How to Prepare for the Lipoprotein(a) Test: Rules for Getting Tested

Lipoprotein(a) is one of the few lipid-metabolism markers that is almost entirely determined by genetics. It is recommended to measure it at least once in a lifetime, so it is important to do it correctly. The editorial team explains how to prepare for the test, what can distort the result and how to read the report.

What lipoprotein(a) is and why it is measured separately

Lipoprotein(a), or Lp(a), is a particle very similar to LDL, whose protein (apoB-100) is joined by an additional glycoprotein — apoprotein(a). It is precisely this "add-on" that makes Lp(a) special: the particle not only carries cholesterol into the vessel wall but also has pro-inflammatory and prothrombotic properties, because apo(a) structurally resembles plasminogen.

The main feature of this marker is that its concentration is more than 90% determined by genes, primarily by variants of the LPA gene. That is why the Lp(a) level in an adult remains relatively stable throughout life and barely changes with diet, training or weight loss. This fundamentally distinguishes it from triglycerides or LDL.

The European Society of Cardiology and the European Atherosclerosis Society recommend measuring Lp(a) at least once in a lifetime in every adult. For an athlete this is especially useful: a high hereditary Lp(a) can remain "invisible" against the background of an excellent standard lipid profile.

Because the test is often done just once, its proper preparation and correct interpretation carry great weight. A mistake or the wrong choice of units can create a false impression of one's own risk for years.

Whether you need to fast

Modern consensus statements on the laboratory assessment of lipids, in particular the joint 2016 position of the EAS and EFLM, indicate that fasting is not mandatory for most lipid markers. For Lp(a) this is even more true: food intake practically does not change its concentration.

However, in practice Lp(a) is usually ordered together with a full lipid profile, glucose or insulin. For those markers it is better to come fasting, so the editorial team advises following the classic rule: 8–12 hours without food, water is allowed. This way you will get a correct comprehensive result in a single visit.

If you are getting only Lp(a) on its own, a light breakfast without a large amount of fat will not spoil the test. It is only important to tell the laboratory whether you have eaten, if the order includes other markers.

Coffee, energy drinks and pre-workout complexes the day before also do not significantly affect Lp(a), but they can change other parameters of the panel. Therefore, in the morning before the test it is better to limit yourself to water.

Factors that can still change the result

Although Lp(a) is stable, there are situations in which its level changes temporarily or persistently. It is worth knowing them so as not to take the test at an "unfavourable" moment and not to draw false conclusions.

• Acute inflammation and infections.Lp(a) behaves partly like an acute-phase protein; during a respiratory infection or after an injury its level may rise.
• Hormonal influences.Androgens and anabolic steroids lower Lp(a), while estrogens and menopausal changes also affect it. While taking hormonal drugs the result does not reflect the "baseline" level.
• Kidney and liver diseases, hypothyroidism, nephrotic syndrome.
• Some medications:niacin and PCSK9 inhibitors moderately lower Lp(a), statins may raise it somewhat.
• Pregnancy— a physiological increase.

The point about androgens is especially important for athletes. If a person receives testosterone for medical reasons or uses anabolic drugs, a low Lp(a) during this period does not mean a low hereditary risk. An objective picture is given by a test taken outside of hormonal intervention.

After an infection, the editorial team advises waiting at least 2–3 weeks of full recovery. Intense training the day before does not significantly affect Lp(a), but for the general panel it is better to avoid exhausting loads within the preceding 24 hours.

The remaining factors — sleep, stress, minor dietary lapses — have practically no effect on Lp(a). That is precisely why a single measurement in a stable state is usually sufficient.

Step-by-step rules for getting tested

Let us reduce the preparation to a simple algorithm. It suits both an isolated test and a comprehensive cardiometabolic panel.

Separately about biotin. Large doses of this supplement can distort the results of immunoassays, which the FDA has drawn attention to. Lp(a), which is most often measured by turbidimetric methods, is usually not affected by biotin, but in comprehensive panels with hormones it is better to stop it 2–3 days beforehand.

Blood is drawn from a vein, fasting in the morning — this is the standard that makes comparison with subsequent tests easier. A repeat measurement should be done in the same laboratory, because methods from different manufacturers differ.

If you take statins or other lipid-lowering drugs, do not stop them on your own before the test. The doctor must know against which therapy the result was obtained.

Units of measurement and interpretation

Lp(a) is reported in two units: mg/dL (particle mass) or nmol/L (number of particles). The 2022 EAS consensus prefers nmol/L. Importantly, there is no simple conversion factor: the size of apo(a) differs between people, so the formulas give only an approximation.

According to this consensus, a level below approximately 30 mg/dL (75 nmol/L) is considered to practically rule out increased risk, the range 30–50 mg/dL is a "grey zone", and above 50 mg/dL (approximately 105–125 nmol/L) is associated with an increased risk of atherosclerotic events and aortic valve stenosis. Very high values above 180 mg/dL (about 430 nmol/L) are equated in risk with familial hypercholesterolemia.

The result is assessed not in isolation but together with LDL, blood pressure, smoking and family history. High Lp(a) is not a diagnosis, but it is a signal to control other risk factors more strictly.

For an athlete with high Lp(a) it is especially important not to worsen the lipid profile by other means — for example, with drugs that sharply lower HDL and raise LDL. High physical fitness does not compensate for hereditary risk.

Editorial conclusions

Lipoprotein(a) is a genetically determined cardiovascular risk factor that is worth measuring at least once in a lifetime. The test does not require strict preparation: food has little effect on the result.

The most important thing is to take it in a stable state: without acute inflammation, outside of hormonal interventions and with all medications reported to the doctor. To compare results, use one laboratory and the same units.

If you take Lp(a) together with a full lipid profile, follow the classic rules: 8–12 hours of fasting, no alcohol and no heavy workouts the day before.

We also recommend reading our materials on preparing for the apolipoprotein B test, on HDL and LDL, and on the effect of anabolic steroids on the lipid profile.

References

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.
2. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–188.
3. Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points — a joint consensus statement from the EAS and EFLM. Eur Heart J. 2016;37(25):1944–1958.
4. Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692–711.
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6. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004;34(8):513–554.
7. U.S. Food and Drug Administration. The FDA warns that biotin may interfere with lab tests: FDA Safety Communication. 2017 (updated 2019).