How to prepare for a lipoprotein(a) blood test
Lipoprotein(a) is one of the most important cholesterol markers that most people have never heard of, and it can be high even in lean, well-trained athletes. Our editorial team explains who should be tested and how to prepare for an accurate result.
What lipoprotein(a) is
Lipoprotein(a), usually written Lp(a) and pronounced "L-P-little-a", is a cholesterol-carrying particle in the blood. Structurally it resembles LDL, the so-called bad cholesterol, but it has an extra protein called apolipoprotein(a) attached. That additional protein seems to make the particle more likely to promote atherosclerosis, inflammation and blood clotting.
Unlike most cholesterol measures, Lp(a) levels are overwhelmingly determined by genetics. A consensus statement from the European Atherosclerosis Society, led by Kronenberg and colleagues, explains that the size of the apolipoprotein(a) protein, coded by the LPA gene, largely dictates how much Lp(a) a person makes. Levels are fairly stable from early childhood onward.
High Lp(a) is common. Large population studies, reviewed by Nordestgaard and colleagues, link elevated levels to a higher risk of heart attack, stroke and narrowing of the aortic valve, independent of other cholesterol measures. Crucially, a fit, lean athlete with excellent LDL can still carry high Lp(a) without knowing it.
This is why interest in the test has grown, including among people who train and want a fuller picture of their cardiovascular risk.
Who should have the test
European guidelines on dyslipidaemia from the European Society of Cardiology and European Atherosclerosis Society, published by Mach and colleagues, recommend that every adult should consider having Lp(a) measured at least once in their lifetime to identify those with very high inherited levels.
HEART UK, the national cholesterol charity, set out in a consensus statement by Cegla and colleagues a call for wider testing in the UK, particularly in people with:
- a personal or family history of premature cardiovascular disease;
- familial hypercholesterolaemia or a strong family history of high cholesterol;
- a first-degree relative with raised Lp(a);
- aortic valve stenosis;
- cardiovascular events despite well-controlled LDL cholesterol.
Availability on the NHS varies by region, and the test may not be offered routinely. Your GP or a lipid clinic can advise on whether it is appropriate for you.
Because the value is largely fixed, most people need only one measurement. Repeat testing is usually reserved for specific situations, such as after starting a treatment known to affect Lp(a) or if the first result was borderline.
How to prepare
The good news is that preparation for an Lp(a) test is straightforward. Lp(a) is not meaningfully affected by a single meal, so fasting is generally not required for the test itself. However, it is often requested alongside a full lipid profile, and some laboratories or clinicians still ask for a fasting sample for that panel.
| Factor | Effect on Lp(a) | Practical advice |
|---|---|---|
| Recent meal | Minimal | Follow the lab's instructions for the wider lipid panel |
| Acute infection or inflammation | May raise temporarily | Postpone if you are unwell |
| Pregnancy | Tends to rise | Testing usually deferred until after |
| Hormone therapies | Some can change levels | Tell the clinician about all hormones |
| Kidney or liver disease | Can alter levels | Interpreted by your doctor |
Avoid a very strenuous session immediately before the test, mainly because it can affect other markers measured at the same time, such as triglycerides and liver enzymes. A normal training day before is unlikely to matter.
Bring a list of medicines and supplements. Testosterone, anabolic steroids and some other hormones can lower Lp(a), which may sound beneficial but usually occurs alongside harmful changes in HDL cholesterol and other risk factors. Disclosing use helps your doctor interpret all the results correctly.
Units and interpreting results
Lp(a) can be reported in two ways: nanomoles per litre (nmol/L), which counts particles, and milligrams per decilitre (mg/dL), which measures mass. Many UK laboratories now use nmol/L, which is preferred by expert bodies. The two units are not directly interchangeable because particle size varies between people.
Thresholds vary between guidelines, but higher values are associated with progressively greater risk. The EAS consensus describes risk as continuous, so it is better to think of Lp(a) as a dial rather than a switch.
A high result does not mean a heart attack is inevitable. It means your other risk factors, such as LDL, blood pressure, smoking and diabetes, deserve particularly close attention. Tsimikas, in a widely cited review, discusses how Lp(a) fits into overall risk assessment.
Because Lp(a) is inherited, a high result has implications for your family. Close relatives may wish to discuss testing with their own GP.
What you can and cannot change
Lifestyle measures, including diet and exercise, have little effect on Lp(a) itself. This can be frustrating for active people used to improving their numbers through effort. Nonetheless, healthy habits remain essential because they reduce the overall burden of risk.
Some medicines affect Lp(a) modestly, and several targeted therapies are in late-stage clinical trials. At present, the main management strategy in the UK is aggressive control of other risk factors, especially LDL cholesterol, under medical guidance.
Our editorial team does not advise using hormones or unlicensed drugs to manipulate Lp(a). Any treatment decisions belong with your GP or a lipid specialist.
Keep a copy of your result. Since it rarely changes, it is a useful piece of lifelong health information to share with future clinicians.
Editorial conclusions
Lipoprotein(a) is an inherited cholesterol particle that raises cardiovascular risk independently of LDL, and fit people are not immune.
Preparation is simple: fasting is usually not needed for Lp(a) itself, but follow instructions for any accompanying lipid tests, avoid testing while ill, and disclose all medicines and hormones.
One measurement is generally enough for life, and a high result means paying closer attention to modifiable risk factors and informing your family.
For related reading, see our articles on the full lipid profile, ApoB testing and how anabolic steroids affect cholesterol.
References
- Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925–3946.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–188.
- Cegla J, Neely RDG, France M, et al. HEART UK consensus statement on lipoprotein(a): a call to action. Atherosclerosis. 2019;291:62–70.
- Nordestgaard BG, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844–2853.
- Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692–711.
