Lifestyle

The Heart Blood Test a Standard Cholesterol Check Leaves Out, Even Though High Levels Run in Families

By Curtis Jones · October 31, 2026

A routine cholesterol check usually leaves out one number that matters for heart health: lipoprotein(a), a fat-carrying particle in the blood that can raise the risk of heart attack and stroke and is largely set by the genes a person is born with.

Lipoprotein(a), usually shortened to Lp(a) and pronounced “L-P-little-A,” is a cholesterol-carrying lipoprotein whose level is mostly inherited, according to the American Heart Association. The National Heart, Lung, and Blood Institute says it is similar in structure to LDL, the so-called bad cholesterol, and, like LDL, deposits cholesterol in the arteries and can show up in plaque.

High levels are common. The heart association says about 1 in 5 people worldwide have high Lp(a), and that a level can be high without a person noticing because it usually doesn’t cause symptoms.

The test is easy to miss. The heart association says the standard lipid panel doesn’t include Lp(a), and the Centers for Disease Control and Prevention says a provider has to order the Lp(a) blood test separately. Cleveland Clinic notes that someone with high Lp(a) may be more likely to have heart and blood vessel disease even if their other cholesterol numbers are fine.

Why it matters. The CDC says high Lp(a) makes a heart attack, a stroke and aortic stenosis, a narrowing of the heart’s aortic valve, more likely, especially in people with familial hypercholesterolemia or signs of coronary heart disease. The agency explains that Lp(a) cholesterol can build up in blood vessel walls, can cause increased clotting and promotes inflammation that makes plaques more likely to rupture. The heart association adds peripheral artery disease to the list.

It runs in families. The CDC says high Lp(a) levels run in families. Cleveland Clinic says the genes inherited from biological parents decide a person’s level, and the amount someone has as a child will most likely stay about the same for years. An NHLBI article quoted Dr. Sotirios Tsimikas, an Lp(a) researcher at the University of California San Diego, calling it likely the leading inherited risk for cardiovascular disease, while adding that an elevated level “doesn’t mean you are going to have an event. It just puts you at a higher risk.”

Who should ask. The heart association recommends every adult be tested at least once. It says testing may be especially important for people with a personal or family history of early heart disease, meaning before 55 in men or 65 in women, a known family history of high Lp(a), or familial hypercholesterolemia, an inherited condition that can cause very high LDL. The CDC says a provider may also suspect high Lp(a) in people with poor circulation in the legs or certain types of aortic stenosis.

Once is usually enough. Because levels are largely genetic and don’t change much with exercise, the NHLBI article said experts noted a one-time screening would be sufficient for most people.

What a high result means. The heart association says lifestyle changes don’t lower Lp(a), and the CDC says current treatments for high levels are limited. The heart association says people can still lower their overall risk of heart disease and stroke by managing cholesterol, blood pressure and diabetes, eating a heart-healthy diet, staying active, keeping a healthy weight and avoiding tobacco. The CDC advises people with high Lp(a) to lower their LDL if it is high. The heart association also recommends testing close relatives, such as parents, siblings and children, when a person’s level is high.

This article is for general information and is not medical advice. Talk with your doctor about whether an Lp(a) test is right for you, and call 911 for chest pain or signs of a stroke. This article was produced with the assistance of AI and fact-checked against the sources cited by LightWave Reports.