What Lp(a) is, and how it differs from LDL cholesterol
Lipoprotein(a), written Lp(a), is a lipoprotein made by the liver. According to the British Heart Foundation, it is similar to LDL cholesterol, the type most people know as bad cholesterol, but stickier because of an attached protein called apolipoprotein(a).
That stickiness is thought to speed up the narrowing of arteries and to increase the risk of clotting.
Lp(a) and LDL cholesterol are therefore related without being interchangeable. Someone can have an LDL result their GP is happy with and an Lp(a) result that adds meaningfully to their cardiovascular risk. One test does not stand in for the other.
Why Lp(a) is inherited and fixed for life
Lp(a) levels are set by the genes inherited from your biological parents. HEART UK, the UK’s cholesterol charity, states that levels do not change through a lifetime and are usually unaffected by lifestyle or environment. Age and sex do not affect them.
Ethnic background does affect typical levels. They are lower in some East Asian populations and higher in some African populations.
A few medical conditions can shift the number: chronic kidney disease, nephrotic syndrome, an underactive thyroid, and the menopause. Outside those, the level a person is born with is broadly the level they keep.
How common elevated Lp(a) is in the UK
HEART UK’s Lipoprotein(a) Taskforce estimates that approximately 1 in 5 people have elevated Lp(a), and that elevated Lp(a) is associated with 5 percent of cardiovascular disease events.
Those figures are estimates. There is no UK-specific population survey of Lp(a) equivalent to the Health Survey for England, so the prevalence figure comes from expert assessment, not a national sample.
The BHF’s UK Cardiovascular Disease Factsheet for January 2026 records over 8 million people in the UK living with cardiovascular disease, around 170,000 deaths a year, and 26 percent of all UK deaths. NHS costs run to an estimated 12 billion pounds a year, and 29 billion pounds to the UK economy overall.
Why a standard NHS cholesterol test does not measure Lp(a)
A routine cholesterol test in general practice reports total cholesterol, LDL or non-HDL cholesterol, HDL cholesterol and triglycerides. Lp(a) is not part of that panel, and both the BHF and HEART UK state this plainly. Measuring it requires a separate test, usually arranged through referral to a specialist lipid clinic.
Because levels are genetically fixed and stable, the BHF advises that you only need to have your Lp(a) levels checked once. There is no annual retest and no monitoring schedule.
Who is tested, and what the numbers mean
HEART UK’s statement of care specifies that Lp(a) should be measured in:
- people with a personal or family history of premature cardiovascular disease, meaning disease in the family under 60 years
- first-degree relatives of someone with an Lp(a) level above 200 nmol/L
- people with familial hypercholesterolaemia or another inherited lipid condition
- people with, or with a family history of, calcific aortic valve disease
- people with a borderline 10-year cardiovascular risk under 15 percent
Familial hypercholesterolaemia affects 1 in 250 people in the UK, around 270,000 people.
UK results are reported in nmol/L, a count of Lp(a) particles. The 2019 HEART UK consensus statement sets the bands at 32 to 90 nmol/L for minor risk, 90 to 200 nmol/L for moderate risk, 200 to 400 nmol/L for high risk, and above 400 nmol/L for very high risk.
What can and cannot lower Lp(a)
The BHF’s position, published in January 2026, is that “currently there are no approved treatments to reduce Lp(a) levels but there are clinical trials looking at other treatments.”
Working through the options one by one:
- Statins do not lower Lp(a). The BHF and HEART UK both state that statins have little effect on the amount of Lp(a), though they may shrink particle size.
- Diet and exercise do not lower Lp(a) to any meaningful degree.
- PCSK9 inhibitors can reduce Lp(a) by roughly 20 to 30 percent as a side effect of the LDL lowering they are approved for, but HEART UK states plainly that they are not currently licensed for lowering Lp(a).
- Lipoprotein apheresis, which filters lipoproteins from the blood, can lower Lp(a) by up to 75 percent. It is an existing NHS specialist treatment, used in a small number of people with recurrent cardiovascular disease despite optimal control of other risk factors.
