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Cardiovascular

Lp(a) and diet: what your diet does and does not do to this inherited lipid particle

Lp(a), lipoprotein(a), is an LDL particle with an extra protein, apolipoprotein(a), which your liver cells make; according to the European Atherosclerosis Society (EAS), Lp(a) is also broken down mainly in the liver. Lp(a) carries cholesterol through your blood, just like LDL.

With a high Lp(a), the risk of cardiovascular disease rises gradually according to the EAS, and more than 90% of the differences in Lp(a) between people come from the LPA gene according to the EAS. Which Lp(a) level you have shows only from a blood test.

Star-SHL expresses Lp(a) in nanomoles per litre (nmol/l) and gives < 75 nmol/l as the reference value. Between people, Lp(a) ranges from below 0.2 to 750 nmol/L according to the EAS.

Doctor's Assessment Included

Lp(a) is a fat particle whose level is largely inherited. Laboratories report it in nmol/l or mg/l, so a result can only be compared with the limit of the laboratory that measured it.

  • Star-SHL and Diagnostiek voor U use < 75 nmol/l, Unilabs < 60 nmol/l and Certe < 500 mg/l.
  • Lifestyle has little effect on the Lp(a) level.
  • A measurement can be useful with heart or vascular disease at a young age, or with heart or vascular disease in the family.

When is this value abnormal?

Decision limits per result, in g/l
Result Value (g/l)
Normal < 0,3
Borderline 0,3–0,5
Elevated ≥ 0,5

Lp(a) is largely inherited and stays almost constant throughout life. The risk rises gradually with the value; the EAS stresses that there is no biological threshold. The NHG guideline CVRM uses > 50 mg/dl (0.50 g/l, 80th percentile) as the cut-off and advises against screening the general population. Some laboratories apply a stricter upper limit (0.3 g/l), which matches the lower end of the EAS grey zone.

Source: Nederlands Huisartsen Genootschap Reference population: Adults (NHG guideline CVRM; EAS 2022)

Source: European Atherosclerosis Society Reference population: Adults (NHG guideline CVRM; EAS 2022)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Lipoprotein(a): what Dutch laboratories use

The upper limit runs from 60 nmol/l at Unilabs to 75 nmol/l at Star-shl.

Reference ranges by group, in nmol/l
Star-shl · Everyone · a limit, not a range < 75 nmol/l
75
Unilabs · Everyone · a limit, not a range < 60 nmol/l
60
Unilabs · Everyone · grey zone for cardiovascular disease 75–125 nmol/l
75 125
Unilabs · Everyone · a limit, not a range · raised risk of cardiovascular disease > 125 nmol/l
125
Certe · Everyone · 18 years and older · a limit, not a range < 500 mg/L
Certe · Everyone · grey zone 300–500 mg/L
Certe · Everyone · a limit, not a range · high risk > 500 mg/L
Diagnostiek voor U · Everyone · a limit, not a range < 75 nmol/L
75
0 137.5 nmol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Lipoprotein(a): what this test measures

An Lp(a) measurement counts how much lipoprotein(a) is in your serum, at Star-SHL in nanomoles per litre. According to the EAS, the number of Kringle-IV repeats in the LPA gene explains about 30 to 70% of the differences between people, and fewer than 23 repeats gives small apo(a) forms and a markedly higher Lp(a).

Lipoprotein(a): why this value matters

The link between Lp(a) and cardiovascular disease is causal according to the EAS and holds across different ethnic backgrounds, with a risk that rises gradually with the value.

Lipoprotein(a): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Lipoprotein(a): when is testing worthwhile?

The 2022 EAS consensus wants Lp(a) measured at least once in every adult, ideally together with the first lipid profile. The Dutch guideline on inherited dyslipidaemia considers screening the whole population unjustified, and names familial hypercholesterolaemia (FH), inherited high cholesterol, among the reasons to consider a measurement.

Lipoprotein(a): symptoms of a high or low value

Low Levels

A poorly working liver lowers Lp(a) according to the EAS, depending on the cause, and below 75 nmol/l Lp(a) falls within the reference value at Star-SHL.

