October 30, 2025, 3:43 am | Read time: 5 minutes
Heart attack despite a healthy diet? Stroke without high blood pressure? The reason might lie in the blood—and few people know about it. Lipoprotein(a) is a value that is genetically determined and can more than double your cardiovascular risk. A single test is enough to be certain. For women, the value should be measured again after menopause. Insurance doesn’t cover it in Germany—but it’s about 20 euros.
Lipoprotein(a) Largely Stable from Childhood
Lipoprotein(a), or Lp(a) for short, is a blood value that is largely stable from childhood, changes little over a lifetime, and determines vascular health over decades. “Lp(a) is genetically predetermined and, according to current knowledge, cannot be positively influenced by our behavior,” explains Dr. Christopher Schneeweis, a specialist in internal medicine and cardiology in Cologne, to FITBOOK. This means: Those with an elevated Lipoprotein(a) level can hardly influence it through diet or exercise.
Determining the value is sensible because Lp(a) more than doubles the risk of heart attack or stroke and is associated with the risk of early aortic valve calcification. International professional societies such as the European Atherosclerosis Society (EAS) also recommend determining Lp(a) once for risk assessment.1
What Exactly Is Lipoprotein(a)?
Lipoprotein(a), or Lp(a) for short, is a type of modified LDL cholesterol. In addition to ApoB100, it carries an additional transport molecule, the so-called Apoprotein a. Similar to the “bad” LDL cholesterol, this Apoprotein a delivers cholesterol to the cells. The so-called “kringles,” which make up Apoprotein a, make Lipoprotein(a) particularly dangerous. Schneeweis explains: “Due to the kringles, Lipoprotein(a) appears to be significantly more atherogenic than LDL cholesterol. This means that deposits in the vessels are promoted by high Lp(a) levels.” Furthermore, Lipoprotein(a) promotes inflammation and blood clotting. “All things we would like to avoid,” the cardiologist clarifies.
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Cardiologist Schneeweis: “Lp(a) Test Should Be Covered by Insurance”
Despite the great importance of the Lipoprotein(a) value, a test for this potentially life-critical blood value is not yet routine at the general practitioner’s office—it can only be tested at one’s own expense. This is met with incomprehension among experts: “Why the value is not routinely determined is unclear to me. In principle, this should be a service covered by insurance,” says Schneeweis.
Costs for Lp(a) Determination Are Around 20 Euros
The Lipoprotein(a) value is not automatically determined when a comprehensive blood test is done at the doctor’s office.
Patients must pay for the Lp(a) test as a so-called IGeL service (“Individual Health Service”). The costs are manageable—depending on the lab, they range from about 17 to 25 euros. The blood sample can be taken at the general practitioner’s office, which sends the sample to a lab that determines the Lp(a) value. The result is available after a few days and can then be interpreted by the attending physician.
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Gender Aspect–Measure Again After Menopause
According to estimates, about one in five people worldwide has an elevated Lipoprotein(a) level, which corresponds to 20 percent of the world’s population.2 Most are unaware of it, as determining the value is not standard. Since the value is almost entirely genetically determined, a single measurement in a lifetime is usually sufficient to assess the risk. Schneeweis: “For women, the value should also be measured again after menopause, as it may have changed.”
When an Elevated Lp(a) Level Is Detected
There is still no approved medication therapy that specifically lowers Lipoprotein(a). Therefore, if an elevated level is detected, it is crucial to address other treatable factors to reduce the risk of a heart attack or stroke. According to Schneeweis, “the other fat-related risk factors in the blood—namely LDL cholesterol and ApoB100—should then be optimally adjusted in this context.” The goal should be to keep LDL and ApoB100 as low as possible to relieve the vessels and prevent complications.
Other risk factors, such as diabetes, high blood pressure, or smoking, should also be viewed “particularly critically” with elevated Lipoprotein(a), according to Schneeweis
When the Value Is Too High
In rare, severe cases, a so-called lipid apheresis—a type of blood washing—may be necessary, according to Schneeweis. “However, this must be done once a week.” An extreme measure that shows how serious this lab value is.
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Family Prevention
As mentioned, Lipoprotein(a) is hereditary. Those with elevated levels likely do not carry this risk alone: parents, siblings, and children have a significantly increased risk of also having high levels. Dr. Christopher Schneeweis therefore advises: “If an elevated Lipoprotein(a) level is detected, first-degree relatives should also be tested in principle.”
A simple blood test can thus be crucial not only for one’s own health but also for early detection in the family. This is especially important if there have been cases of early heart attacks or strokes in the family, i.e., before the age of 60.
Medications Could Significantly Reduce Risk for Millions in the Future
There is still no approved therapy that can specifically lower Lp(a). However, according to Schneeweis, several medications are currently in the testing phase. They could significantly reduce the risk for millions of affected individuals in the coming years. Until then, the expert’s recommendation is: “If you don’t know your Lp(a) level yet, have it determined at your next blood test.”