Complete Testing & Optimization Guide
Optimal ranges, provider comparison, and strategies to improve your Lipoprotein (a) levels
Only 5 providers include this test
Lipid Panel / Cardiovascular Health
Desirable:<30 mg/dL, Borderline:30-50 mg/dL, High:>50 mg/dL
Abnormal Lipoprotein (a) levels can indicate underlying health issues that may go undetected without proper testing. Regular monitoring helps catch problems early when they're most treatable.
Understanding your Lipoprotein (a) levels enables targeted interventions, tracks treatment effectiveness, and helps optimize your overall health and performance.
Lipoprotein (a), abbreviated as Lp(a), is a unique cholesterol particle consisting of an LDL-like particle with an additional protein called apolipoprotein(a) attached to it. Often called "the forgotten cholesterol,"Lp(a) is a powerful independent risk factor for cardiovascular disease, stroke, and aortic valve stenosis. What makes Lp(a) particularly challenging is that your levels are 70-90% genetically determined and largely unresponsive to diet and lifestyle changes.
Lp(a) is highly atherogenic and prothrombotic, meaning it both promotes plaque formation and increases blood clotting tendency. The apolipoprotein(a) component has structural similarity to plasminogen, interfering with the body's clot-dissolving mechanisms. Lp(a) particles are smaller and more easily oxidized than regular LDL, making them particularly damaging to arterial walls. Approximately 20-30% of the population has elevated Lp(a) levels, often without knowing it.
Despite being discovered in 1963, Lp(a) has only recently gained widespread clinical attention as a critical cardiovascular risk factor. Elevated Lp(a) can explain premature heart disease in people with otherwise healthy lipid profiles and may account for much of the "residual risk"in statin-treated patients. Major cardiology societies now recommend at least one Lp(a) measurement in every adult's lifetime for risk stratification, as knowing your Lp(a) level can significantly impact cardiovascular prevention strategies.
Bottom line: TSH and Free T4 alone miss people with conversion problems. Free T3 is the only way to know if you have enough active thyroid hormone at the tissue level.
| Range Type | Level | Clinical Significance |
|---|---|---|
| Explains premature heart disease and "familial"patterns | Highly atherogenic and prothrombotic properties | Undetectable by standard cholesterol tests |
| Optimal Lp(a) Ranges | Standard:<30 mg/dL or <75 nmol/L | Functional/Optimal:<14 mg/dL or <35 nmol/L |
| Clinical Concern:>50 mg/dL or >125 nmol/L | Lp(a) can be measured in mg/dL or nmol/L;nmol/L is preferred as it accounts for particle size variations. Conversion varies by isoform. Levels >50 mg/dL (>125 nmol/L) confer 2-4x increased cardiovascular risk. Levels >180 nmol/L are considered very high risk. Note:Lp(a) levels remain relatively stable throughout life after age 5. | Aggressive LDL-C and ApoB Lowering |
| Since Lp(a) itself is difficult to lower, compensate by aggressively reducing other atherogenic particles. Target LDL-C <70 mg/dL (or <55 mg/dL if very high Lp(a)) using statins, ezetimibe, or PCSK9 inhibitors. This "treat the company it keeps"approach reduces overall cardiovascular risk. | PCSK9 Inhibitors | PCSK9 inhibitors (evolocumab, alirocumab) can reduce Lp(a) by 20-30%, the most effective currently available therapy. While modest, this reduction may be clinically meaningful in very high-risk patients. These medications also substantially lower LDL-C and ApoB. |
Standard lab range:Desirable:<30 mg/dL, Borderline:30-50 mg/dL, High:>50 mg/dL
Low-dose aspirin (81mg daily) may be particularly beneficial in patients with elevated Lp(a) due to its prothrombotic effects. Discuss with your physician, weighing bleeding risks against cardiovascular benefits. Evidence suggests aspirin may be more effective in high Lp(a) individuals.
