Lipoprotein(a) Measurement Guidelines

Primary Indications for Lp(a) Testing in Adults

The American College of Cardiology recommends measuring Lipoprotein(a) once in adults with a family history of premature cardiovascular disease, unexplained early cardiovascular events in first-degree relatives, known elevated Lp(a) in family members, familial hypercholesterolemia, recurrent CVD despite optimal statin therapy, or borderline-to-high cardiovascular risk 1, 2, 3, 4
The American College of Cardiology suggests that personal or family history of premature atherosclerotic CVD is a strong indication for Lp(a) testing in adults (men <55 years, women <65 years) 1, 2, 3, 4
Unexplained early cardiovascular events in first-degree relatives is a strong indication for Lp(a) testing in adults 1, 2, 3
Known elevated Lp(a) in first-degree relatives (>200 nmol/L or >75 nmol/L depending on guideline) is a strong indication for Lp(a) testing in adults 1, 2, 3
Familial hypercholesterolemia diagnosis is a strong indication for Lp(a) testing in adults 4
Recurrent CVD despite optimal lipid-lowering therapy (particularly statin treatment) is a strong indication for Lp(a) testing in adults 4
Borderline cardiovascular risk (5-15% 10-year risk) where Lp(a) may reclassify risk is a reasonable indication for Lp(a) testing in adults 4

The American College of Cardiology recommends measuring Lp(a) as early as age 2 years in children with a family history of early CVD or significant hypercholesterolemia (LDL-C ≥190 mg/dL or total cholesterol ≥240 mg/dL) 5, 6, 7
Repeat testing at puberty (≥12 years) is recommended even if previous values were normal, as levels may change 7
Perform cascade screening of first-, second-, and third-degree biological relatives when elevated Lp(a) is identified 5, 7

The European Society of Cardiology recommends measuring Lp(a) at least once in every adult's lifetime to identify those at very high lifetime cardiovascular risk 8
Traditional thresholds for elevated Lp(a) are >30 mg/dL or >75 nmol/L (approximately 75th percentile in white populations) 4
Markedly elevated Lp(a) (>75 nmol/L) combined with elevated LDL-C increases myocardial infarction risk 10-fold or higher 6, 7

The American Heart Association/American Stroke Association explicitly states that routine screening for Lp(a) should be avoided unless specific indications are present 1, 2, 3
Lp(a) should only be measured once (or repeated at puberty in children) because levels are genetically determined and remain stable throughout adult life 8
The European guidelines emphasize that Lp(a) measurement is most valuable in patients at intermediate or high cardiovascular risk where the result will influence management decisions 4