory processes, and support normal heart function.⁶'⁹ Furthermore, the REDUCE-IT study showed that in people with an increased cardiovascular risk, high-dose EPA therapy significantly reduced the risk of major cardiovascular events.⁷
According to the European Food Safety Authority (EFSA), a daily intake of just 250 mg of EPA and DHA contributes to the maintenance of normal heart function.⁸
You can find out more about the effects, dosage, and natural sources in our article “Omega-3 Fatty Acids”
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Dietary Fiber: Natural Support for Your Cholesterol Levels
Although fiber is not a micronutrient, it should definitely be mentioned in the context of heart health. A high-fiber diet can help to positively influence LDL cholesterol levels and at the same time supports healthy bowel function and a long-lasting feeling of fullness.
Foods such as whole grains, legumes, vegetables, fruits and nuts are particularly rich in fiber.
Magnesium: What role does it play in cardiovascular health?
Magnesium contributes to normal muscle function - this includes the heart muscle. It also supports normal energy metabolism and the normal functioning of the nervous system. Sufficient magnesium intake is therefore part of a balanced diet and can contribute to numerous physiological processes.
Get enough protein
Adequate protein intake supports the maintenance of muscle mass – especially in combination with regular strength training. Good muscle mass promotes an active metabolism and facilitates physical activity, which in turn is an important component of cardiovascular prevention.
Coenzyme Q10: Why Your Heart Needs a Lot of Energy
The heart is one of the organs with the highest energy requirements. Coenzyme Q10 is a component of the mitochondrial respiratory chain and plays an important role in electron transport. It is thus involved in the formation of ATP – the most important energy source for our cells.
Homocysteine: What do B vitamins have to do with heart health?
The vitamins B6, B12 and Folate contribute to normal homocysteine metabolism. Elevated homocysteine levels are considered another marker in the context of cardiovascular health, independently of lipoprotein(a). Therefore, it may be useful to assess this value as well in the overall context.
Antioxidants from fruits and vegetables
A plant-based diet provides numerous vitamins and phytochemicals such as polyphenols or carotenoids. These substances are intensively studied for their importance for cell health and protection against oxidative stress. A varied diet with plenty of vegetables, fruits, herbs, and spices helps supply the body with these natural plant compounds.
Beyond LDL: Why Non-HDL Cholesterol and ApoB Also Matter
LDL cholesterol is one of the most important blood values for assessing cardiovascular risk. In certain situations, however, non-HDL cholesterol and apolipoprotein B (ApoB) can also provide additional information.²
Non-HDL cholesterol includes the cholesterol of all ApoB-containing lipoproteins – including LDL, VLDL, and lipoprotein(a). The ApoB value, on the other hand, shows how many potentially vascular-relevant lipoprotein particles are circulating in the blood in total. Both values can supplement risk assessment, especially in cases of elevated triglycerides, diabetes, or other metabolic changes.²
It is important to note, however: Lipoprotein(a) remains an independent, predominantly genetically determined risk factor that is assessed independently of LDL, non-HDL cholesterol, and ApoB.¹ ²
Overview of the most important blood values:
| Blood Value | What does it indicate? |
|---|---|
| LDL-Cholesterol | Shows how much cholesterol is transported via LDL. |
| Non-HDL-Cholesterol | Captures the total amount of all ApoB-containing cholesterol transporters. |
| Apolipoprotein B (ApoB) | Shows how many potentially vessel-relevant lipoprotein particles are present in the blood in total. |
| Lipoprotein(a) | A predominantly genetically determined risk marker, assessed independently of other blood values. |
Each of these blood values provides different information and complements the assessment of individual cardiovascular risk.
Conclusion
Lipoprotein(a) is a predominantly genetically determined blood value and an independent risk factor for cardiovascular diseases. Since Lp(a) levels can hardly be influenced by lifestyle, professional societies recommend a single measurement in adulthood – especially with a family history.²
However, an elevated Lp(a) level does not mean that you are helplessly exposed when it comes to your heart health. With well-managed LDL cholesterol, a healthy lifestyle, regular exercise, and control of blood pressure and blood sugar, your personal cardiovascular risk can be positively influenced.²
Anyone who knows their Lp(a) level can better assess their individual risk and, together with their doctor, take the appropriate measures for long-term heart health.
More blog posts on the topic
Heart health through Omega-3: Everything you should know about the benefits and correct dosage.
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This article is based on carefully researched sources:
References & Bibliography
- Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in
atherosclerotic cardiovascular disease and aortic stenosis: a European
Atherosclerosis Society consensus statement. European Heart Journal.
2022;43(39):3925–3946. DOI: 10.1093/eurheartj/ehac361 - Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 Focused Update
of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European
Heart Journal. 2025;46(42):4359–4378. DOI: 10.1093/eurheartj/ehaf190 - Reyes-Soffer G, Ginsberg HN, Berglund L, et al. Lipoprotein(a): A
Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic
Cardiovascular Disease. A Scientific Statement From the American Heart
Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2021. Consensus-Link - Duarte Lau F, Giugliano RP. Lipoprotein(a) and its Significance in
Cardiovascular Disease: A Review. JAMA Cardiology. 2022. Consensus-Link - Marcovina SM. Lipoprotein(a): a genetically determined risk factor for cardiovascular
disease. Critical Reviews in Clinical Laboratory Sciences. 2023. Consensus-Link - Mozaffarian D, Wu JHY (2011). Omega-3 fatty acids and cardiovascular disease: Effects on risk factors, molecular pathways, and clinical events. Journal of the American College of Cardiology, 58(20), 2047–2067.
- Bhatt DL, Steg PG, Miller M et al. (2019). Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. New England Journal of Medicine, 380(1), 11–22.
- EFSA Panel on Dietetic Products, Nutrition and Allergies (2012). Scientific Opinion on the tolerable upper intake level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA). EFSA Journal, 10(7), 2815.
- Calder PC (2013). Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British Journal of Clinical Pharmacology, 75(3), 645–662.
- Arsenault BJ, Kamstrup PR. Eight reasons why lipoprotein(a) should be
measured in everyone at least once in a lifetime. European Heart Journal.
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