Question 30 of 433
What is Lp(a), and should I be tested?
The short answer
Lp(a), said “L-P-little-a,” is an inherited cholesterol particle that raises heart attack and stroke risk. Test it once in your life. Then read the next paragraph carefully.
About one in five people has a high level. It is set by your genes, and diet and exercise barely move it. A level of 125 nmol/L or more is considered high.
Now the 2026 news. For years we hoped that new drugs that lower Lp(a) by 80 percent or more would prevent heart attacks. In September 2026, the first large trial reported. The drug, pelacarsen, lowered Lp(a) as designed in more than 8,300 patients with heart disease. It did not significantly reduce heart attacks, strokes, or cardiac deaths. Two other drugs, olpasiran and lepodisiran, are still in trials and may do better because they lower Lp(a) even further. We will see.
What should you do meanwhile? Still test once; the 2026 guideline recommends it for every adult. A high Lp(a) is still a warning sign, and it runs in families. If yours is high, the proven response is to be aggressive about everything else: LDL, blood pressure, blood sugar, smoking. That advice has not changed.
“This book is for education. It is not medical advice, and reading it does not make you my patient or create a doctor-patient relationship.” From the book’s medical disclaimer. Full disclaimer
ROBUST GENETIC / OBSERVATIONAL — Lp(a) and cardiovascular risk; event benefit from specific Lp(a)-lowering drugs remains unresolved.Evidence grade (draft mapping)CObservationalPart 3, Q30 · Sources: R4, R9
Sources cited
- R4 Blumenthal RS et al. 2026 ACC/AHA multisociety Guideline on the Management of Dyslipidemia. Journal of the American College of Cardiology. 2026. doi:10.1016/j.jacc.2025.11.016. Link pending verification
- R9 Novartis. Lp(a)HORIZON phase III topline results for pelacarsen in patients with elevated Lp(a) and established cardiovascular disease. September 4, 2026. Link pending verification
From Longevity Unmasked by Afshine Ash Emrani, MD, FACC. Medical disclaimer. This book is for education. It is not medical advice, and reading it does not make you my patient or create a doctor-patient relationship. Nothing here is meant to diagnose, treat, cure, or prevent any disease. Medicine is personal: a test, drug, supplement, or exercise plan that helps one person can harm another. Do not start, stop, or change any medication or treatment because of something you read in these pages. Talk with a licensed clinician who knows your history first. If you think you are having a medical emergency, call 911. The author disclaims responsibility for any loss or harm arising from use of the information in this book.