Short answer: Lp(a) is a largely inherited cholesterol-carrying particle, and a routine lipid profile usually does not measure it. Cardiologist Dr. Rajeev Garg said the test need not be done for everyone, but people at high risk of coronary artery disease, or with a strong family history of it, should get it. Because Lp(a) is genetic, it is often called a once-in-a-lifetime test.
“My lipid profile is normal. So why is the doctor talking about another cholesterol test?”
If that question has been sitting at the back of your mind, maybe after a parent’s heart attack or a cousin’s angioplasty, you’re not alone. A regular lipid report shows LDL, HDL and triglycerides. It usually doesn’t show Lp(a), a different cholesterol-carrying particle that many Indian families have never heard of.
We’ve already explained the basics in our guide to Lipoprotein(a), the inherited cholesterol risk. This post answers the practical questions people ask next: do I need this test, should I do it only once, and what does it mean if my other numbers look fine?
In our Dil Ke Doubts session on cholesterol, triglycerides and Lp(a), Heart Health India Foundation founder Ram Khandelwal, who had his own heart attack at 33, put these questions to cardiologist Dr. Rajeev Garg, Senior Interventional Cardiologist and Heart Failure Specialist at Apollo Hospitals, Hyderabad, and EC Member of the Cardiological Society of India (CSI).
This article is based on the questions and answers in Dil Ke Doubts Webinar 04 (10 Sep 2026), part of Heart Health India Foundation’s World Heart Month 2026 series with the Cardiological Society of India and the World Heart Federation‘s Don’t Miss a Beat campaign.
Here’s what he told us, in plain words.
What is Lp(a), and why does it matter?
Dr. Garg described Lp(a) as a cholesterol-carrying particle that is largely inherited, passed down in families and linked from childhood with genetic risk. He said elevated Lp(a) is one of the high-risk factors in Southeast Asians, and that it can double or triple the risk of coronary artery disease. He also linked it to stroke and aortic valve disease.
As a rough guide, he said less than 30 mg/dL is normal and more than 50 mg/dL is considered high. Ask your doctor how to read the number on your own report. If your Lp(a) is high, he said you should definitely consult a cardiologist, even though treatment options today are limited.
Does everyone need an Lp(a) test?
Not everyone, he said. In his words: “It need not be done for everyone.” It should be done in people who are at high risk of coronary artery disease, or who have a strong family history of coronary artery disease. He added that clinical studies in cardiology also use it as an extra (accessory) test.
So if heart disease runs in your family, this is a fair question to take to your doctor. Our post on why preventive tests matter long before symptoms appear explains why checking early helps.
Why is Lp(a) called a once-in-a-lifetime test?
Because it is genetic. Dr. Garg explained that there is no lifestyle “cause” that pushes Lp(a) up, the way diet can raise ordinary triglycerides. As he put it: “There is no causative factor for Lp(a). That’s why they say you should do it only once a lifetime.”
If my Lp(a) is high, should my children be tested?
Ram asked exactly this. Dr. Garg’s answer: “Yes, definitely you can get it done”, as part of the family picture, because a raised Lp(a) is passed on genetically. One test in one person can start a useful conversation for the whole family.
“But my LDL, HDL and triglycerides are normal…”
This is the question that trips up so many of us. Dr. Garg’s answer was a clear no: those usual numbers can look normal, and Lp(a) can still be high because of a genetic tendency towards coronary artery disease.
That’s also why Lp(a) is not part of the routine lipid profile in usual pathology labs. He explained that it is a different particle, like LDL with an extra protein attached, so it has to be ordered separately. If you want to understand the rest of your report, see our post on beating bad cholesterol, and for the common heart tests, understanding your heart tests.
If medicines barely change Lp(a), what can I actually do?
Hearing “there is limited treatment” can feel helpless. Dr. Garg didn’t leave it there.
- Strict healthy lifestyle changes. He said people with high Lp(a) should follow strict healthy lifestyle modification, “as we do for coronary artery disease”.
