Lipoprotein(a): The Cholesterol Test Most Indians Have Never Had

Lipoprotein(a), or Lp(a), is a cholesterol-carrying particle in your blood. Its level is set almost entirely by your genes, and a high level raises your risk of heart attack, stroke and narrowing of the aortic valve. A routine lipid profile does not measure it, which is why most people have never had the test.

Guidelines now say every adult should have the lipoprotein(a) test at least once. If yours is high, no approved medicine yet lowers it in a way that protects the heart. What helps is controlling every other risk factor harder and earlier.

Your Lp(a) result	What it usually means
Below 30 mg/dL (below 75 nmol/L)	Lp(a) adds little to your risk
30 to 50 mg/dL (75 to 125 nmol/L)	Grey zone, read with your other risk factors
Above 50 mg/dL (above 125 nmol/L)	High, it adds to your heart and stroke risk

These cut-offs come from the 2022 European Atherosclerosis Society (EAS) consensus statement. Labs differ a little at the edges.

What is lipoprotein(a)?

Your blood carries cholesterol inside small particles. LDL, the “bad cholesterol” on a normal report, is one of them. Lp(a) is an LDL particle with an extra protein, called apolipoprotein(a), attached to it.

That extra protein makes Lp(a) more harmful than plain LDL. It helps cholesterol settle in artery walls and drives inflammation there. It is also linked with calcium build-up on the aortic valve.

The EAS statement says more than 90% of the difference in Lp(a) between people comes from genes. Your adult level is usually reached by about age 5 and then stays roughly the same for life. You cannot guess it from your weight, diet or LDL. A slim, fit person with a perfect LDL can still have a very high Lp(a).

Why does it matter for Indians?

South Asians carry high Lp(a) often, and they seem to pay a high price for it.

In the INTERHEART Lp(a) study, researchers led by Paré compared 6,086 people after a first heart attack with 6,857 people without one, across seven ethnic groups. An Lp(a) above 50 mg/dL raised the odds of a heart attack by about 48%, even after allowing for other risk factors such as diabetes or smoking. The share of heart attacks linked to high Lp(a) ranged from 0% in Africans to 9.5% in South Asians.

A 2019 review in the Indian Heart Journal by Enas and colleagues estimated that about one in four Indians has an Lp(a) of 50 mg/dL or more.

I see this in the OPD. A man in his thirties comes in after a heart attack. He does not smoke, his sugar is normal, and his LDL is only a little high. In that patient, Lp(a) is one of the first tests I ask for.

It matters for heart valves too. The EAS statement treats the Lp(a) gene as a major contributor to aortic valve narrowing, and high Lp(a) is linked with calcium on the valve. Our guide to aortic valve sclerosis and stenosis explains how that narrowing starts. When I find a calcified aortic valve in someone younger than I would expect, I ask whether Lp(a) has ever been checked.

Who should get the lipoprotein(a) test?

The short answer is every adult, once. The 2026 ACC/AHA dyslipidemia guideline and the EAS statement both recommend measuring Lp(a) at least once in adulthood.

It matters most if:

• You had a heart attack, stent, bypass or stroke at a young age
• A parent, brother or sister had one at a young age
• Your LDL cholesterol is very high, or runs in the family
• Your heart disease keeps progressing even though your LDL is well controlled
• You have aortic valve calcium earlier in life than usual

Most people need the test only once. The ACC/AHA guideline notes that lifestyle changes Lp(a) very little, so repeat testing is generally not needed. A level measured in childhood is the exception, because Lp(a) can still rise until adulthood.

How do you read your Lp(a) result?

First, check the unit on your report. Lp(a) is reported either in mg/dL or in nmol/L, and the EAS statement is clear that one cannot be converted to the other with a simple formula. A result of 60 means very different things in each unit.

Then compare it with the table at the top. Below 30 mg/dL, Lp(a) is not your problem. Above 50 mg/dL, it adds to your risk. Between the two, it depends on the rest of your risk profile, including your age and family history. When a patient shows me a report, I check the unit before anything else.

The exact line is still being settled. The 2025 ESC/EAS dyslipidaemia update says it is reasonable to treat Lp(a) above 50 mg/dL (above 105 nmol/L) as a reason to reassess risk, especially in people close to a treatment decision.

Can you lower lipoprotein(a) with diet or exercise?

Not much.

According to the EAS statement, exercise has little or no effect on Lp(a), and lifestyle changes in general move it very little. No supplement, juice or herbal product has been shown to bring it down in a way that protects the heart. I tell patients not to spend money on anything that promises to.

