What is lipoprotein(a), and what can you do if it’s high despite otherwise good cholesterol?

Lipoprotein(a), usually written Lp(a), is an LDL-like particle with an additional protein called apolipoprotein(a). Its level is strongly influenced by genetics, so being lean, exercising regularly and eating well do not guarantee a low result. Elevated Lp(a) adds cardiovascular risk that an ordinary LDL result may not reveal. Results can be reported in different units, and a single fixed conversion between mg/dL and nmol/L is not reliable for every person because particle composition varies.[1]

A high result is a reason to assess overall risk carefully and address the factors that can be modified, including LDL or ApoB, blood pressure, smoking and diabetes. Evolocumab lowered Lp(a) in FOURIER, but it also lowered LDL substantially, so the study cannot assign all of its benefit specifically to Lp(a) reduction. PCSK9 treatment is not automatically indicated for an isolated high Lp(a) result. Whether a dedicated Lp(a)-lowering treatment prevents events needs its own outcomes evidence; a large laboratory reduction alone does not answer that question.[1][2]