Investigational treatments aimed directly at Lp(a) are in late-stage clinical trials. None is licensed in the UK, and none is a treatment option today.
Managing the risk you can change
An Lp(a) result is still useful, because it changes how hard a clinician works on everything else. UK management focuses on driving down each modifiable risk factor: LDL and non-HDL cholesterol, blood pressure, smoking, weight and diabetes control.
Statins are first line under NICE guideline NG238, and per the BHF a low-dose statin lowers LDL by up to about 30 percent while a high dose lowers it by more than 40 percent. Beyond statins, NICE has recommended ezetimibe (TA385), alirocumab (TA393), evolocumab (TA394), bempedoic acid with ezetimibe (TA694) and inclisiran (TA733). NHS.uk also lists injectable options including alirocumab, evolocumab and inclisiran.
If your LDL cholesterol has stayed high on treatment, our article on what happens when statins are not enough covers the next steps. Broader changes belong in the same conversation, and we have looked separately at the evidence on cutting down on alcohol.
Where UK guidance stands on Lp(a)
NICE’s current lipid guideline, NG238, published on 14 December 2023 and last reviewed on 2 September 2025, does not contain Lp(a)-specific recommendations. HEART UK’s Lipoprotein(a) Taskforce is asking NICE to add them.
That gap explains much of the inconsistency patients encounter. Testing depends on local lipid clinic practice, with no national recommendation behind it, so two people with identical family histories can have very different experiences of whether Lp(a) is ever mentioned to them.
Frequently asked questions
Is Lp(a) the same as bad cholesterol?
No. Lp(a) is related to LDL cholesterol but distinct from it. Both are lipoproteins made by the liver, but Lp(a) carries an extra protein, apolipoprotein(a), which makes it stickier. You can have a normal LDL cholesterol result and a high Lp(a) result at the same time.
Does the NHS test for Lp(a) in a standard cholesterol check?
No. A standard cholesterol test in general practice does not measure Lp(a). Testing is arranged separately, usually through referral to a specialist lipid clinic, and HEART UK sets out specific groups where it should be measured, such as people with a family history of premature cardiovascular disease.
Can diet and exercise lower Lp(a)?
No, not meaningfully. HEART UK states that Lp(a) levels are usually unaffected by lifestyle or environment and do not change through a lifetime. Diet and exercise remain worth doing for blood pressure, weight, LDL cholesterol and diabetes risk, but they will not move your Lp(a) number.
Do statins lower Lp(a)?
No. Both the British Heart Foundation and HEART UK state that statins have little effect on the amount of Lp(a), although they may shrink particle size. Statins remain the first line treatment for high LDL cholesterol under NICE NG238, and lowering LDL is still worthwhile for anyone with raised Lp(a).
How often should Lp(a) be retested?
Once is generally enough. Because levels are determined genetically and stay stable across a lifetime, the British Heart Foundation states that you only need to have your Lp(a) levels checked once. There is no need for annual retesting or ongoing monitoring of the number itself.
Is there a medicine that lowers Lp(a)?
Not yet in the UK. The British Heart Foundation stated in January 2026 that there are currently no approved treatments to reduce Lp(a) levels, and that clinical trials are looking at other treatments. Lipoprotein apheresis can lower Lp(a) by up to 75 percent but is reserved for a small number of specialist cases.
About Panthera
Panthera Biopartners is a site management organisation running commercial clinical trials at seven UK clinics, in Glasgow, Enfield, Keele, Preston, Rochdale, Sheffield and York, and has been the top global recruiter on several studies. Panthera does not conduct first in human studies. You can read about the cardiovascular clinical trials currently running at our sites. Participation is voluntary, participants can withdraw at any time, and everyone has time to read a Participant Information Sheet and ask questions before consenting.
Disclaimer
Not medical advice. This article is general information about lipoprotein(a) and cardiovascular risk. Decisions about testing, referral and treatment should be made with your GP or specialist, who can take your full medical history into account.
Conflicts and affiliations. Panthera Biopartners runs clinical trials, including studies relating to cardiovascular disease. If you are considering a study, discuss your suitability with your own clinician and with the study team before making a decision.
