The American College of Cardiology (ACC) and American Heart Association (AHA) just released their updated guidelines on cholesterol and heart disease risk in 2026. One of the most important updates? A clear, strong recommendation that every adult should have their Lp (a) checked at least once in their lifetime. The American Heart Association now echoes that same message.
Here’s what that means for you in plain language.
First — What Is Lp(a)?
Lipoprotein (a) or Lp (a) is a cholesterol-carrying particle in your blood. Your level is mostly inherited, and when it’s high, it can raise your risk of heart disease and stroke. Think of it as a stickier, more troublesome cousin of LDL (“bad”) cholesterol — one that promotes plaque buildup in the arteries, triggers inflammation, and can interfere with your body’s natural clot-dissolving system all at the same time.
About 1 in 5 people worldwide have high Lp(a). This is a risk factor that’s been quietly affecting millions of people — and most of them have never been tested.
Your Regular Cholesterol Test Doesn’t Check This
This is one of the most important things I want you to take away from this post. The standard lipid panel — the routine cholesterol test — doesn’t include Lp(a). The only way to know your level is through a separate blood test that your doctor orders specifically for it.
So even if your doctor told you your cholesterol looks great, you may still have a significantly elevated Lp(a) and have no idea.
Does insurance cover the test?
Currently, insurance coverage of the blood test is inconsistent. Medicare has not covered it recently. With this change in medical guidelines, I hope that insurance companies, including Medicare, will start covering the lab test.
In the meantime, you can get good cash pay prices for the blood test. My patients pay a little under $20.
Who Should Get Tested?
The short answer: everyone. The new guidelines give their highest-level recommendation — a Class 1 — for Lp(a) testing in all adults. A few groups deserve especially prompt testing:
- Family history of early heart disease. Testing is especially important if you have a family or personal history of premature heart disease — defined as under age 55 for men and under age 65 for women.
- Known family history of high Lp(a). Because Lp(a) is largely genetic, if one family member has it, others are at risk too. This is called cascade screening — testing close relatives to find others who may not know they’re affected.
- Familial hypercholesterolemia (FH). If you’ve been diagnosed with FH — an inherited condition where people are born with very high LDL levels — Lp(a) testing is particularly important.
The good news: no fasting is required beforehand, and a single lifetime measurement is generally all you need, since Lp(a) is more than 90% genetically determined and stays very stable over time.
Are Some People at Higher Risk?
Yes. Lp(a) levels tend to be higher in people of African descent and in South Asian populations. If you fall into either of these groups, getting tested is especially worthwhile.
Levels may also increase during certain life stages, such as pregnancy and menopause. And certain medical conditions — including kidney disease, liver disease, and thyroid disease — can raise Lp(a) levels as well. This is worth discussing with your doctor if any of these apply to you.
What Do the Numbers Mean?
If your Lp(a) comes back elevated, here’s a straightforward way to understand the risk levels:
| Lp(a) Level | What It Means |
| ≥50 mg/dL (125 nmol/L) | Elevated — affects about 1 in 5 people; roughly 40% higher heart risk |
| ~80–100 mg/dL (200–250 nmol/L) | About double the average heart disease risk |
| ≥180 mg/dL (~430 nmol/L) | About 4 times the average risk — similar to a serious inherited cholesterol disorder |
Your individual risk depends on many factors beyond Lp(a) alone — including your age, blood pressure, and other health conditions.
Why Does It Matter? What Can Lp(a) Actually Do?
High Lp(a) levels can cause clotting, inflammation, and plaque buildup in your arteries. Over time, this can reduce or even block blood flow to important organs, significantly raising your risk for heart attack, stroke, aortic stenosis (stiffening of the heart valve), and peripheral artery disease (blockages in the leg arteries).
In other words, it doesn’t just affect your heart — it can affect your entire circulation. That’s why understanding your Lp(a) level matters so much for your long-term health picture.
What Can Be Done About It?
I want to be straightforward with you: we currently don’t have an FDA-approved drug that specifically targets Lp(a). But that doesn’t mean there’s nothing to do. Far from it.
