Many of us have a relative who died relatively young from a heart attack or stroke. Sometimes you hear about a man in his mid-30s dying of a heart attack despite being seemingly healthy.
It turns out there is a major heart attack and stroke risk factor that we often don’t get tested for or even hear about: elevated lipoprotein(a).
I learned about this potential risk factor after my dad got tested and discovered he had it. Then my brother also found out he had the same thing.
So it became something I wanted to understand about my own health. Being in my early 30s, I still have time to make changes to impact my quality of life decades down the line.
I decided to do one of those full-spectrum lab tests through a third-party company to get a broader picture of my overall health. Much of the information was reassuring. The service even estimated my “biological age” at a decade younger than my actual age.
But alongside those encouraging results was something that deserved attention: my lipoprotein(a) was elevated.
That result led to further testing, a visit with a preventive cardiologist, and a different understanding of my cardiovascular health.
What is lipoprotein(a)?
Lipoprotein(a), often shortened to Lp(a) and pronounced “L-P-little-a,” is a cholesterol-carrying particle in the blood. Its level is largely inherited, which means that people who exercise regularly and eat well can still have an elevated result. It also means it likely won’t get checked in someone who is otherwise healthy.
According to the American Heart Association, approximately one in five people worldwide has high Lp(a). It generally causes no symptoms, but elevated levels can increase the risk of heart attack and stroke. A blood test is needed to find out your level.
For me, this was a reminder that a reassuring overall picture doesn’t mean every individual risk factor is low.
Looking beyond the blood test
The risk information I received suggested that my elevated Lp(a) substantially increased my estimated long-term cardiovascular risk.
I followed up with a coronary artery calcium scan, which detected calcium in my coronary arteries (an indicator of coronary artery disease), which was startling for my age and gender, and put me near the 100th percentile for my score (which, unlike a grade on a test, is definitely not a good thing).
A coronary artery calcium score helps assess calcified plaque in the arteries supplying the heart. Both the actual score and its comparison with people of a similar age and sex matter when interpreting the result. A high percentile is a comparison with other people, not a percentage of arterial blockage.
I then saw a preventive cardiologist to better understand what these findings meant for me and how to address my risk.
Focusing on what I can influence
Since then, I’ve focused on a largely plant-based diet and continued exercising regularly. I’ve lowered my overall cholesterol through lifestyle changes.
There is an important distinction here: these changes don’t actually lower Lp(a) itself. Because Lp(a) is largely genetically determined, lifestyle changes usually have little effect on its level. However, addressing other cardiovascular risk factors remains an important part of prevention. Depending on a person’s situation, that plan may also include medication that helps lower LDL cholesterol.
My approach is personal to my health history and the guidance I received. But the broader lesson is useful: an inherited risk factor doesn’t make healthy habits pointless. It makes understanding your overall risk especially worthwhile.
A conversation worth having
You don’t need to purchase a comprehensive testing package to ask about Lp(a). You can discuss the blood test with your healthcare professional.
The 2026 ACC/AHA cholesterol guideline recommends measuring Lp(a) at least once in adulthood. Having a close relative with elevated Lp(a), as I do, is another reason to bring it up.
Useful questions include:
Have I already had my Lp(a) tested?
How does my family history affect my cardiovascular risk?
If my level is elevated, what should my prevention plan include?
Elevated Lp(a) does not mean a heart attack or stroke is inevitable. It is one part of a larger risk picture.
Learning about mine gave me information I could act on. I’m sharing my experience because it might help someone else start that conversation sooner.
Sources and more information:
American College of Cardiology. (2026, March 13). ACC/AHA issue updated guideline for managing lipids, cholesterol. Summarizes the recommendation to measure Lp(a) at least once in adulthood.
Read the guideline summary
American Heart Association. Lipoprotein(a). Explains inherited Lp(a), its prevalence, cardiovascular risks, and testing.
Read the resource
National Heart, Lung, and Blood Institute. (2024, January 17). Lipoprotein(a): What to know about elevated levels. Discusses genetic influences, the limited effect of lifestyle on Lp(a) itself, and managing other cardiovascular risk factors.
Radiology: Cardiothoracic Imaging. (2021). An update on coronary artery calcium interpretation at chest and cardiac CT. Explains calcium scores and the distinction between an absolute score and an age-, sex-, and race-specific percentile.
Read the article