High-dose niacin (1-3g daily) can lower Lp(a) by 20-30%, but cardiovascular outcome benefits remain unproven and side effects are common. Generally not recommended as first-line therapy. Newer therapies are in development. Use only under physician supervision.
Novel RNA-based therapies (antisense oligonucleotides, siRNA) can reduce Lp(a) by 80-90% and are currently in phase 3 trials. Consider enrolling in clinical trials if you have very high Lp(a) (>200 nmol/L). These therapies may be available commercially by 2025-2026.
Low Lp(a) (<10 mg/dL) is beneficial and protective against cardiovascular disease;no adverse effects
Genetic factors;low Lp(a) is associated with reduced cardiovascular risk and is considered protective
Note: Lp(a) and Cardiovascular Risk
Note: Kamstrup et al., "Genetic Evidence That Lipoprotein(a) Associates with Atherosclerosis,"Journal of the American College of Cardiology, 2012
Clinical trials showing that PCSK9 inhibitors reduce Lp(a) by 20-30% and that this reduction may contribute to cardiovascular benefit, suggesting therapeutic value even with modest Lp(a) lowering.
Source:Tsimikas et al., "PCSK9 Inhibitors Reduce Lipoprotein(a),"Journal of the American College of Cardiology, 2020
Expert consensus statement from major cardiology societies recommending at least one Lp(a) measurement in all adults for cardiovascular risk stratification, particularly those with premature CVD or strong family history.
Source:Wilson et al., "Use of Lipoprotein(a) in Clinical Practice,"Circulation, 2019
Phase 2 trial results demonstrating that antisense oligonucleotide therapy targeting Lp(a) production reduces levels by up to 90%, with phase 3 outcomes trials underway to determine cardiovascular benefits.
Source:Tsimikas et al., "Antisense Therapy Targeting Lipoprotein(a),"New England Journal of Medicine, 2020
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Source:None
| Provider | Includes Test | Annual Cost | Total Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ |
 WHOOP Advanced Labs | — | $349 | 65 |
 Labcorp OnDemand | — | $398 | 30+ |
| — | $486 | 40+ | |
| — | $468 | 83 | |
| ✓ | $798 | 100+ | |
 InsideTracker | — | $680 | 48 |
 Function Health | ✓ | $499 | 100+ |
| ✓ | $900 | 70+ | |
| ✓ | $1150 | 110 | |
| — | $Varies | 75+ |
Choose from 5 providers that include this biomarker in their panels
Lipoprotein (a) is a lipid panel / cardiovascular health biomarker that Genetic cardiovascular risk factor The normal reference range is Desirable:<30 mg/dL, Borderline:30-50 mg/dL, High:>50 mg/dL. Regular testing helps track changes and identify potential health issues early.
5 out of 10 major blood testing providers include Lipoprotein (a) in their standard panels. These include Superpower, Blueprint, Mito Health and others.
For most people, testing Lipoprotein (a) 2-4 times per year is recommended to establish baseline levels and track trends. If you have abnormal results or are actively working to optimize this biomarker, more frequent testing (quarterly) may be beneficial. Always consult with your healthcare provider for personalized testing frequency recommendations.
The standard laboratory reference range for Lipoprotein (a) is Desirable:<30 mg/dL, Borderline:30-50 mg/dL, High:>50 mg/dL. However, many functional medicine practitioners recommend tighter "optimal" ranges for peak health and performance. Your ideal range may vary based on your age, sex, health goals, and other individual factors. Work with a healthcare provider familiar with optimal ranges to determine your target levels.
Most direct-to-consumer blood testing services that include Lipoprotein (a) provide the physician order as part of their service. However, some states have restrictions on direct-to-consumer testing. Check with your chosen provider about availability in your state and whether they provide the necessary physician authorization.
Genetically determined risk factor for heart disease and stroke. Not affected by lifestyle changes. High levels require more aggressive management of other risk factors.
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs and before making decisions about blood testing.
