What is Lp(a) and why does it matter more for Black men?

Lipoprotein(a) is a modified LDL particle that is genetically determined, diet does not change it, most statins reduce it only 10–25%, and standard lipid panels do not measure it. It independently doubles to triples early cardiovascular risk. In people of African ancestry, Lp(a) is elevated at approximately twice the rate of European ancestry populations: Black individuals have 2.44 times the odds of elevated Lp(a) compared to non-Hispanic white individuals, confirmed in a 2024 JACC:Advances study.

This means that a Black man with a reassuring LDL of 110 mg/dL may be carrying an Lp(a) of 80 nmol/L, well above the 70 nmol/L threshold for materially elevated cardiovascular risk, that his standard annual physical will never detect. The man who leaves his primary care appointment with "normal cholesterol" and has never had his Lp(a) measured has received an incomplete cardiovascular risk assessment by definition. Lp(a) is measured once in a lifetime from a standard blood draw; the result rarely changes over time because it is genetically set. The test costs under $50 at direct-to-consumer labs. In a Black man over 35 with any family history of early cardiovascular disease, this test is not optional. (JACC:Advances, June 2024)

Cardiologist's calibrated position, Solid (1) for elevated Lp(a) prevalence in African ancestry populations.

What to do: Order Lp(a) once. Know the number. If your result is above 70 nmol/L (or above 50 mg/dL depending on the assay), discuss aggressive ApoB target management with your cardiologist, and ask about a CAC score to assess whether plaque accumulation has already begun.

For the full picture, read The Cardiac Inheritance.