Lipoprotein(a) or LP(a) levels above 30 mg/dL were associated with more cardiovascular events and coronary heart disease. Levels above 120 mg/dL were associated with more cardiovascular death and ischemic stroke.
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Not sure if this CC allowed. Or if it’s available in all 50 states. But, if you’re having a hard time getting a doc to order the right cardio lab work you might be interested in UltaLabs (yes Ulta like the beauty store). A lipoprotein (a) tests runs $38.95. The providing lab facility (Quest in our area) adds a puncture charge. If you can find a provider that subscibes to Ultalabs the costs drop dramatically from the ones published on their website.
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In addition, one can join Function Health. I pay $365/yr for 140 lab tests twice a year. It includes things like lp(A) and your cholesterol particle size. Heart wise, I’m screwed. I think the only thing one can do about the high lp(A) is try to lower your LDL cholesterol (because you can’t lower lp (A), though apparently there are studies for new medications coming out.
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Also some clinical trials underway
“The validation or refutation of the Lp(a) hypothesis, namely that lowering plasma Lp(a) will lead to clinical benefit, is ongoing in 3 clinical outcome trials. This essay reviews the discovery of Lp(a), summarizes the seminal pathophysiological findings since its discovery, discusses ongoing clinical trials with novel drugs and approaches, and provides a look ahead to unanswered questions.“
https://www.ahajournals.org/doi/10.1161/ATVBAHA.124.319483
Also from this 2024 article:
“ Pending the results of clinical trials, the management of patients with elevated Lp(a) should consist of optimal management of all other CVD risk factors and consideration for the use of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors. Recent studies suggest patients with a history of CVD and LDL-C <100 mg/dL randomized to placebo in PCSK9 inhibitor trials have ≈25% higher risk of events than those with low Lp(a). However, in subjects randomized to active treatment, there was an outsized benefit despite only modest (<20 mg/dL) absolute Lp(a) reduction.29 Statins reduce LDL-C–mediated risk but do not appear to have beneficial effects on Lp(a)-mediated risk and can also induce an increase in Lp(a) values.30 The clinical relevance of this phenomenon is not known yet. First-degree relatives should also be screened and identified for earlier risk factor management. A paradigm for the care of patient with elevated Lp(a) has been developed in the author’s institution by a dedicated Lp(a) Clinic that provides details on patient management.31”
From Nov 2025 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 92 • NUMBER 11 NOVEMBER 2025:
“ Lipoprotein(a) in clinical practice:
What clinicians need to know
THE BOTTOM LINE
Lipoprotein(a) is a prevalent, genetic, independent
risk factor for adverse atherosclerotic cardiovascular
disease outcomes that is essentially unaffected by life-
style changes and currently lacks approved therapies.
Intensifi cation of proven preventive and atheroscle-
rotic cardiovascular disease risk-reduction measures
is generally indicated in individuals with elevated
lipoprotein(a) levels. PCSK9 inhibitors are associated
with modest lipoprotein(a) reduction. Emerging RNA-
based and small-molecule therapies show promising
lipoprotein(a)-lowering effects; ongoing phase 3 trials
are evaluating their impact on atherosclerotic cardio-
vascular disease outcomes.”
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That looks super interesting. They also use Quest as their lab.
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Perhaps LP(a) is not routinely measured because there is nothing currently that can be done about it.
However, if one’s LP(a) is high, perhaps a more aggressive focus on reducing modifiable CVD risks (not just LDL) may be indicated.
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I think if doctors aren’t measuring it because you can’t change it, that’s the last thing they should do. People should measure to know their risk. Seems very important to know the risk and compensate in other areas where you can actually do something to help.
Yeah, I like Quest. It’s hard to believe they can do all those tests so cheaply. And they give you a massive report that explains all the tests, your values, problematic tests, and what to do about blood tests out of the norm. They give you so much information, it’s overwhelming to wade through it.
Count me in.
My level is way high.
I’m having new labs drawn next week to see if the current drug combo is working.
Are you talking about a statin drug or something else, if you don’t mind me asking?
I’m on Crestor plus Zetia.
If this doesn’t work well enough, there’s an injectible.
So far, my LDL has been reduced to 135 no matter was dose or combo. We will see if this combo is effective.
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PCSK9 inhibitor? Not a statin, but sometimes used for those whom statins are not effective enough or cause unwanted effects.
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Repatha is an example of anti-PCSK9 antibody approved by the FDA commonly prescribed for folks who can’t tolerate statins.
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Yes, thanks for the reminder. Rapatha would be the next one we add.
BTW, I’m a big fan of Dr Radio on Sirius XM channel 110. It’s real docs from NYU Langone. Dr. Fred Feit talks about these drugs all the time. And, all the notable related research.
BTW, I’ve read that only Cardiologists can rx these higher level meds. My internist sent me to a cardiologist to work through all this.
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I am also a big fan of Doctor Radio. I first learned about lipoprotein from Fred Feit and it motivated me to get mine checked. My level is the same as my LDL - 78. I’m on Crestor and my doctors feel that everything is under control.
Dr. Feit’s show is on Thursdays from 6-8 a.m. Its repeated at other times or you can listen through the Sirius app.
Slightly off topic, but my favorite Doctor Radio show is Emergency Medicine-so knowledgeable and entertaining (Thursdays from 8-10 a.m.)
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My husband who has high Lp(a), is taking Praluent and atorvastatin to lower his LDL to below 30. It was low to begin with. His Lp(a) decreased from 210 to 160. He has been a lifelong runner—completing eight marathons—and has maintained a weight under 145 pounds at 5’10" his entire adult life. Our children were also tested and have higher-than-average Lp(a) levels; my daughter has since started Crestor. After seeing my husband’s experience, our neighbor—who is a fellow physician—now routinely orders Lp(a) testing for his patients.
Edit to add- my husband says they’ve done cross section studies to indicate that 20% of the US population carry high Lp(a) levels — and most don’t even realize it.
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The study linked in the initial post of this thread indicates that:
| Percentile | LP(a) in mg/dL | Note |
|---|---|---|
| 48 | 10 | |
| 51 | 11 | |
| 74 | 30 | 30-60 is where increased risk started being detected |
| 76 | 33 | |
| 88 | 60 | |
| 91 | 66 | |
| 96 | 83 | |
| 97 | 90 | |
| 98 | 120 | |
| 99 | 131 |
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And Quest will aggregate all my tests…those ordered thru my regular doc, the ones ordered thru the NP via Ultalabs. I have over 12 years of data at the click of a button.
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Labs are back and reviewed by cardiologist.
My LDL has decreased from 135 to 79 with the combination of Crestor and Zetia.
I don’t know when LPa will be retested.
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Wow, LDL below 30? I’ve never heard of cholesterol recommended to be lowered to that level. I thought below 70 was good enough.
I thought Lp(a) couldn’t be changed (though my sister read a study that said red wine could lower it slightly, so I’m going with that 
). Your husband managed to lower it 50 points? That’s amazing.