Lipoprotein(a) or Lp(a): the hidden hereditary risk factor

Someone with a thoroughly healthy lifestyle, a fine cholesterol profile and yet a heart attack around 45: that is exactly the scenario where Lp(a) often turns out to be the missing piece. Lp(a), in full lipoprotein(a), is a largely hereditary risk factor for cardiovascular disease that barely changes with diet or exercise. What I find striking about Lp(a): you usually measure it only once in your life, and yet that one result says something lasting about your risk.

What exactly is Lp(a)?

Lp(a) is a particle in your blood that resembles LDL cholesterol, but with an extra protein attached. A high Lp(a) is associated with a higher risk of cardiovascular disease and of aortic valve calcification. Because the value is largely fixed in your genes, someone with a healthy lifestyle can still have a raised Lp(a).

You measure it via your Lp(a) blood value. For the bigger picture, read our pillar on preventing cardiovascular disease.

How do you read an Lp(a) result?

Lp(a) is often reported in nmol/L, sometimes in mg/dL. The breakdown below is a widely used rule of thumb; your doctor always interprets the value in the context of your whole risk profile.

Why is Lp(a) often missed?

Lp(a) is not part of every standard cholesterol test. As a result, someone can see normal cholesterol values for years and still carry a raised hereditary risk. Especially with early cardiovascular disease in the family, Lp(a) can be the missing piece. The Dutch Heart Foundation (Hartstichting) points out that a loaded family history is an important reason to look beyond LDL and HDL alone.

Also read our explainer on ApoB, hs-CRP and homocysteine, other markers that look beyond ordinary cholesterol.

What can you do about a raised Lp(a)?

Because Lp(a) is hereditary, you can barely lower the value yourself through lifestyle. What you do control are your other risk factors. A raised Lp(a) is precisely a reason to take those more seriously:

• Keep LDL tight: your doctor may apply a lower target if your Lp(a) is high.
• Blood pressure and blood sugar: have them measured and keep them in a healthy range.
• Do not smoke: smoking amplifies the risk that comes with a high Lp(a).
• Inform your family: because it is hereditary, first-degree relatives may benefit from testing too.

According to RIVM (the Dutch public health institute), cardiovascular disease remains one of the leading causes of death in the Netherlands, which makes weighing a hereditary factor like Lp(a) all the more relevant.

Lp(a) versus ordinary cholesterol: what is the difference?

People often confuse Lp(a) with their ordinary cholesterol. They measure something related, but behave very differently. This difference also shapes how you handle them:

• How influenceable: your LDL falls with diet, exercise and, where needed, medication. Lp(a) barely changes from that.
• Measurement frequency: you measure cholesterol periodically to follow a trend. Lp(a) is usually a one-off measurement for life.
• What you do with it: with a high LDL you steer on the value itself. With a high Lp(a) you mainly steer on your other risk factors.

Both belong in the same conversation about your heart risk, but call for a different response.

Frequently asked questions

How often should I have Lp(a) measured?

Because the value is largely hereditary and stable, one measurement in your life is usually enough. Discuss with your GP whether it makes sense in your situation.

Can I lower Lp(a) with diet?

Barely. Lp(a) is largely genetically determined. Lifestyle mainly helps keep your other risk factors favourable.

What does a high Lp(a) mean for my family?

Because Lp(a) is hereditary, your parents, siblings and children may also have a raised value without knowing it. If you find a high Lp(a), it can be worthwhile to discuss this within your family, so that first-degree relatives can consult their own GP about whether testing makes sense in their situation. It is no cause for panic, but valuable information to share.

My advice: if you have early cardiovascular disease in the family, discuss Lp(a) with your GP. A normal cholesterol does not rule out a hereditary risk. You can map Lp(a) alongside your lipids via a lipid profile. A raised value can point to increased risk, but is not a diagnosis. At Vitalcheck, every blood test result includes a professional assessment by a BIG-registered doctor. Always discuss treatment decisions with your GP.

Sources

• Hartstichting (Dutch Heart Foundation). Heredity and cardiovascular disease. Accessed 2026.
• RIVM (Dutch public health institute). Cardiovascular disease: figures and context. Accessed 2026.