Lipoprotein(a) is the strongest inherited risk factor for heart disease. The American Heart Association and American College of Cardiology revised their testing guidelines in March 2026. The AHA and ACC now recommend every adult test their Lp(a) at least once. This is a Class 1 recommendation, the strongest the AHA/ACC issues.

This is a major shift. The previous 2018 guidelines mentioned Lp(a) only as a “risk enhancer” without a specific testing recommendation. Now, the 2026 dyslipidemia guidelines place it front and center: universal screening, cascade testing for family members, and integration into treatment decisions.

The 2026 guidelines now recommend universal testing of Lipoprotein(a). Source: 2026 ACC/AHA Dyslipidemia Guideline.

Why Lp(a)?

Our guide to Lipoprotein(a) describes the science in more detail. But in brief, each Lp(a) particle a cholesterol particle with an extra protein wrapped around it, making it “stickier” than normal LDL. One study estimates each Lp(a) particle is 6.6x more atherogenic than ordinary cholesterol.

Only 0.2% of the US population tests for Lp(a)

Almost nobody has had their Lp(a) measured. An analysis of 300 million patient records shows that only 0.2% of the U.S. population has been tested for Lp(a). Lp(a) has increased 22x over the last decade, but from an extremely low base.

Testing of Lp(a) has increased by 22x in the last decade. Source: Journal of the American College of Cardiology, 2025

What counts as elevated Lp(a)?

About 20% of people have elevated Lp(a) levels (≥125 nmol/L or ≥50 mg/dL). At that threshold, ASCVD risk increases by about 40%. At very high levels (≥250 nmol/L), risk doubles.

Lp(a) level	Relative ASCVD risk increase
<75 nmol/L (<30 mg/dL)	Reference (low)
75–124 nmol/L (30–49 mg/dL)	1.2×
≥125 nmol/L (≥50 mg/dL)	1.4×
≥250 nmol/L (≥100 mg/dL)	2×
≥350 nmol/L (≥150 mg/dL)	3×
≥430 nmol/L (≥180 mg/dL)	4×

Data from the UK Biobank Study, as cited in the 2026 AHA/ACC guideline.

What to do if your Lp(a) is elevated

There are no FDA-approved drugs specifically for lowering Lp(a) — yet. Several Lp(a) drugs in clinical trials: lepodisiran (Eli Lilly) lowered Lp(a) by 93.9% in a Phase II trial, and pelacarsen (Novartis) results from the Lp(a) HORIZON trial are expected this year.

In the meantime, the guidelines recommend aggressive ApoB management, PCSK9 inhibitors (for some), and cascade testing (if your Lp(a) is elevated, your parents, siblings, and children should be tested too).

How to get your Lp(a) tested

If you haven’t had your Lp(a) measured, the AHA/ACC now says you should. Empirical’s comprehensive heart panel includes Lp(a), ApoB, hsCRP, and the other biomarkers emphasized in the new guidelines, available direct to you starting at $190.