Skip to main content
Your session has expired. Reloading...
Cardiovascular

Lp(a) in men: heart attack, aortic valve and what treatment exists

Lp(a), in full lipoprotein(a), is a cholesterol-carrying particle in the blood made of an LDL particle with the protein apolipoprotein(a) attached. According to the European Atherosclerosis Society (EAS), mainly the liver and, to a small extent, the kidneys clear Lp(a).

A high Lp(a) is a cause of cardiovascular disease and of narrowing of the aortic valve according to the EAS; the aortic valve is the valve through which the heart pumps blood into the main artery. Only a blood test measures how high Lp(a) is.

The EAS expresses Lp(a) in nanomoles per litre, among other units, and proposes that guidelines consider a grey zone, for example 75 to 125 nmol/L, with a value below that zone that would rule out the risk and a value from 125 nmol/L that would rule it 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 lipoprotein(a) in serum; Star-SHL uses immunoturbidimetry, names AML as its source and gives < 75 nmol/l as the reference value. According to the EAS, Lp(a) usually reaches adult levels by around age five, but the value can still rise until adulthood.

Lipoprotein(a): why this value matters

The LPA gene, which largely sets the level of Lp(a), has been established since 2013 as a major contributor to the risk of narrowing of the aortic valve, according to the EAS. A high Lp(a) goes together with calcification of that valve according to the EAS, especially in relatively young, healthy people aged 45 to 54.

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.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Lipoprotein(a): when is testing worthwhile?

The EAS advises an Lp(a) measurement at least once in adults, while the Dutch guideline on inherited dyslipidaemia sees no justification for screening the general population and considers a measurement for, among others, people with more than a 5% chance of dying from cardiovascular disease within ten years according to the SCORE table.

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

Low Levels

An Lp(a) below 60 nmol/l falls within the reference value at Unilabs; Unilabs gives no lower limit. In men, Lp(a) stays relatively constant according to the EAS, and castration, surgical or with medicines, raises the value slightly according to the EAS.

High Levels

A high Lp(a) goes together with a higher absolute and relative risk of narrowing of the aortic valve, ischaemic stroke, heart attack and heart failure according to the EAS. For thrombosis in the veins, the evidence in the EAS consensus does not demonstrate a causal link.

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 very high Lp(a) and progressing cardiovascular disease despite optimal treatment of the other risk factors, lipoprotein apheresis can be considered according to the EAS, a treatment that filters Lp(a) out of the blood, as uncontrolled data indicate benefit. Pelacarsen, a new medicine that blocks the production of apo(a) in the liver, gave mean falls in Lp(a) of 80 and 72% in early studies according to the EAS, depending on the dosing.

Lipoprotein(a): frequently asked questions

How big is the risk with a high Lp(a)?

The Dutch guideline on inherited dyslipidaemia gives no exact figure for the risk of cardiovascular disease with a high Lp(a): because quantitative data were lacking, it could draw no conclusion about the ten-year or lifetime risk. The EAS describes the risk as rising gradually with the value, already below the usual limits.

Does nicotinic acid work against a high Lp(a)?

Nicotinic acid is not recommended by the EAS for a high Lp(a), because two outcome studies showed no clinical benefit. According to the Dutch guideline on inherited dyslipidaemia, nicotinic acid did lower Lp(a) in earlier studies, without that leading to less cardiovascular disease.

Does aspirin help with a high Lp(a)?

Whether aspirin helps with a markedly raised Lp(a) is uncertain according to the EAS, and current data do not support basing aspirin use on the Lp(a) value.

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

Tests with related values

These panels measure values from the same category as this marker.

Testosterone

Complete Men's Health Panel

A broad men's health panel: hormones, heart, metabolic, and organ function in one blood draw.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Glucose (Fasting) Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone Ferritin hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€289,-
Prostate

Men Over 40 Panel

Age-appropriate screening including testosterone and PSA.

HbA1c (Glycated Hemoglobin) PSA (Prostate-Specific Antigen) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€279,-

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
Welzijn en Sport Official BIG registration BIG 49928676701 Opens in a new tab

Lipoprotein(a)

€36,-