Blood WorkLipoprotein(a), or Lp(a), is a cholesterol-carrying particle whose level is set mostly by your genes. A high level raises the risk of heart attack and stroke, even when your LDL cholesterol is normal. The 2026 ACC/AHA guideline recommends that every adult have it measured at least once. At Passion Health, Lp(a) is $25 on its own or included in the $149 Full Blood Work.
What is Lp(a)?
Lp(a) looks like an LDL particle with an extra protein, apolipoprotein(a), attached. That extra piece makes it more likely to add to plaque, inflammation and blood clotting. Your level is mostly inherited, it stays about the same through adult life, and lifestyle changes don't lower it.
About 1 in 5 people worldwide have high Lp(a), and most have no symptoms. Levels tend to be higher in people of African and South Asian descent.
Who should get an Lp(a) test?
Every adult, once. The 2026 ACC/AHA dyslipidemia guideline recommends measuring Lp(a) at least once in all adults, and the National Lipid Association's 2024 statement says the same. It matters most if you:
- Have had a heart attack or stroke young, or have a parent or sibling who did.
- Have a close relative with high Lp(a). Because it's inherited, parents, siblings and children often share it.
- Have high LDL cholesterol that responds poorly to treatment.
- Are of South Asian or African descent.
What is a high Lp(a) level?
Risk rises steadily with the level; there isn't a single danger line. These are the cutoffs the guidelines use:
| Lp(a) level | What it means |
|---|---|
| Under 75 nmol/L | Low risk (National Lipid Association, 2024) |
| 75 to 124 nmol/L | In between; your clinician weighs it with your other risk factors |
| 125 nmol/L or higher (about 50 mg/dL) | High. Heart attack and stroke risk about 1.4 times higher; a risk-enhancing factor (ACC/AHA 2026) |
| 250 nmol/L or higher (about 100 mg/dL) | Very high. Risk about 2 times higher (ACC/AHA 2026) |
Labs report Lp(a) in nmol/L, which is preferred, or in mg/dL. The two don't convert exactly, so the mg/dL figures above are approximate. We report nmol/L.
How to prepare for an Lp(a) test
No fasting is needed. For most adults, one test is enough for life. Your clinician may repeat it if the first result was borderline, or if kidney disease or menopause could have changed it.
Can you lower Lp(a)?
Not much, for now. Diet and exercise don't lower Lp(a). Some cholesterol medicines, such as PCSK9 inhibitors, lower it modestly. Statins don't lower Lp(a), but they remain the main treatment because they lower overall risk. Lipoprotein apheresis, a blood-filtering procedure, is used for a small number of people with very high levels and heart disease.
Drugs designed specifically to lower Lp(a) are in clinical trials. On September 4, 2026, Novartis reported that pelacarsen lowered Lp(a) but did not significantly reduce heart events in its main phase III trial. Other drugs are still being studied. As of September 2026, no medicine is FDA-approved specifically to lower Lp(a).
What the 2026 guideline recommends now: treat a high Lp(a) as a reason for more intensive LDL-lowering, and control blood pressure, blood sugar and smoking.
If your Lp(a) is high at Passion Health
We treat it as a lifelong risk factor. That means a lower LDL goal, closer attention to blood pressure and blood sugar, an ApoB check to see how many particles you carry, and a coronary calcium score if it would change your treatment. We'll also suggest that your parents, brothers, sisters and children get tested.
Lp(a) test cost in Texas
Self-pay. $25, plus one $29 draw and clinician review fee per order. Or get it in the $149 Full Blood Work with 35 other results, where the fee is waived. Since you usually need it only once, it's one of the least expensive ways to learn about your long-term heart risk.
With insurance. If we're in network with your plan, we bill it when the test is covered. You pay cash for a test only after we tell you the price in writing, and Medicare patients sign an Advance Beneficiary Notice first.
Lp(a) questions
Is Lp(a) a one-time test?
For most adults, yes. The 2026 ACC/AHA guideline recommends measuring it at least once. Because it's mostly inherited, it changes little over time, so a repeat is only needed in specific situations your clinician will explain.
What is a dangerously high lipoprotein(a)?
There's no single danger cutoff; risk rises with the level. At 125 nmol/L (about 50 mg/dL) or higher, heart attack and stroke risk is about 1.4 times higher, and at 250 nmol/L (about 100 mg/dL) or higher it's about double.
Can diet or exercise lower Lp(a)?
No. Lp(a) is set mainly by your genes. Healthy habits still matter because they lower your overall heart risk, but they won't change your Lp(a) number.
Is Lp(a) the same as LDL cholesterol?
No. Lp(a) is a separate particle that looks like LDL with an extra protein attached. A standard cholesterol panel doesn't measure it, so it needs its own test.
Should my family be tested for Lp(a)?
If your level is high, yes, it's worth discussing. Lp(a) is inherited, so parents, siblings and children often have high levels too.
Sources
- ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia, Circulation, March 13, 2026
- American Heart Association: 2026 dyslipidemia guideline, top things to know
- American College of Cardiology: Lower Sooner, how the 2026 dyslipidemia guideline changes practice
- American Heart Association: Lipoprotein(a)
- National Lipid Association: focused update on use of lipoprotein(a) in clinical practice, J Clin Lipidol, 2024
- Novartis: Lp(a)HORIZON phase III topline results for pelacarsen, September 4, 2026