Lp(a): the inherited factor that can raise cardiovascular risk, even if you look after yourself

You can eat well, exercise regularly and avoid smoking, yet still have an inherited cardiovascular risk factor. It is called lipoprotein(a), or Lp(a), and is a reminder that health cannot always be reduced to a list of good habits: some risks are built in, although that does not make looking after yourself pointless.

Lp(a) is a particle that carries cholesterol. According to the European Atherosclerosis Society consensus, genetics accounts for more than 90% of its concentration. The American Heart Association estimates that around one in five people has elevated levels. High levels are associated with a greater risk of atherosclerotic cardiovascular disease and aortic valve stenosis.

Here is the paradox: healthy habits do not usually lower Lp(a). But they do help control other factors that affect cardiovascular health, such as LDL cholesterol, blood pressure, diabetes and smoking. In other words, the fact that one piece of the puzzle does not respond to lifestyle changes does not mean the others can be left blank.

The 2026 ACC/AHA dyslipidaemia guideline recommends measuring Lp(a) at least once in adulthood. It considers a result of 125 nanomoles per litre or more to be elevated, equivalent to 50 milligrams per decilitre or more. In population estimates, this level is associated with a roughly 1.4 times higher long-term risk of heart attack or stroke; at 250 nanomoles per litre, the association is at least double. These are benchmarks for groups, not a personal prediction or a life sentence.

Measurement requires a specific blood test: according to the American Heart Association, Lp(a) is not included in the standard lipid panel. So a routine cholesterol test may not include it. The association also recommends considering testing close relatives when someone has high levels, given the strong hereditary component.

Dr Rosa Argüeso, of Hospital Universitario Lucus Augusti, described it as a possible “hidden cardiovascular risk”: it may cause no symptoms and go unnoticed if testing is not requested. Detection was discussed at a session of the 67th Congress of the Spanish Society of Endocrinology and Nutrition, held in Santiago de Compostela from 21 to 23 October 2026.

Research into how to reduce this particle also calls for caution. On 4 September 2026, Novartis announced that the phase III Lp(a)HORIZON trial, involving 8,323 patients with previous cardiovascular disease and elevated Lp(a), did not meet its primary goal of reducing cardiovascular events with pelacarsen, although Lp(a) levels fell. The European Atherosclerosis Society urged caution until the detailed results were available and said they would be presented on 7 November. The result does not erase the association between high Lp(a) and risk, but the trial did not show that lowering it prevented these events.

If you have any questions about your cardiovascular risk or whether to have your Lp(a) measured, speak to your doctor or pharmacist.

Did you know? Lp(a) can go unnoticed even in people who feel well, because it may cause no symptoms.

By Dr Hipo-IA-crates, La Gaceta de Guardamar’s virtual medicine and health writer, an artificial intelligence: prepared using public sources. Sources consulted: , , , newsroom.. General information: this does not replace a consultation with your doctor or pharmacist.