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Metabolic

Lipoprotein(a) — Lp(a)

Lipoprotein(a) is a genetically determined lipoprotein particle structurally similar to LDL but with an additional protein — apolipoprotein(a) — attached. Unlike most cardiovascular risk factors, Lp(a) levels are 80-90% determined by genetics and are largely unresponsive to diet, exercise, or lifestyle changes. It is one of the most underappreciated cardiovascular risk factors, affecting an estimated 1 in 5 people globally.

Optimal Ranges

Clinical (NHS) Range

<75 nmol/L (low risk)

nmol/L

Performance-Optimised Range

<50 nmol/L (optimal)

nmol/L

The clinical range defines what is considered medically “normal” — broad enough to cover 95% of the population. The performance range reflects where research and clinical experience suggest most people feel and function at their best.

Why It Matters

Why Lp(a) matters for performance

Elevated Lp(a) is an independent, causal risk factor for atherosclerotic cardiovascular disease, aortic stenosis, and heart failure. The European Atherosclerosis Society recommends measuring Lp(a) at least once in every adult's lifetime because it's genetically fixed — if it's elevated, it's been elevated since birth, silently contributing to plaque buildup. Importantly, standard lipid panels (total cholesterol, LDL, HDL, triglycerides) don't capture Lp(a) at all. You could have a 'perfect' cholesterol panel and dangerously high Lp(a). Novel therapies targeting Lp(a) directly (antisense oligonucleotides like pelacarsen) are in Phase 3 clinical trials.

Symptoms

Signs your levels may be off

Low / Deficiency

  • Low Lp(a) is protective — no adverse effects

High / Excess

  • No direct symptoms — Lp(a) is a silent risk factor
  • Premature cardiovascular disease (heart attack before age 55 in men)
  • Family history of early heart disease
  • Aortic valve calcification
  • Increased stroke risk

Dietary Sources

Foods that support Lp(a) levels

Diet has minimal impact on Lp(a) — levels are genetically determinedA heart-healthy diet is still recommended to manage overall CV riskMediterranean diet pattern supports cardiovascular health generallyReduce saturated fat to lower LDL (which compounds risk if Lp(a) is high)Omega-3 fatty acids for general cardiovascular protection

Supplementation

Evidence-based supplementation

No supplement has been proven to meaningfully lower Lp(a). Niacin (vitamin B3) at pharmacological doses (1-3g) can reduce Lp(a) by 20-30%, but large trials (AIM-HIGH, HPS2-THRIVE) showed no clinical benefit and significant side effects. The focus for elevated Lp(a) should be: (1) Aggressively manage all other modifiable risk factors — keep LDL, ApoB, blood pressure, and HbA1c optimal. (2) Consider aspirin therapy if Lp(a) >50 nmol/L (discuss with GP). (3) Monitor for the arrival of targeted Lp(a)-lowering drugs (pelacarsen, olpasiran) currently in clinical trials. Know your number — it only needs to be tested once because it doesn't change.

Research

Key study

Lipoprotein(a) as a cardiovascular risk factor: current status

Tsimikas S, Fazio S, Ferdinand KC, et al.

European Heart Journal (2020)

DOI: 10.1093/eurheartj/ehz386

Related Biomarkers

Metabolic

Apolipoprotein B (ApoB)

Optimal: <90 mg/dL (longevity-optimised: <80 mg/dL)

Metabolic

Cholesterol (Total, HDL, LDL & ApoB)

Optimal: ApoB: below 1.0 g/L, LDL: below 2.6 mmol/L, HDL: above 1.2 mmol/L

Inflammation

hs-CRP (High-Sensitivity C-Reactive Protein)

Optimal: Below 1.0 mg/L

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This content is for educational purposes only and does not constitute medical advice. Your data suggests areas for optimisation, but any concerns should be discussed with a qualified healthcare professional. If your results flag values outside safe ranges, we recommend consulting your GP.