High Levels

A high Lp(a) can occur with reduced kidney function according to the EAS: in nephrotic syndrome, a kidney disease with heavy protein loss in the urine, Lp(a) is 3 to 5 times as high as in people without the disease.

Lipoprotein(a): causes of a low or high value

What lowers the value

  • Reduced liver function

    Lp(a) is made in the liver, so a poorly working liver can lower the level.

  • Overactive thyroid

    An overactive thyroid can lower Lp(a); after treatment the level rises by 20 to 25 percent.

  • Hormone therapy after menopause

    Hormone replacement therapy after menopause lowers Lp(a) by about 25 percent.

  • Severe acute illness

    In life-threatening conditions such as sepsis or severe burns, Lp(a) is lower.

What raises the value

  • Inherited level

    The Lp(a) level is thought to be mainly set by the genes and to barely change from adulthood.

  • Kidney disease

    Reduced kidney function can raise Lp(a), and in nephrotic syndrome the level is 3 to 5 times higher.

  • Pregnancy

    Lp(a) can double during pregnancy.

  • Underactive thyroid

    An underactive thyroid can raise Lp(a); treatment lowers it by 5 to 20 percent.

Lipoprotein(a): lifestyle and this value

The EAS wants a high Lp(a) read within the total risk of cardiovascular disease, with early management of the other risk factors through lifestyle. Diet shifts Lp(a) in both directions according to the EAS table of non-genetic influences, by about 10 to 15% up or about 15% down, depending on the type of fat in the diet.

Lipoprotein(a): frequently asked questions

Does fasting change the Lp(a) value?

Lp(a) stays the same with fasting: the EAS lists no effect of fasting on the value.

Why is Lp(a) higher with kidney disease?

Reduced kidney function can raise Lp(a) according to the EAS, possibly because the liver makes more Lp(a) when protein is lost through the urine or the dialysis fluid, or because Lp(a) is broken down less.

Is a low Lp(a) always favourable?

A very low Lp(a) goes together with a higher chance of diabetes according to a meta-analysis cited by the EAS.

Lipoprotein(a): sources

  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. Grijs gebied 30-50 mg/dl, per de FAQ in Atherosclerosis 2023. (retrieved 2026) doi.org
  2. NHG-Standaard Cardiovasculair risicomanagement (M84). Gepubliceerd juni 2019, laatste aanpassing september 2024. Tabel 22, Overzicht van afkapwaarden bij niet-nuchter afgenomen bloed (80e percentiel): "Lp(a) > 50 mg/dl". Geraadpleegd 14 juli 2026. (retrieved 2026) richtlijnen.nhg.org
  3. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  4. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  5. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  6. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  7. Kronenberg F, 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, Table 1. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  8. Federatie Medisch Specialisten, Richtlijn Erfelijke dyslipidemie in de 2e en 3e lijn, module Behandeling patiënten met verhoogd Lp(a), richtlijnendatabase.nl, geraadpleegd 2026-10-03 (retrieved 2026) richtlijnendatabase.nl

Tests with related values

These panels measure values from the same category as this marker.

GLP-1

GLP-1 Baseline Panel

Your starting point before the first injection: blood sugar, cholesterol, pancreas, liver, kidneys, thyroid and nutrients in one measurement.

Insulin (Fasting) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Bilirubin (Total) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides Bilirubin (Direct) Bilirubin (Indirect) HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€214,-
GLP-1

GLP-1 Extended Panel

The 6-month measurement: everything from the check-in plus insulin, ApoB and your nutrients — especially relevant if you have been eating much less for a while.

Insulin (Fasting) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€196,-
GLP-1

GLP-1 Check-in Panel

The 3-month safety and progress check clinics do: pancreas, liver, kidneys, salts and your metabolic progress on GLP-1 medication.

ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Potassium Sodium Glucose (Fasting) Total Cholesterol Lipase Creatinine Triglycerides eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€109,-

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
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Lipoprotein(a)

€36,-