A simple, one-time blood test could reveal a hidden risk for heart attack and stroke that standard cholesterol checks miss.

The Silent Genetic Risk: Why Your Lp(a) Level Matters

A new analysis of over 20,000 patients and a recently updated Canadian clinical guideline both underscore the association between elevated levels of Lipoprotein(a) [Lp(a)], a genetically determined cholesterol-carrying particle, and an increased risk of cardiovascular events.

Key Findings from Multi-Study Analysis

Data from 20,070 participants aged 40 and older across three major NIH studies (ACCORD, PEACE, and SPRINT) was presented at the SCAI 2026 Scientific Sessions. Researchers analyzed plasma samples for Lp(a) levels, grouping them as <75, 75-125, 125-175, and ≥175 nmol/L.

Over a median follow-up of 3.98 years, 1,461 major adverse cardiovascular events (MACE) occurred (7.3%), including myocardial infarction, stroke, coronary revascularization, and cardiac death.

Lp(a) levels of ≥175 nmol/L were independently associated with a higher risk of MACE (HR 1.31, 95% CI: 1.10-1.55), cardiovascular death (HR 1.49, 95% CI: 1.07-2.06), and stroke (HR 1.64, 95% CI: 1.14-2.37). No significant association was found for heart attack.

The association was more pronounced in patients with pre-existing heart disease (HR 1.30, 95% CI: 1.07-1.57) compared to those without (HR 1.18, 95% CI: 0.91-1.54).

Canadian Guideline Recommends Routine Screening

A clinical guideline published in the Canadian Journal of Cardiology recommends a one-time blood test for Lp(a) for all Canadian adults. This builds on previous recommendations and aligns with advice from the American College of Cardiology.

A person is considered at elevated risk with Lp(a) levels ≥100 nmol/L and at very high risk at ≥190 nmol/L.
Routine cholesterol tests do not measure Lp(a); a specific blood test, which is covered by all Canadian provinces, is required.
Approximately one in five Canadians (about eight million people) are estimated to have high Lp(a). Because there is no routine screening and no symptoms, many are unaware of their levels.

Prevalence and Risk Factors

Lp(a) is a particle composed of protein and fat. High levels promote plaque buildup in blood vessels and increase inflammation and clotting risk. Levels are largely determined by genetics and typically do not change significantly over a lifetime, though they can be raised by factors such as pregnancy and menopause.

People of African, Caribbean, or South Asian ancestry have a higher likelihood of elevated levels.
Lifestyle changes such as diet and exercise do not lower Lp(a), although they are beneficial for overall health.
No medication is currently approved specifically to lower Lp(a), though drug trials are underway.
Patients with high Lp(a) are typically prescribed statins to lower LDL cholesterol.

Expert Statements

Dr. Subhash Banerjee (interventional cardiologist, Baylor Scott & White) stated that for the first time, researchers can quantify a specific Lp(a) level that puts patients at significantly higher risk for major cardiovascular events, especially stroke and death. He recommended a simple blood test for detection and aggressive management of other risk factors.

Dr. Sonia Anand (professor, McMaster University and co-author of the Canadian guideline) stated that measuring Lp(a) is an important step in preventing a common cause of death among Canadians and noted that elevated levels confer a two- to four-fold increased risk of a cardiovascular event.

Dr. Alykhan Abdulla, a family doctor in Manotick, Ont., noted that immediate family members of someone with high Lp(a) should also get tested and that conditions such as known heart disease, stroke, and other chronic conditions may signal a need for testing.

Personal Account

Darren Ali of Maple Ridge, B.C., reported experiencing only upper back pain before suffering a massive heart attack at age 45. He stated he was otherwise healthy with no prior warning. He is currently enrolled in a drug trial for Lp(a) and reported that his 25-year-old daughter has higher Lp(a) than he had at the time of his heart attack and is taking statins.