Question 1

What do the 2026 AHA/ACC guidelines say about Lp(a)?

Accepted Answer

The 2026 AHA/ACC guidelines recommend that every adult test their Lp(a) at least once in their lifetime, the strongest level of recommendation (Class 1). This is a major shift from the 2018 guidelines, which mentioned Lp(a) only as a “risk enhancer.” The guidelines also recommend cascade testing: if your Lp(a) is high, your parents, siblings, and children should be tested too.

Question 2

Can you lower Lp(a)?

Accepted Answer

Unlike most cholesterol markers, Lp(a) does not respond much to diet or exercise. Your level is set by your genes. Statins do not lower Lp(a) and may slightly raise it. PCSK9 inhibitors reduce Lp(a) by about 20-30%, and new targeted therapies specifically for Lp(a) are in late-stage clinical trials. If your Lp(a) is elevated, the most important step is to aggressively control other modifiable risk factors (LDL, ApoB, blood pressure, inflammation) to offset the added risk.

Question 3

How much does a lipoprotein(a) test cost?

Accepted Answer

A standalone Lp(a) test typically runs $15 to $75 at direct-to-consumer labs. Insurance often covers it when ordered for cardiovascular risk assessment, especially given the new guideline recommendation that everyone get tested at least once. Empirical Health includes Lp(a) in both the comprehensive and advanced heart health panels at no extra charge.

Question 4

How often should I test Lp(a)?

Accepted Answer

Most people only need to test Lp(a) once. Because it is genetically determined, your level stays essentially the same throughout your life. A few exceptions: kidney disease can raise Lp(a), and levels may shift after menopause due to declining estrogen. If you start a PCSK9 inhibitor or enroll in a clinical trial for an Lp(a)-lowering drug, retesting makes sense to measure your response.

Question 5

What is a normal Lp(a) level?

Accepted Answer

Lp(a) below 75 nmol/L (or roughly 30 mg/dL) is considered normal. Levels above 125 nmol/L (50 mg/dL) are high risk for cardiovascular disease and aortic valve disease. Because labs report Lp(a) in different units (nmol/L vs. mg/dL), make sure you know which unit your results use. The two units are not directly interchangeable because Lp(a) particle size varies between individuals.

Question 6

Why is Lp(a) reported in nmol/L instead of mg/dL?

Accepted Answer

nmol/L counts the number of Lp(a) particles. mg/dL measures the mass of those particles. Recent guidelines, including the 2026 AHA/ACC, prefer nmol/L because Lp(a) particles vary widely in size between people, so two people with the same mg/dL can have very different particle counts and very different risk. There is no universal conversion factor, but a rough estimate is 1 mg/dL ≈ 2.5 nmol/L. Risk thresholds: above 75 nmol/L is elevated, above 125 nmol/L is high, above 200 nmol/L is very high.

Question 7

What is Lp(a) and why should I test it?

Accepted Answer

Lp(a), or Lipoprotein(a), is a type of cholesterol particle that carries both cholesterol and a clot-promoting protein. It is the strongest inherited risk factor for heart disease. About 20% of people have elevated Lp(a), and most have never been tested. The 2026 AHA/ACC guidelines now recommend everyone get tested at least once in their lifetime. Since Lp(a) is almost entirely determined by genetics and stays stable over time, a single test tells you your lifetime level.

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Know your Lp(a). Know your health.