Of all the changes in the 2026 dyslipidemia guideline, one stands out as immediately actionable for nearly everyone: every adult should have their lipoprotein(a) measured at least once in their lifetime. If you've never heard of lipoprotein(a) — usually written Lp(a) and pronounced "L-P-little-a" — you're in the majority. And that's precisely the problem the guideline is trying to fix.
What Is Lp(a)?
Lp(a) is an LDL-like cholesterol particle with an extra protein attached. It promotes atherosclerosis the way LDL does, but with two additional concerns: it appears to promote clotting, and it is implicated in aortic valve disease. Critically, your Lp(a) level is genetically determined — it is set by the genes you inherited, it stays relatively stable across your lifespan, and it barely responds to diet, exercise, or standard cholesterol medication.
Why One Test Is Enough
Because Lp(a) is genetic and stable, a single measurement tells you where you stand for life. That's why the guideline frames it as a once-in-a-lifetime test rather than an annual one. Roughly one in five people carries an elevated level — most of them unaware, because Lp(a) is not part of a standard cholesterol panel and does not meaningfully show up in your routine LDL number.
What the Numbers Mean
Per the evidence reviewed in the guideline, an Lp(a) above 125 nmol/L is associated with roughly a 1.4-fold increase in cardiovascular risk, and levels above 250 nmol/L carry double the risk or more — independent of your other cholesterol numbers. An elevated result doesn't mean an event is inevitable. It means your overall prevention plan should be more aggressive: lower LDL targets, earlier attention to blood pressure and metabolic health, and in some cases advanced imaging to look for early disease.
Why Test for Something We Can't Directly Treat?
It's the most common question about Lp(a) — and the guideline's answer is important. Knowing your Lp(a) changes how aggressively we manage everything else. A patient with an LDL of 110 and a normal Lp(a) is in a very different position than a patient with the same LDL and an Lp(a) of 300 nmol/L: the second patient warrants meaningfully more intensive LDL-lowering and closer surveillance. Several targeted Lp(a)-lowering therapies are also in late-stage clinical trials, which means patients who know their number today will be first in line to benefit if those therapies prove out.
Getting Tested
Lp(a) is a simple blood test — it just has to be ordered. At Cardiolucent, Lp(a) is part of our advanced lipid panel, alongside apolipoprotein B and particle-based measurements that see what a standard panel misses. Dr. Kedan reviews the results with you directly and folds them into a personalized prevention strategy through our advanced lipid management program. If you or a family member has a history of early heart disease — or you've simply never been tested — one blood draw settles the question for life.
Source: 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia — a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, published in Circulation and the Journal of the American College of Cardiology, March 2026.