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Cardiovascular

Lp(a): an inherited lipid particle, limits and what a high result means

Lp(a), in full lipoprotein(a), is an LDL particle, a particle that carries cholesterol through the blood, with an extra protein attached: apolipoprotein(a), which resembles plasminogen in structure. According to the European Atherosclerosis Society (EAS), Lp(a) carries the protein apoB just like LDL, but far fewer Lp(a) particles circulate.

A high Lp(a) is causally and continuously associated with cardiovascular disease and with narrowing of the aortic valve, according to the EAS. The level of Lp(a) is more than 90% genetically determined according to the EAS, and only a blood test shows how much Lp(a) is in the blood.

Star-SHL and Unilabs express Lp(a) in nanomoles per litre (nmol/l): Star-SHL gives < 75 nmol/l as the reference value, Unilabs < 60 nmol/l. Unilabs also gives for cardiovascular disease: below 75 nmol/l rule out, 75 to 125 nmol/l a grey zone, above 125 nmol/l rule in.

Doctor's Assessment Included

Lp(a) is a fat particle whose level is largely inherited. Laboratories report it in nmol/l or mg/l, so a result can only be compared with the limit of the laboratory that measured it.

  • Star-SHL and Diagnostiek voor U use < 75 nmol/l, Unilabs < 60 nmol/l and Certe < 500 mg/l.
  • Lifestyle has little effect on the Lp(a) level.
  • A measurement can be useful with heart or vascular disease at a young age, or with heart or vascular disease in the family.

When is this value abnormal?

Decision limits per result, in g/l
Result Value (g/l)
Normal < 0,3
Borderline 0,3–0,5
Elevated ≥ 0,5

Lp(a) is largely inherited and stays almost constant throughout life. The risk rises gradually with the value; the EAS stresses that there is no biological threshold. The NHG guideline CVRM uses > 50 mg/dl (0.50 g/l, 80th percentile) as the cut-off and advises against screening the general population. Some laboratories apply a stricter upper limit (0.3 g/l), which matches the lower end of the EAS grey zone.

Source: Nederlands Huisartsen Genootschap Reference population: Adults (NHG guideline CVRM; EAS 2022)

Source: European Atherosclerosis Society Reference population: Adults (NHG guideline CVRM; EAS 2022)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Lipoprotein(a): what Dutch laboratories use

The upper limit runs from 60 nmol/l at Unilabs to 75 nmol/l at Star-shl.

Reference ranges by group, in nmol/l
Star-shl · Everyone · a limit, not a range < 75 nmol/l
75
Unilabs · Everyone · a limit, not a range < 60 nmol/l
60
Unilabs · Everyone · grey zone for cardiovascular disease 75–125 nmol/l
75 125
Unilabs · Everyone · a limit, not a range · raised risk of cardiovascular disease > 125 nmol/l
125
Certe · Everyone · 18 years and older · a limit, not a range < 500 mg/L
Certe · Everyone · grey zone 300–500 mg/L
Certe · Everyone · a limit, not a range · high risk > 500 mg/L
Diagnostiek voor U · Everyone · a limit, not a range < 75 nmol/L
75
0 137.5 nmol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Lipoprotein(a): what this test measures

The Lp(a) test measures the concentration of lipoprotein(a) in the serum, at Star-SHL and Unilabs in nanomoles per litre (nmol/l), with (immuno)turbidimetry, a measurement of the cloudiness that forms when the particle is bound. According to Unilabs, the Lp(a) concentration is mostly genetically determined and inversely related to the number of repeats of a protein domain, the kringle, in apo(a).

The EAS writes that a low number of Kringle-IV repeats, fewer than 23, goes with small apo(a) forms and a markedly higher Lp(a).

Lipoprotein(a): why this value matters

According to the 2022 EAS consensus, Lp(a) is causally and continuously linked to cardiovascular disease, including narrowing of the aortic valve; for thrombosis in the veins, such a causal link has not been demonstrated. According to the EAS, the risk rises gradually with the concentration, already at values below the usual limits.

The Dutch guideline on inherited dyslipidaemia of the Federation of Medical Specialists considers the risk raised with an Lp(a) above the 80th percentile, 50 mg/dl.

Lipoprotein(a): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Heart checkup · €209,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Lipoprotein(a): when is testing worthwhile?

According to the 2022 EAS consensus, Lp(a) should be measured at least once in adults, preferably with the first lipid profile. The Dutch guideline on inherited dyslipidaemia sees no justification for Lp(a) as screening in the general population, and calls a measurement worth considering, among others, with cardiovascular disease at a young age, with familial hypercholesterolaemia (FH, inherited high cholesterol), with cardiovascular disease or raised Lp(a) in the family, and with recurring cardiovascular disease despite optimal treatment of the blood lipids.

