Lipoprotein(a) is largely genetically determined and stays fairly stable through adult life, so a single measurement is usually enough. Raised levels add to atherosclerotic and aortic valve risk independently of LDL, and are not captured by the standard risk equations.
A high result is most useful as a risk enhancer: it can tip a borderline-risk patient towards starting a statin, and it is a reason to test first-degree relatives. Statins do not lower it meaningfully.
- Measure lipoprotein(a) once in adulthood, particularly with premature cardiovascular disease in the family.
- Use a raised level as a risk enhancer when the statin decision is borderline.
- Offer cascade testing to first-degree relatives of someone with a high level.
- Do not repeat the test to monitor statin therapy; statins barely change it.
Why it matters
An inherited risk factor that standard equations ignore can change a borderline decision.
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