- Don’t expect the usual fixes to move this number. He said Lp(a) is not meaningfully changed by the usual drugs, coffee or stress in the way patients hope.
- Niacin has drawbacks. Vitamin B3 (niacin) was the one drug thought to act on it, but he said it has a lot of side effects.
- Statins may raise it. He noted that statins can increase Lp(a) by about 5–20%, which surprises many people who assume every cholesterol medicine lowers every cholesterol number. Please don’t stop or change any medicine on your own because of this; talk to your cardiologist.
- Newer treatments are still investigational. He mentioned an investigational gene-silencing (antisense) injection that is promising, but said it had not reached the market and the treatment of Lp(a) “eludes the general public at the moment”.
The practical message: know your number, take family history seriously, and work with your doctor on everything else you can change. Many common beliefs about cholesterol don’t hold up, as we explain in cholesterol myths that hurt heart patients.
What you can do next
- If you have a strong family history of heart disease, or you are at high coronary risk yourself, ask your doctor: “Should I get an Lp(a) test once?”
- Don’t assume a “normal” lipid profile answers the Lp(a) question. It is usually a separate test.
- If your Lp(a) is high, ask your cardiologist what lifestyle and risk-factor plan they want for you, and whether your children or other family members should be tested.
- Share this with your family WhatsApp group, especially with the person who says “but my reports are fine” after a parent’s heart attack.
- Explore more sessions from the series on our Dil Ke Doubts World Heart Month 2026 page, and read our earlier post on gas or heart attack.
Frequently asked questions
It measures lipoprotein(a), a largely inherited cholesterol-carrying particle linked to coronary artery disease, stroke and aortic valve disease. It is usually ordered separately from a routine lipid profile.
Dr. Rajeev Garg said it need not be done for everyone. It should be done in people at high risk of coronary artery disease or with a strong family history of it.
Because it is genetic and there is no lifestyle cause that raises it, it is often treated as a test you do once, unless your doctor advises otherwise.
Yes. Dr. Garg said the usual LDL, HDL and triglyceride numbers can be normal while Lp(a) is high.
Dr. Garg said yes, they can be tested as part of the family picture, because raised Lp(a) is passed on genetically.
In this session he said Lp(a) is not meaningfully changed by the usual drugs, and statins can even raise it by about 5–20%. Lifestyle still matters for your overall heart risk. Newer therapies were described as investigational. Do not change any medicine without your cardiologist.
Watch the full session
Want to hear it from Dr. Garg himself? The full Dil Ke Doubts session is below. His Lp(a) answers start at about 27:30.
▶️ Watch the full session: Cholesterol, Triglycerides and Lp(a) · Please also Subscribe on YouTube @hearthealthindia.
In Dr. Garg’s words: “It need not be done for everyone. It should be done in patients who are at a high risk of having coronary artery disease or who have a strong family history of coronary artery disease… There is no causative factor for Lp(a). That’s why they say you should do it only once a lifetime.”
Authoritative sources (for further reading)
These links support general education about Lp(a) and cholesterol. They do not replace Dr. Garg’s words in the session above, and they are not a personal diagnosis.
- MedlinePlus — Lipoprotein (a) blood test
- NHLBI (NIH) — Blood cholesterol
- WHO — Cardiovascular diseases (CVDs) fact sheet
- European Society of Cardiology — Guidelines hub
- Cardiological Society of India
About this article
Disclaimer: The medical information in this article is based only on the views shared by the session speaker, Dr. Rajeev Garg. It is for educational purposes only and is not medical advice. Please consult your cardiologist for advice personalised to you. In an emergency, go to the nearest hospital immediately. See also our medical disclaimer.
You don’t have to figure this out alone
Heart Health India is a community of patients, families and caregivers learning together, with India’s cardiologists, how to look after our hearts. If heart disease runs in your family, come ask your questions, share what you’re going through, and hear from people who’ve been there, including our Nutrition & Cholesterol group.