Exercise, a better diet and stopping smoking will barely change your Lp(a), but they cut your overall risk. Our guide to daily habits that prevent heart disease covers the changes worth making.

Statins are a common worry. A statin does not lower Lp(a), and the EAS statement notes it may raise it slightly. I do not stop a statin because of a high Lp(a). It still lowers your LDL, and that still lowers your risk.

What lowers your risk if your Lp(a) is high?

You cannot fix the number yet, so you fix everything around it. The EAS statement recommends early and intensive control of every other risk factor in people with high Lp(a).

In practice, that means:

• LDL cholesterol. With a high Lp(a), I aim for a lower LDL than I would otherwise accept.
• Blood pressure and sugar. Both are treated earlier rather than watched.
• Smoking. It has to stop completely.

If you already have heart disease, our guide to life after angioplasty covers the medicines and habits that protect a stent. If you have diabetes, the diabetes and heart disease guide explains why sugar control matters twice over.

PCSK9 inhibitors, injections used to bring LDL down, also lower Lp(a) by 15% to 30%, though they are not approved for Lp(a) itself. Niacin is not recommended, because two outcome trials showed no benefit. Lipoprotein apheresis, a dialysis-like filtering of the blood, is kept for very high Lp(a) with disease that keeps progressing. Do not start aspirin on your own because of a high Lp(a); the EAS statement found no data to support that.

Where do the new Lp(a) drugs stand?

Several drugs that sharply lower Lp(a) are in large trials. The first outcome result has been disappointing.

Lp(a)HORIZON tested pelacarsen in 8,323 people who already had heart disease and a high Lp(a). On 4 September 2026, Novartis announced that the drug lowered Lp(a) but did not meet its main goal. In the overall trial group, it did not reduce major heart and stroke events, the trial’s main measure. The full results have not been published yet. The honest answer today is that nobody has yet shown that lowering Lp(a) itself prevents heart attacks.

Two other drugs are still being tested. Olpasiran is in the OCEAN(a)-Outcomes trial, with results not expected before 2028. Lepodisiran is in the ACCLAIM-Lp(a) trial, expected to finish in 2029.

As of October 2026, no medicine is approved specifically to lower Lp(a) in India or elsewhere. If anyone offers you one, ask what trial result it is based on.

Should your family be tested?

Yes, if your level is high. Lp(a) is inherited, so your children and siblings may carry the same high level without knowing it. The EAS statement calls it reasonable to test anyone whose parent or sibling has a markedly high Lp(a).

That is often the most useful thing a high result does. A son or daughter in their twenties finds out early, with decades to keep LDL and blood pressure in check.

What does the test involve?

It is a simple blood test. The EAS statement lists fasting as having no effect on Lp(a), so you can give the sample at any time unless a fasting lipid profile is drawn with it.

Most routine lipid profiles in India do not include it, so ask for lipoprotein(a) by name. The price differs from lab to lab; ask for the current rate before you go.

If your result is high, you can book a consultation with Dr. Prem Ratan Degawat in Jaipur. Bring your lipid reports and a note of any heart problems in your family. For a wider check, see how to know if your heart is healthy.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

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FAQs

What is a normal lipoprotein(a) level?

There is no single normal value, because risk rises steadily with the level. The European Atherosclerosis Society uses below 30 mg/dL (75 nmol/L) as low risk and above 50 mg/dL (125 nmol/L) as high. Levels in between are read alongside your other risk factors, such as LDL cholesterol and family history.

Can lipoprotein(a) be reduced naturally?

Not in a meaningful way. Lp(a) is more than 90% genetic, and exercise and diet change it very little. No supplement has been shown to lower it and protect the heart. Healthy habits are still worth it, because they lower your overall risk, which is what high Lp(a) adds to.

Does a statin lower lipoprotein(a)?

No. A statin does not lower Lp(a) and may raise it slightly. You should still take your statin if your doctor has prescribed one, because lowering LDL cholesterol reduces your risk of heart attack and stroke. With a high Lp(a), your doctor may set an even lower LDL target.

Do I need to repeat the Lp(a) test?

Usually not. Your adult level is set early in life and stays about the same, so one test is enough for most people. A repeat may be useful if the first test was done in childhood, if the result was close to a cut-off, or if a different lab reported it in a different unit.

Does high lipoprotein(a) cause any symptoms?

No. High Lp(a) causes no symptoms on its own. It shows up only through what it leads to over the years: a heart attack, stroke or a narrowed aortic valve, sometimes at a young age. That is why the blood test is the only way to know your level.