What is lipoprotein (a) - Lp(a) or “Lp little a” - and why do you need an Lp(a) blood test?

If you’ve never heard of lipoprotein (a), you’re not alone. Most doctors haven’t come across it either, even though it’s the commonest genetic risk factor for heart disease and international guidelines recommend we all get tested. In this short article we’ll get straight to the point and explain what lipoprotein (a) is and why you need an Lp(a) blood test.

Lipoprotein (a) is also written Lp(a) and pronounced “LP little a”. As the name suggests, Lp(a) is a “lipoprotein” which is a combination of lipid (fat) and protein. You’ve probably heard of lipoproteins before, though you might not have realised it.

LDL (or low density lipoprotein) and HDL (or high density lipoprotein) are two other lipoproteins and you’ll probably have seen their names if you’ve ever had your cholesterol levels checked.

In fact, Lp(a) is actually a modified type of LDL. We all have a gene called LPA. This LPA gene encodes a protein called apolipoprotein (a). When apolipoprotein (a) sticks to LDL, it converts LDL to Lp(a). So we all have some amount of Lp(a) in our blood but the exact amount depends on our LPA genes which we inherit from our parents.

Some people have LPA genes which mean they produce a lot of Lp(a) while others have LPA genes which mean their Lp(a) levels are low.

You may already know that LDL is a very important factor leading to heart disease. LDL molecules can escape the blood vessels and get into the arterial wall where it can lead to inflammation and narrowing in a process called atherosclerosis.

Turns out that Lp(a) can cause atherosclerosis in exactly the same way as LDL, except that it’s far more potent. This means that if you have high levels of Lp(a) you’re at much higher risk of developing atherosclerosis and heart disease than if your levels were low. Given that 1-in-4 of us die from heart disease anyway, anything that increases your risk even further is a big deal.

High Lp(a) levels also increase your risk for narrowing of one of your heart valves (“aortic stenosis”), stroke and chronic kidney disease

High Lp(a) is very common. Roughly 20-30% of us have high levels of Lp(a)¹. Sex and ethnicity also play a role. People of South Asian or Black ethnicities are more likely to have high Lp(a) levels than White and Chinese populations². Lp(a) levels also tend to be slightly higher in women than men³.

It’s really important to understand that Lp(a) levels are almost entirely determined by your genes. This means that things like diet and exercise have very little effect on your Lp(a) level. So you can be the fittest person on the planet and still be at higher risk of heart disease because of high Lp(a) levels.

Furthermore, if you have the relevant genes, your levels of Lp(a) will be high from as early as two years old and will stay high for life.

In short, international guidelines recommend that everyone should check their Lp(a) levels at least once⁴. Because Lp(a) levels are genetically determined and will not change, you only really need to test your Lp(a) level once. If your Lp(a) level is normal then you don’t need to test it again.

Although everyone should check their Lp(a) as a matter of routine, it’s even more important for some people. If you have a family history of heart disease, Lp(a) might be to blame and you should certainly check your levels. If someone in your family has high Lp(a), you’re at higher risk yourself and should take an Lp(a) test.

Unfortunately, even though guidelines recommend we all have our Lp(a) level checked, this is another area of preventative healthcare that the NHS is not offering.

However, it’s really simple to check your Lp(a) level with our Lp(a) blood test. You'll use the easy at home test kit to take a small blood sample from a fingerprick and send it to our lab for analysis. You’ll get your Lp(a) level back within a couple of days along with a report from one of our doctors explaining what your Lp(a) result means and whether you need to take any action.