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The heart test most people don’t know about but should
07/02/2025
By Sunny Intwala, MD, MBA, Cardiologist, Nuvance Health Heart and Vascular Institute
We all know the basics of heart health. Get your cholesterol checked, eat well and stay active. As the lead of the Prevention Council across Nuvance Health with a mission to help guide preventive cardiology efforts in the region, I want to point out another number that could reveal a hidden risk, one that doesn’t show up on standard tests and doesn’t respond to lifestyle changes.
It’s called lipoprotein(a), or Lp(a), and it could be the key to understanding your real risk for heart attack or stroke.
What is lipoprotein(a)?
Lp(a) is a type of cholesterol particle that looks like LDL, or “bad” cholesterol, but it has a unique protein attached to it called apolipoprotein(a). This makes it more likely to stick to artery walls and promote plaque buildup or blood clots.
Unlike regular cholesterol, Lp(a) is almost entirely determined by your genes. You can eat perfectly, exercise regularly and still have high levels.
Related Content: What is cholesterol and why does it matter
Why is the test Important?
High Lp(a) increases your risk for serious cardiovascular problems, even if your cholesterol and blood pressure are normal. It’s been linked to early heart attacks, strokes, valve disease and repeat cardiac events despite being on the right medications.
The challenge is Lp(a) is not included in most routine cholesterol panels. That means many people walk around with elevated risk and don’t even know it.
Who should get tested?
A simple blood test can check your Lp(a) level. You only need it once, but it can make a difference. You should talk to your doctor if:
- You have a family history of early heart disease or stroke
- You’ve had a heart attack or stroke with no clear cause
- Your LDL cholesterol is high and doesn’t respond well to treatment
- You have known aortic valve disease or familial hypercholesterolemia
- You want a more complete view of your cardiovascular risk
Learn more about preventive cardiology at Nuvance Health.
What if your Lp(a) is high?
We can’t lower Lp(a) directly through diet or exercise, but we can lower your overall risk. That means managing LDL cholesterol more aggressively, reducing blood pressure, avoiding smoking and staying active.
Certain medications, like PCSK9 inhibitors, may help. In addition, new therapies specifically designed to lower Lp(a) are on the horizon.
The bottom line: Lp(a) is one of the most important — and overlooked — genetic factors in heart disease. One test can offer clarity and help you and your care team make smarter, more personalized decisions.
Knowing your Lp(a) level gives you and your doctor the chance to act early, and that can make all the difference.