1. Take your modifiable risk factors seriously. Even if you can’t change your genes, you can change your habits. Although lifestyle changes don’t directly lower Lp(a) levels, you can lower your overall risk of heart disease and stroke by managing other risk factors such as cholesterol, blood pressure, and diabetes; eating a heart-healthy diet; getting regular physical activity; maintaining a healthy weight; avoiding tobacco products; and getting 7–9 hours of restful sleep each day. heart
The guidelines reinforce this: people with elevated Lp(a) who followed healthy lifestyle habits had a 67% lower risk of heart disease compared to those who didn’t. That’s a remarkable difference — and it shows how much power you have even when your genetics aren’t working in your favor.
2. Statins are still essential — with a caveat. Statins (like atorvastatin or rosuvastatin) are the cornerstone of heart disease prevention. They don’t lower Lp(a) — and may very slightly raise it — but they remain critical for reducing your overall cardiovascular risk. If your doctor has prescribed one, keep taking it.
3. PCSK9 inhibitors offer added benefit. These injectable medications powerfully lower LDL cholesterol and also reduce Lp(a) by about 15–30%. For patients with established heart disease and elevated Lp(a) who haven’t reached their cholesterol goals on statins alone, the new guidelines specifically recommend that PCSK9 inhibitors be strongly considered.
4. Lipoprotein apheresis — for the highest-risk patients. This procedure filters Lp(a) directly out of the blood, much like dialysis. It’s FDA-approved for patients with elevated Lp(a) (≥60 mg/dL) who also have a genetic cholesterol condition and established heart or peripheral artery disease. It’s a specialized treatment reserved for the most severe cases.
5. New treatments are on the horizon. This is genuinely exciting territory. Several new drugs currently in large clinical trials can lower Lp(a) by 70–98%. These include injectable medications given monthly or even just once or twice a year, as well as a daily pill. Results from these trials are expected between 2026 and 2029. If they prove effective at reducing heart attacks and strokes, it could be a life-changing event for the millions of people with high Lp(a).
The Bottom Line
Lp(a) testing should now be considered a standard part of adult preventive care — like checking your blood pressure or your A1c. One simple blood test can reveal something important about your lifelong cardiovascular risk that your routine cholesterol panel completely misses.
If you’ve never had your Lp(a) checked, ask about it at your next visit. At Jacksonville Concierge Medicine, we offer comprehensive cardiovascular risk assessments — including Lp(a) — as part of our approach to proactive, personalized care.
Dr. Kyle Mikals is a board-certified Internal Medicine physician and co-owner of Jacksonville Concierge Medicine. He specializes in primary care and lifestyle medicine for adults in Jacksonville, Nocatee, the Beaches, and St. Johns County.
References
- Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Journal of the American College of Cardiology. 2026.
- National Library of Medicine (MedlinePlus). Lipoprotein (a) Blood Test. 2022.
- Nordestgaard BG, Langsted A. Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024.
- Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies. Journal of the American College of Cardiology. 2017.
- Reyes-Soffer G, Ginsberg HN, Berglund L, et al. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2022.
- Alhomoud IS, Talasaz A, Mehta A, et al. Role of Lipoprotein(a) in Atherosclerotic Cardiovascular Disease: A Review of Current and Emerging Therapies. Pharmacotherapy. 2023.
- Tsimikas S, Marcovina SM. Ancestry, Lipoprotein(a), and Cardiovascular Risk Thresholds: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2022.
- Xie S, Galimberti F, Olmastroni E, et al. Effect of Lipid-Lowering Therapies on Lipoprotein(a) Levels: A Comprehensive Meta-Analysis of Randomized Controlled Trials. Atherosclerosis. 2025.
- Rader DJ. Targeting Lipoprotein(a) — the Next Frontier in Cardiovascular Disease. New England Journal of Medicine. 2025.
- Nissen SE, Linnebjerg H, Shen X, et al. Lepodisiran, an Extended-Duration Short Interfering RNA Targeting Lipoprotein(a): A Randomized Dose-Ascending Clinical Trial. JAMA. 2023.
- Nissen SE, Wolski K, Watts GF, et al. Single Ascending and Multiple-Dose Trial of Zerlasiran, a Short Interfering RNA Targeting Lipoprotein(a): A Randomized Clinical Trial. JAMA. 2024.
- Duarte Lau F, Giugliano RP. Lipoprotein(a) and its Significance in Cardiovascular Disease: A Review. JAMA Cardiology. 2022.
- American Heart Association. Lipoprotein(a). heart.org. Accessed May 2026. https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a
