Table of Contents
Key Takeaways:
Approximately 20% of people have elevated lipoprotein(a). Lp(a) levels are primarily inherited and remain relatively stable throughout life.
Elevated Lp(a) is recognized by major cardiovascular organizations as an independent risk factor for cardiovascular disease. Most experts consider 50 mg/dL (125 nmol/L) or higher to be elevated.
Your overall cardiovascular risk depends on factors like age, LDL cholesterol, blood pressure, diabetes, smoking status, and family history.
Receiving a lab result showing elevated lipoprotein(a) levels can be unsettling, especially if you're not sure exactly what that means. An estimated 1 in 5 people worldwide has elevated lipoprotein(a), yet many don't know it until it's discovered during blood testing.
One of the most important things to understand is that Lp(a) is primarily determined by your genes. Unlike LDL ("bad") cholesterol, lipoprotein(a) levels aren’t meaningfully changed by diet, exercise, or most dietary supplements. Lp(a) test results provide valuable information about your inherited cardiovascular risk that can help you and your healthcare provider make informed decisions about your overall heart health.
Here's what you should know about what elevated lipoprotein(a) levels mean, why they matter, and what steps you should consider after receiving your results.
There is currently no established dietary supplement shown to lower Lp(a). If your level is elevated, discuss your results with your healthcare provider.
What Is Lipoprotein(a)?
Lipoprotein(a), often abbreviated Lp(a), is a cholesterol-carrying particle found in the bloodstream. It's similar to LDL cholesterol in a few ways, but includes an additional protein called apolipoprotein(a), which means that it works differently within the body.
Unlike traditional cholesterol markers, lipoprotein(a) levels are largely determined by genetics. Your LPA gene is responsible for producing apolipoprotein(a), and inherited variations in this gene account for most differences in Lp(a) levels between individuals.
Because Lp(a) is inherited, lifestyle habits that improve overall cardiovascular health (such as eating a nutritious diet, exercising regularly, or maintaining a healthy weight) typically do not effectively manage Lp(a) in the same way they may manage other types of cholesterol.
Major organizations, including the American Heart Association (AHA), the American College of Cardiology (ACC), and the European Atherosclerosis Society (EAS), recognize elevated Lp(a) as an independent, genetically determined cardiovascular risk factor associated with atherosclerotic cardiovascular disease, heart attack, stroke, and calcific aortic valve disease.
Evidence supporting this association continues to grow. In a UK cohort of 26,619 people with LPA results, 17.6% were flagged as elevated, and cardiovascular risk rises as LPA concentrations rise.
You'll still need to adhere to important heart-healthy habits to promote and support overall cardiovascular health because other heart-healthy factors respond positively to these habits.
What Does "Elevated" Lipoprotein(a) Mean?
One challenge with interpreting lipoprotein(a) levels is that laboratories may report results using either milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). These measurements are not directly interchangeable because Lp(a) particle size varies widely.
According to the European Atherosclerosis Society consensus on lipoprotein(a):
Less than 30 mg/dL (<75 nmol/L): Generally considered normal
30-50 mg/dL (75-125 nmol/L): Intermediate or "gray zone"
Greater than 50 mg/dL (>125 nmol/L): Elevated and associated with increased cardiovascular risk
It's important to understand that these thresholds are guidelines rather than strict cutoffs. Someone with an Lp(a) level of 130 nmol/L is not automatically in danger, while someone at 124 nmol/L is not automatically in perfect cardiovascular health.
For the first time, the 2026 ACC/AHA multisociety guideline recommends that every adult have their Lp(a) measured at least once — a Class I recommendation. Since Lp(a) levels are largely inherited and remain relatively stable over time, a single measurement is often sufficient unless your healthcare provider recommends repeat testing.
If your lab report shows elevated lipoprotein(a), avoid interpreting the number in isolation. Your healthcare provider can explain what it means alongside your LDL cholesterol, blood pressure, family history, age, diabetes status, smoking history, and other cardiovascular risk factors.
What Are the Risks of High Lp(a)?
Research consistently shows that elevated lipoprotein(a) is associated with a higher likelihood of several cardiovascular conditions.
