Very high (≥100 mg/dL or ≥250 nmol/L)? No — elevated but not extreme
lpa-moderately-highFewer than 5 people have reached this rule so farFavours starting or intensifying LDL-lowering; check first-degree relatives' Lp(a)
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
This elevated Lp(a) counts as a risk-enhancing factor in your Lipids recommendation above — it shifts a borderline-risk decision toward a statin, keeps one on the table even with a CAC score of 0, and lowers the LDL-C goal.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
Lp(a) isn't just informational here: the ACC/AHA framework folds it into the primary-prevention statin decision, and this tool now does the same.
ACC/AHA (US)
Graded as a risk enhancer, which the guideline recommends considering at borderline risk.
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
ESC (Europe)
Lp(a) above 50 mg/dL (105 nmol/L) as a risk-enhancing factor in all adults.
2025 ESC/EAS focused update on dyslipidaemias · Recommendation tables · class and level read from the guideline tables on 2026-09-30
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 2a · Level B-NR
Your Lp(a) (78 mg/dL) is elevated. It favours starting or intensifying LDL-lowering (a statin, and if needed ezetimibe or a PCSK9 inhibitor), plus tight control of every other modifiable risk factor. Your LDL target itself comes from your overall risk category, not from the Lp(a).
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
No approved therapy directly targets Lp(a), so the excess inherited risk is offset by lowering LDL-C harder. The guideline uses Lp(a) to favour intensifying treatment; it does not set a separate numeric LDL target. Lp(a) is largely genetic — first-degree relatives may want their own level checked once.
ACC/AHA (US)
Graded as optimal early control of modifiable risk factors in anyone with elevated Lp(a). No Lp(a)-lowering drug is approved.
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
Adding a PCSK9 antibody with proven cardiovascular benefit in established heart disease when LDL-C goals are not met on a maximally tolerated statin
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 1 · Level B-NR
Promising, but not in the guidelines yet.
The first Lp(a)-lowering drug to finish a large outcomes trial did not work. In September 2026 pelacarsen was reported to have missed its primary endpoint — it lowered Lp(a), but did not reduce heart attacks, strokes, or cardiovascular death.
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
This matters for how you read everything above. Lp(a) is unquestionably a marker of risk, but Lp(a)HORIZON is the first real test of whether lowering it changes outcomes, and the answer was no in that population — people already on good statin and blood-pressure treatment. Full results are expected at the November 2026 AHA meeting. A second drug, olpasiran, is still in its outcomes trial (OCEAN(a)-Outcomes, due to complete around the end of 2026) and lowers Lp(a) by a larger margin, so the question isn't closed. But nobody should be waiting on an Lp(a) drug as a plan. Lowering LDL further, and controlling everything else, is the plan.
Novartis — Lp(a)HORIZON Phase 3 topline results for pelacarsen (September 2026)
“Borderline risk + high Lp(a)” — an illustrative profile, not a real user.
Asked after: Lp(a) elevated
Cited by the recommendations above.
A trial that could change this, still running or reported too recently to be settled.
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Runs in lib/engine/lpaFlag.ts as lpa-moderately-high.