Stealth Cholesterol Is More Dangerous Than You Think

Even if you're still young, it's important to monitor your cholesterol. Your cholesterol levels mean more than you think, especially if you have conditions like obesity or diabetes. The Centers for Disease Control and Prevention recommends that adults undergo cholesterol screenings every 4 to 6 years. Since cholesterol levels tend to rise with age, you may want to consider more frequent checkups. A standard cholesterol test measures levels of LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.

However, a routine cholesterol screening might not detect a particular type of cholesterol known as lipoprotein(a), or Lp(a). This "stealthy" form of cholesterol is genetically inherited and affects about one in five people worldwide, according to the American Heart Association. While it is a form of cholesterol, Lp(a) is more dangerous because it has a higher tendency to stick to the walls of blood vessels. Cleveland Clinic likens them to speed bumps in your blood vessels. Over time, these speed bumps can block blood flow to vital organs, increasing the risk of serious cardiovascular issues. People with high Lp(a) have a high risk of heart attack, stroke, and coronary artery disease, even if they have a healthy lifestyle.

Similar to high cholesterol, having high Lp(a) doesn't have symptoms. Although having a family member with high Lp(a) increases your risk of having higher levels of Lp(a), other factors may also increase your risk. People with African or South Asian heritage may have higher Lp(a) levels, but post-menopause, diabetes, and chronic kidney disease may also lead to increased levels of Lp(a).

If you have any of the risk factors of heart disease or high Lp(a), your doctor may request a special test for Lp(a). People who have familial hypercholesterolemia, a genetic condition that leads to an unusually high buildup of LDL cholesterol, may also be checked for high Lp(a). Unlike a routine cholesterol test, cardiologists tell NBC News that only a single Lp(a) test is needed because these levels typically don't change.

While developing healthy habits can help lower your high cholesterol, they don't affect your levels of Lp(a). That doesn't mean you don't have options. Lifestyle changes can lower your risk of heart disease, such as managing your LDL cholesterol and weight, eating a healthy diet, and regular exercise. It also helps to limit alcohol use and quit smoking.

To help reduce your risk of complications due to a high Lp(a) level, your doctor may also recommend taking aspirin, a statin, or a PCSK9 inhibitor to help bring down LDL cholesterol (here are some side effects of cholesterol medications). Clinical trials for drugs to help lower Lp(a) specifically are also underway. According to WebMD, five medications are currently being developed.

Ionis Pharmaceuticals has developed pelacarsen, which was found to be safe and effective in lowering Lp(a) in earlier clinical trials. A 2023 article in the Journal of Clinical Lipidology reported that a single dose of pelacarsen can reduce Lp(a) by as much as 74%, depending on the dosage. Novartis Pharmaceuticals has licensed the drug, and the results of its phase 3 clinical trials are expected this year.

Eli Lilly and Company's phase 2 trial of lepodisiran was found to reduce Lp(a) by 94% in its highest dosage after 60 and 180 days, according to a 2025 study in the New England Journal of Medicine. Even the lowest dose of lepodisiran showed a 41% drop in Lp(a). The company is currently enrolling participants in its phase 3 trials. The results of Amgen's phase 2 trial on olpasiran were published in a 2024 article in the Journal of the American College of Cardiology. Olpasiran's highest dosage reduced Lp(a) by 84% and maintained those levels for about a year after treatment.