Lipoprotein (a) goes mainstream: Test now—outcome trials coming soon
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It has become increasingly clear that we need a new standard for identifying this dangerous cholesterol abnormality, making screening every adult a necessary first step.
—Nathaniel E. Lebowitz, MD
If a person has elevated Lp(a), there may be a need to be more aggressive about lowering their LDL cholesterol, managing their blood pressure and blood sugar, and working on behavioral components like increasing exercise, proper nutrition, and avoiding tobacco.
—Sirisha Vadali, MD
New research presented at the 2026 meeting of the Society for Cardiovascular Angiography & Interventions (SCAI) has found that very high levels of lipoprotein(a)—also known as Lp(a)—are associated with a greater risk of major cardiovascular events, specifically stroke or cardiovascular death but not heart attack, especially in those who already have heart disease.[] Elevated Lp(a) is exceptionally common, present in one in five people,[] and it has a genetic element.[]
Nathaniel E. Lebowitz, MD, a clinical cardiologist and cholesterol specialist at Hackensack University Medical Center, who recently collaborated with the American Heart Association on the Lp(a) Discovery Project, describes Lp(a) as a “super-sticky, inherited type of cholesterol that doesn't respond to lifestyle changes.” Even in patients who eat well, manage stress, and exercise regularly, it can lurk unseen, Dr. Lebowitz explains.
The good news: Therapeutic inroads are being made toward managing very high Lp(a), though no targeted Lp(a)-lowering therapy has yet shown that lowering Lp(a) reduces cardiovascular events. Lp(a) HORIZON, testing pelacarsen, is the first dedicated cardiovascular outcomes trial of an Lp(a)-lowering therapy and is expected to report in 2026. []
There’s a simple Lp(a) blood test available
But you don’t have to wait on trial results or drug approval to take action. Recent guideline updates from the American Heart Association and the American College of Cardiology recommend that patients have a simple Lp(a) blood test.[] It’s easy, low-cost, and available to any patient, regardless of age.
“It has become increasingly clear that we need a new standard for identifying this dangerous cholesterol abnormality, making screening every adult a necessary first step,” Dr. Lebowitz says.
“Simply because we have no way at present of reducing a very high Lp(a) to normal does not mean we cannot dramatically reduce the risk from it—we can. Uncovering elevated Lp(a) empowers physicians to intensify standard lipid-lowering therapies and gives patients a clear understanding of their baseline risk as we prepare for the targeted therapies coming down the pipeline,” he adds.
How does Lp(a) testing change modifiable risk, family screening, or aspirin prescriptions?
Sirisha Vadali, MD, a non-invasive cardiologist and advanced lipidologist at HonorHealth, tells MDLinx that the blood test results can change how you approach prevention. “If a person has elevated Lp(a), there may be a need to be more aggressive about lowering their LDL cholesterol, managing their blood pressure and blood sugar, and working on behavioral components like increasing exercise, proper nutrition, and avoiding tobacco,” she says. “Depending on the overall risk, we may also use tools such as coronary artery calcium scoring to help guide treatment decisions. Family screening is also important since Lp(a) is largely inherited, so I often recommend that first-degree relatives discuss testing with their healthcare provider.”
Lp(a) testing may also change how you prescribe aspirin to your patients. According to Laxmi Mehta, MD, a cardiologist at The Ohio State University Wexner Medical Center, “Aspirin may be appropriate as an additional therapy for some people who are deemed to be at very high cardiovascular risk, but the decision should be made…after carefully weighing the benefits versus potential bleeding risks.”
Clinicians are widely supportive of the Lp(a) blood test
Cardiologist Afshine Emrani, MD, writing on X, characterized Lp(a) in this way: “Genetically determined. Set at birth. Essentially never changes. Diet, exercise, and weight loss do nothing to it. Statins don't lower it. This is why the marathon runner with perfect cholesterol has a heart attack at 47.” He went on:“Test it exactly once. One measurement gives you your lifetime number. Guidelines support testing every adult. Most never have been.”
Chayakrit Krittanawong, MD, agrees. Also writing on X, he said, “One simple blood test can uncover a risk you may have carried your whole life.”
Related: Statins haven't stopped heart disease. What will?