Very high (≥100 mg/dL or ≥250 nmol/L)? Yes
lpa-very-highNo one has reached this rule yetTreat LDL harder than risk alone suggests; goal still set by risk category; maximal control of other factors
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.
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.
Emerging Lp(a)-lowering therapies (pelacarsen, olpasiran) — Phase 3 status · How it's used
Your Lp(a) (160 mg/dL) is very high. It argues for treating your LDL harder than your risk category alone would — and for being maximally aggressive with blood pressure, weight, smoking, and glucose, since there's no approved drug for the Lp(a) itself.
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.
Emerging Lp(a)-lowering therapies (pelacarsen, olpasiran) — Phase 3 status · Current standard (indirect management only)
Promising evidence that hasn't become standard care yet — worth knowing, not yet worth expecting.
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.
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) · Investigational — first outcomes trial was negative
“Borderline risk, zero calcium but 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-very-high.