What to Know About Lp(a) on Awareness Day

March 24 marks Lp(a) Awareness Day, a time to spotlight an often-overlooked but important risk factor for heart disease: lipoprotein(a), or Lp(a). While many patients are familiar with cholesterol numbers like LDL, far fewer have heard of Lp(a) — even though elevated levels are largely genetic and can significantly increase the risk of heart attack, stroke and other cardiovascular conditions. With heart disease remaining the leading cause of death in the United States, raising awareness about Lp(a) testing could play a critical role in prevention.

In this interview with The Educated Patient, Abeer Berry, D.O., shares both her clinical expertise and personal experience after discovering her own elevated Lp(a) during routine testing. Her story highlights an important reality: Even health care professionals can be surprised by hidden risk factors. Berry emphasizes that because Lp(a) is inherited and not routinely included in standard cholesterol tests, many people may be living with elevated levels without knowing it. Her message encourages patients to be proactive — ask questions, seek testing when appropriate and take steps to manage overall heart health, even when certain risks are beyond their control.

Many patients have never heard of Lp(a). What exactly is it, and why is it important for heart health?

Abeer Berry, D.O.: Lp(a), or lipoprotein(a), is a genetic marker that indicates an inherited “bad” cholesterol particle. Elevated Lp(a) is a key risk factor for heart disease. Too much of this protein can increase inflammation and blood clotting, risking occurrence of heart attack, stroke and peripheral artery disease. As many as one in five Americans have high Lp(a) levels — but many don’t know it.

You discovered your own elevated Lp(a) after routine testing. Can you share what that experience was like and what you learned from it?

AB: As a cardiologist, I aim to fully involve my patients to help them make well-informed decisions about their heart health and not feel like they are in the dark looking for answers. Discovering that I had elevated Lp(a) allowed me to take on the perspective of my patients. Suddenly, my heart was not what I thought it was — it needed the same, thorough care I give my patients.
Now, I must pay special attention to lifestyle factors to ensure I lower my overall cardiovascular risk. Since Lp(a) levels are genetic, I immediately thought about how this would impact my twin daughters. I’m making sure they are screened early and often. The knowledge of our elevated Lp(a) helps not only to prevent my potential future cardiovascular events but also to ensure my daughters are aware of their own risk and know how to combat the possible effects. It was a powerful reminder that some of these life-threatening conditions are invisible and asymptomatic.

How is Lp(a) different from the cholesterol numbers patients usually hear about?

AB: While both are lipoproteins, Lp(a) is different from LDL, the common term for “bad” cholesterol. Lp(a) is a modified form of LDL with an extra component, Apo(a). This extra protein makes it easier for Lp(a) to get trapped, causing plaque buildup that narrows the arteries, resulting in reduced blood flow.
LDL is based on genetics or lifestyle factors, while Lp(a) is determined strictly by genetics. A healthy lifestyle does not prevent you from the possibility of having high Lp(a) levels. Similarly, you could have a normal LDL number but a high Lp(a) number, meaning that a low number on an LDL test does not mean that you do not need to pursue Lp(a) testing.

Who should consider getting tested for Lp(a), and when should testing happen?

AB: Testing is crucial for those who have a known family history of elevated Lp(a) levels. However, not many people get their Lp(a) levels evaluated since the standard cholesterol test does not include Lp(a). This results in individuals left unaware of a family history riddled with elevated levels of Lp(a). Those who have a family or personal history of heart disease or premature cardiovascular disease or a diagnosis of familial hypercholesterolemia need to be proactive about Lp(a) testing.

Use your knowledge to your advantage to fight for your health. This is not a fixed rule, though — anyone who wants to know more about their cardiovascular health is encouraged to ask their doctor about Lp(a) testing.

Are there lifestyle changes or steps patients can take to help lower their overall risk if they have elevated Lp(a)?

AB: While lifestyle changes cannot lower Lp(a) levels, it is entirely possible and extremely important to lower your overall risk of heart disease. Ensuring you are eating a healthy diet and getting enough physical exercise and sleep are some of the crucial habits that can help you build a healthy cardiovascular profile. One should monitor their weight and strive to maintain a healthy weight. In addition, tobacco should be avoided, and alcohol should be limited. Although having elevated Lp(a) levels is outside of your control, these lifestyle factors are absolutely in your control and can change your life and health for the better.

Taking your medications as prescribed will also ensure your risk for high blood pressure, high cholesterol, obesity and diabetes is lowered. Your doctor may set your LDL goal lower than that of the general population, prescribing you a medication for cholesterol even if you weren’t previously considered to have high cholesterol, since direct treatment for Lp(a) is not universally available yet.

This is currently a measure I am taking myself. Adhering to this advice will reduce your risk of cardiovascular events with an elevated Lp(a).

What is the single most important message you want patients to understand about Lp(a) and heart health?

AB: Educate yourself and advocate for yourself on all aspects of heart health. Don’t be afraid to ask questions. While Lp(a) testing rates are incredibly low, we can change that together. For those who are at an elevated risk, seek testing. For those who want to understand their heart health on a deeper level, I encourage you to add Lp(a) testing to your normal cholesterol panel next time you talk to your doctor.