Getting Your Cholesterol Checked? Doctors Say This Often-Overlooked Test Could Help Determine Your Heart Disease Risk

If your doctor says your cholesterol looks good, you probably leave the appointment feeling fairly confident about your overall health. You got the blood work, reviewed the results and, ideally, came away with one less thing to worry about. But there’s something else that, at high levels, can raise your risk of heart disease and stroke that a standard cholesterol panel doesn’t measure.

That’s lipoprotein(a), or Lp(a) for short. How much you have is mostly determined by genetics, and diet and exercise generally do little to change it. That means your Lp(a) could be high even if you eat well, exercise often and have other cholesterol numbers your doctor is happy with.

It’s also more common than you might think: About 1 in 5 people worldwide have elevated Lp(a), according to the American Heart Association (AHA).

That’s why the updated 2026 cholesterol guidelines from the American College of Cardiology, American Heart Association and other medical organizations recommend measuring Lp(a) at least once in adulthood. The catch is that the blood test has to be ordered separately, so getting your cholesterol checked alone doesn’t necessarily mean you already know that number.

We asked cardiologists what this test can tell you and what should actually happen if your number comes back high.

Cholesterol travels through your bloodstream inside particles called lipoproteins. Lp(a), pronounced “L-P-little-a,” looks a lot like an LDL particle, but with an extra protein attached, explains Archna Bajaj, M.D., a lipid disorders specialist at Penn Medicine and associate professor of clinical medicine at the University of Pennsylvania.

Like LDL, Lp(a) can lead to plaque buildup in your arteries, which raises your risk of heart attack and stroke. High levels are also linked to a condition called aortic stenosis, in which the valve that lets blood leave your heart becomes narrowed.

The tricky part is that you can’t simply look at the rest of your cholesterol results and assume you know what your Lp(a) is doing, explains Dr. Bajaj. She recently saw a woman in her late 40s who had no known medical conditions and wasn’t taking any meds. Her LDL cholesterol was 110 mg/dL, but her dad had had his first heart attack at just 50. The woman wanted to know whether there was more to her own risk than her routine bloodwork was showing, so Dr. Bajaj checked her Lp(a) level.

The results showed it was over 300 nmol/L, which is about four times the upper limit of normal for the test (normal <75 nmol/L). “While she was initially hesitant on starting any medication, after I explained the risk associated with very high Lp(a) levels and that it likely explained her father’s early heart disease, she agreed to start a statin to lower her LDL-cholesterol and reduce her risk for having heart disease in the future,” Dr. Bajaj adds.

If you’re an adult and haven’t had yours checked, bring it up at your next appointment—even if your cholesterol numbers have always looked good. The current guidelines recommend testing every adult at least once, but it’s even more pertinent if high Lp(a) runs in your family or you have a family history of early heart disease—before age 55 in men or 65 in women.

Finding out your number only requires a blood test, which your primary care doctor can order, says Dr. Bajaj. Even though Lp(a) is mostly inherited, she explains that you don’t need genetic testing to measure it.

You also don’t need to fast for the Lp(a) test, although you may want to double-check if you’re getting other bloodwork done at the same time. Before heading to the lab, check whether your insurance covers it and what you might owe out of pocket so there are no surprises.

Before you zoom in on the number, look at the letters next to it. Labs measure Lp(a) in one of two ways: nanomoles per liter (nmol/L) or milligrams per deciliter (mg/dL). That means a result of 100 could fall into a different risk category depending on which units your lab uses.

The National Lipid Association breaks it down this way:

• Lower risk: Below 75 nmol/L or below 30 mg/dL.
• Intermediate risk: 75 to below 125 nmol/L or 30 to below 50 mg/dL.
• Higher risk: 125 nmol/L or higher, or 50 mg/dL or higher.

Stick with whichever unit appears on your report. Trying to convert the number yourself won’t necessarily give you an accurate answer, because there isn’t a single reliable formula for doing that, explains Dr. Bajaj.

And before the words “higher risk” send you spiraling, remember that these ranges only describe the risk associated with your Lp(a). In other words, they can't tell you how likely you are to have a heart attack on their own. To determine that risk, your doctor will include other factors like your age, other cholesterol numbers, blood pressure and medical and family history, as well as whether you smoke or have diabetes.

“I tell patients that elevated Lp(a) is largely inherited, so it is not a reflection of poor lifestyle choices or something they did wrong,” says Dr. Bajaj.

And if you’re wondering whether your healthy habits even matter if they can’t do much to change this number, they absolutely do. Eating well and exercising can help improve your blood pressure and blood sugar, which lowers your overall heart risk even if your Lp(a) stays put.

Still, your doctor may recommend medication. Statins don’t directly lower Lp(a), but they do lower LDL cholesterol and help prevent heart attacks and strokes, explains Cheng-Han Chen, M.D., board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California.

However, your doctor needs to look at your overall risk before deciding whether you need medication and how low to aim with your LDL cholesterol, explains Daniel E. Soffer, M.D., an internist, clinical lipidologist and associate professor of medicine at the University of Pennsylvania. Someone who already has heart disease may need a more aggressive approach than someone whose other risk factors are low.

As for medication that specifically targets Lp(a), researchers are working on it, but none is currently approved for that purpose. There is a treatment called lipoprotein apheresis, which filters Lp(a) and LDL out of the blood, but it’s reserved for a small group of patients who meet specific criteria, explains Dr. Soffer, including certain inherited cholesterol disorders and artery disease. Most people won’t need it.

Not necessarily. Your primary care doctor can walk you through your result and help you figure out what to do next. If your Lp(a) is very high, early heart disease runs in your family, or your risk is hard to pin down, seeing a cardiologist or a lipid specialist can help.

In some cases, your doctor may discuss a coronary artery calcium scan, which looks for calcified plaque in the arteries that supply your heart. Yu-Ming Ni, M.D., board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, says he uses these scans to help guide medication decisions when a patient’s risk assessment leaves uncertainty.

And if you’ve had preeclampsia or gestational diabetes, mention it—even if that pregnancy was years ago and you haven’t thought about the complication in ages. “That history still matters when assessing your heart health,” says Tala K. Al-Talib, M.D., a cardiologist and medical director of cardiology at Johns Hopkins Greenspring Station.

If your Lp(a) is high, definitely let your siblings, parents, and adult children know, recommends Dr. Bajaj. Since elevated levels run in families, your result could give them a reason to get tested, and uncover a risk factor they might’ve otherwise missed.

For younger children, start with their pediatrician. The National Lipid Association recommends testing certain children, including those with a parent or sibling who has elevated Lp(a), instead of routinely testing every child.

If you’ve never had your Lp(a) tested, at your own next appointment, it’s a smart idea to ask: “Have I ever had my Lp(a) checked, and if it’s high, how would that change my prevention plan?”

“Pregnancy, menopause and certain health conditions, including kidney or thyroid disease, can affect the number, though, so let your doctor know what’s going on with your health so they can decide when to test and whether there’s a reason to check it again,” adds Dr. Bajaj. You might only need the test once, but you should come away knowing what the result means for you and what you can do next to protect your heart.

Finding out your Lp(a) levels are high can feel unsettling, especially if you’ve been doing what you can to stay healthy, but the result can give your doctor important information about how to manage other risk factors.