Lipoprotein(a): symptoms of a high or low value

Low Levels

A low Lp(a), below 75 nmol/l at Star-SHL or below 60 nmol/l at Unilabs, falls within the reference values; neither laboratory gives a lower limit. According to a meta-analysis cited by the EAS, a very low Lp(a) does go together with a higher chance of diabetes.

High Levels

A high Lp(a) goes together with a higher risk of narrowing of the aortic valve, ischaemic stroke, heart attack and heart failure, according to the EAS. In the top third of the population, with a (very) high Lp(a), the risk of cardiovascular disease and cardiovascular death is more than 20% higher according to the EAS.

A high Lp(a) goes together with calcification of the aortic valve according to the EAS, especially in relatively young, healthy people aged 45 to 54.

Lipoprotein(a): causes of a low or high value

What lowers the value

  • Reduced liver function

    Lp(a) is made in the liver, so a poorly working liver can lower the level.

  • Overactive thyroid

    An overactive thyroid can lower Lp(a); after treatment the level rises by 20 to 25 percent.

  • Hormone therapy after menopause

    Hormone replacement therapy after menopause lowers Lp(a) by about 25 percent.

  • Severe acute illness

    In life-threatening conditions such as sepsis or severe burns, Lp(a) is lower.

What raises the value

  • Inherited level

    The Lp(a) level is thought to be mainly set by the genes and to barely change from adulthood.

  • Kidney disease

    Reduced kidney function can raise Lp(a), and in nephrotic syndrome the level is 3 to 5 times higher.

  • Pregnancy

    Lp(a) can double during pregnancy.

  • Underactive thyroid

    An underactive thyroid can raise Lp(a); treatment lowers it by 5 to 20 percent.

Lipoprotein(a): lifestyle and this value

With a raised Lp(a), the EAS advises reading the result within the total risk of cardiovascular disease and tackling the other risk factors early and more intensively, among other things through lifestyle. According to the EAS, statins can raise Lp(a) slightly, although the data vary, but the EAS advises against stopping them, because the benefit for the heart and blood vessels is much greater with a high Lp(a); PCSK9 inhibitors lower Lp(a) by 15 to 30%, but are not registered for lowering Lp(a).

According to the Dutch guideline on inherited dyslipidaemia, there are no randomised studies that examined whether lowering Lp(a) specifically leads to less cardiovascular disease.

Lipoprotein(a): frequently asked questions

Is Lp(a) inherited?

Yes, according to the EAS Lp(a) is more than 90% genetically determined by the LPA gene, and the Dutch guideline on inherited dyslipidaemia assumes that the value hardly changes from adulthood. Given the possible extra risk, the EAS considers it reasonable to measure Lp(a) when a parent, brother or sister has a markedly raised Lp(a).

Does Lp(a) change when you are fasting?

Fasting does not change Lp(a) according to the EAS: its table of non-genetic influences on Lp(a) lists no effect for fasting.

Can Lp(a) be lowered with diet?

Diet changes Lp(a) in both directions according to the EAS: a low-carbohydrate diet high in saturated fat gave about a 15% fall, and replacing saturated fat with carbohydrate or unsaturated fat about a 10 to 15% rise. According to the EAS, physical activity has no or minimal effect on Lp(a).

Lipoprotein(a): sources

  1. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43(39):3925-3946. Grijs gebied 30-50 mg/dl, per de FAQ in Atherosclerosis 2023. (retrieved 2026) doi.org
  2. NHG-Standaard Cardiovasculair risicomanagement (M84). Gepubliceerd juni 2019, laatste aanpassing september 2024. Tabel 22, Overzicht van afkapwaarden bij niet-nuchter afgenomen bloed (80e percentiel): "Lp(a) > 50 mg/dl". Geraadpleegd 14 juli 2026. (retrieved 2026) richtlijnen.nhg.org
  3. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  4. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  5. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  6. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  7. Kronenberg F, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43(39):3925-3946, Table 1. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  8. Federatie Medisch Specialisten, Richtlijn Erfelijke dyslipidemie in de 2e en 3e lijn, module Behandeling patiënten met verhoogd Lp(a), richtlijnendatabase.nl, geraadpleegd 2026-10-03 (retrieved 2026) richtlijnendatabase.nl

Test Products

This marker is included in the following test panels.

Heart & vessels

Heart checkup

An extensive blood test with 12 heart and vessel values — the full cholesterol profile, Apo(B), Lp(a), hsCRP, homocysteine and blood sugar — for insight into your heart and vessel health.

Total Cholesterol LDL Cholesterol HDL Cholesterol Non-HDL Cholesterol Cholesterol/HDL Ratio Triglycerides ApoB (Apolipoprotein B) Lipoprotein(a) hs-CRP (High Sensitivity CRP) Glucose (Fasting) HbA1c (Glycated Hemoglobin) Creatinine eGFR (Estimated Glomerular Filtration Rate) LDL/HDL Ratio
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Medical standards

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Medical policy
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Lipoprotein(a)

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