With that in mind, some of the specific risks associated with high lipoprotein(a) include:
Atherosclerotic cardiovascular disease
Heart attack
Ischemic stroke
Calcific aortic valve stenosis
According to the American Heart Association, Lp(a) levels of 125 nmol/L (50 mg/dL) or higher may increase cardiovascular risk. Levels around 250 nmol/L (100 mg/dL) have been associated with substantially higher risk, with some studies suggesting approximately double the risk compared with lower levels.
It’s important to keep in mind that an elevated Lp(a) result doesn’t guarantee that someone will experience a heart attack or stroke. On the other end of things, a person with normal Lp(a) can still develop cardiovascular disease due to other risk factors.
Someone with elevated Lp(a) who has healthy blood pressure, well-managed LDL cholesterol, does not smoke, exercises regularly, and has no diabetes may have a very different overall cardiovascular outlook than someone with elevated Lp(a) plus multiple additional risk factors.
This is why physicians emphasize overall cardiovascular risk assessment rather than focusing on a single line on a comprehensive heart health screening.
What Should You Do If Your Lp(a) Is Elevated?
The first step is to share your results with your healthcare provider (if they haven't already mentioned it), who can evaluate them alongside your complete medical history and cardiovascular risk profile.
Depending on your situation, your doctor may recommend:
A comprehensive cardiovascular risk assessment
Reviewing LDL cholesterol and other lipid markers
Evaluating blood pressure
Assessing blood sugar or diabetes risk
Reviewing family history of premature cardiovascular disease
Discussing smoking status and other lifestyle factors
Because Lp(a) itself is difficult to modify, physicians often focus on optimizing other modifiable cardiovascular risk factors that can contribute to overall risk.
Current treatment options specifically targeting Lp(a) remain limited. Lipoprotein apheresis is available to some patients with severe inherited lipid disorders under specific circumstances. PCSK9 inhibitors have demonstrated small but meaningful reductions in Lp(a) in some studies, although they are prescribed for broader cholesterol management rather than specifically for elevated Lp(a).
Cardiovascular health supplements (including nattokinase) have been studied for aspects of circulation and cardiovascular wellness, but there is currently no established clinical evidence that nattokinase directly lowers lipoprotein(a) levels.
Any decision about supplementation should be discussed with your healthcare provider, particularly if you take blood-thinning medications or have existing cardiovascular conditions.
The Bottom Line on Elevated Lipoprotein(a)
An elevated lipoprotein(a) level provides valuable information about your inherited cardiovascular risk, but it's only one of many important health factors. Because Lp(a) is primarily genetic, it is generally not meaningfully altered by diet, exercise, or most supplements.
If you've been told your Lp(a) is elevated, schedule a discussion with your healthcare provider. Together, you can review your overall risk profile, determine whether additional testing is appropriate, and develop a personalized plan for supporting long-term cardiovascular health. While research into Lp(a)-targeted therapies continues to advance, informed conversations with your healthcare team remain the most important next step after receiving an elevated result. For more educational content around heart health, check out the rest of the Toku blog.
FAQs
Is elevated Lp(a) serious?
Elevated Lp(a) is a recognized cardiovascular risk factor, but it is one of many. Its significance depends on your overall cardiovascular risk profile. Your doctor can help you understand what your level means in the context of your full health picture.
Can I lower my Lp(a) with diet or exercise?
Unlike LDL cholesterol, Lp(a) levels are primarily set by genetics and do not respond meaningfully to diet, exercise, or most lifestyle changes. Some medications under investigation may reduce Lp(a), but currently approved options are limited. Talk to your doctor about your options.
How often should I test my Lp(a)?
The AHA's 2026 dyslipidemia guidelines recommend that all adults measure Lp(a) at least once. Because Lp(a) is genetically determined, levels generally remain stable throughout life and do not require frequent retesting unless your doctor recommends otherwise.
Does high Lp(a) always lead to heart disease?
No. Elevated Lp(a) increases cardiovascular risk, but it does not guarantee heart disease. Many people with high Lp(a) live healthy lives, particularly when other risk factors like blood pressure, LDL cholesterol, and blood sugar are well managed.
*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. Keep out of reach of children. Consult with your physician before use if you are pregnant, nursing, have a medical condition, or taking anticoagulants. Discontinue use and consult with your health care professional if you experience any adverse reaction to this product.
Sources:
Lipoprotein(a) | American Heart Association
Feature | Lipoprotein(a): An Independent Risk Factor For CV Disease | American College of Cardiology
Lipoprotein(a): the neglected risk factor in cardiovascular health | PMC
