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Dr. Alessandro Giardini
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Your child has had a blood test and somewhere on the report is a measurement you have never seen before. Lipoprotein(a), usually written as Lp(a), is not part of a routine cholesterol panel. Most parents have never heard of it until it appears on a result sheet, often with a value flagged as elevated.
Dr. Alessandro Giardini measures Lp(a) selectively in children undergoing a cardiovascular risk assessment. It provides a piece of information that standard cholesterol testing misses, and understanding what it does and does not mean makes a real difference to how families feel about the result.
Lp(a) is a cholesterol-carrying particle with an extra protein attached to it called apolipoprotein(a). That protein makes Lp(a) behave differently from ordinary LDL cholesterol in two important ways. It promotes cholesterol deposition in artery walls, and it interferes with the body's natural clot-dissolving mechanisms. Both effects contribute to cardiovascular risk over decades.
The critical distinction from standard cholesterol is that Lp(a) levels are almost entirely genetic. Diet, exercise, and weight have little meaningful effect. A child's Lp(a) level is set by the genes they inherit, stabilises by around age five, and remains essentially constant for life. This is why a single measurement is usually sufficient. Repeat testing is rarely necessary.
Lp(a) is measured in nanomoles per litre (nmol/L) or milligrams per decilitre (mg/dL), and unfortunately different laboratories use different units. A level above 75 nmol/L (approximately 30 mg/dL) is generally considered elevated. Around one in five people worldwide carries a level in this range.
The result is not a diagnosis. An elevated Lp(a) on its own does not mean a child has or will develop heart disease. What it does is add to the overall picture of inherited cardiovascular risk, particularly when other factors are also present. A child with both elevated Lp(a) and high LDL cholesterol, for example, carries a higher combined risk than either measurement alone would suggest.
Dr. Giardini does not recommend Lp(a) testing for every child. It is most informative in specific situations: when there is a strong family history of premature heart disease that standard cholesterol testing does not fully explain, when a parent or close relative has a known elevated Lp(a), or when a child has familial hypercholesterolaemia and the clinician wants a complete picture of cardiovascular risk.
Testing is a simple blood draw. It does not require fasting. Because the level is genetically fixed, one measurement in childhood tells you everything you need to know.
There are currently no approved medications that specifically lower Lp(a) in children, though several drugs targeting Lp(a) are in advanced clinical trials in adults. This sometimes frustrates parents, but it does not mean the information is wasted.
Knowing that Lp(a) is elevated changes the clinical conversation in a meaningful way. It may strengthen the case for more aggressive LDL cholesterol management, because reducing LDL becomes even more important when Lp(a) is also contributing to risk. It informs long-term monitoring decisions. It also gives families information they can share with their GP and with relatives who may carry the same genetic trait.
For a broader overview of inherited cholesterol conditions and treatment, see the main page on high cholesterol in children.
No. Lp(a) levels are not affected by recent food intake, so fasting is unnecessary.
It stabilises by around age five and remains essentially constant throughout life. Repeat testing is rarely needed.
Unlike standard cholesterol, Lp(a) does not respond meaningfully to diet, exercise, or weight management. The level is determined almost entirely by genetics.
Yes, testing siblings and parents is reasonable because Lp(a) is inherited. Each first-degree relative has a significant chance of carrying a similar level.
Author: Dr. Alessandro Giardini, MD, PhD
Written 10/05/2026