Men, on average, develop cardiovascular disease 7 to 10 years earlier than women. One of the most important – yet often overlooked – reasons is a genetically elevated level of Lp(a) in the blood. Lp(a), or lipoprotein(a), is an inherited form of cholesterol that can significantly increase the risk of atherosclerosis, heart attacks, and valve calcification. Because Lp(a) is not included in standard cholesterol tests, elevated levels often go unnoticed – even in men who otherwise live a healthy lifestyle.

Did you know…

• About 1 in 5 men have elevated Lp(a) levels (>125 nmol/L).
• Men with high Lp(a) have up to 4 times greater risk of having a heart attack before the age of 55.
• In 25% of young men who suffer a heart attack, elevated Lp(a) is the main underlying cause.
• Lp(a) is also a strong risk factor for aortic valve calcification, a condition that can take years to cause symptoms.

Why Lp(a) deserves extra attention in men

In men, vascular calcification tends to develop earlier and progress faster than in women. This is partly due to hormonal differences, testosterone offers less cardiovascular protection than estrogen, but mainly because of genetic predisposition.

An elevated Lp(a):

• Accelerates the buildup of cholesterol in artery walls.
• Increases the likelihood of blood clots and inflammation.
• Contributes to aortic valve calcification, which can lead to shortness of breath, fatigue, and heart failure later in life.

Most men with elevated Lp(a) have no symptoms until damage has already occurred.

When testing for Lp(a) is recommended

Testing for Lp(a) is especially important for men who:

• Have experienced a heart attack or vascular event before age 55, or have a family history of early heart disease.
• Maintain a healthy lifestyle yet still have high cholesterol or heart problems.
• Experience shortness of breath or fatigue that may be linked to valve calcification.
• Develop heart problems at a young age without an obvious cause.

A simple blood test can reveal your genetic risk.

What men can do

While you cannot change your Lp(a) level, you can significantly reduce its impact on heart health:

• Keep your LDL cholesterol as low as possible — this helps offset the extra risk.
• Exercise regularly and follow a heart-healthy diet (plenty of vegetables, whole grains, fish, and nuts).
• Quit smoking — smoking amplifies the negative effects of Lp(a).
• Get regular check-ups, especially if heart disease runs in your family.

A single test can reveal whether genetic factors play a role and that insight could prevent heart problems years in advance.

Why this matters

Measuring Lp(a) allows heart problems in men to be detected much earlier, often before symptoms appear. For younger and middle-aged men, especially those with a family history of heart disease, Lp(a) is the most underestimated risk factor that can be easily tested — and knowing your level could make all the difference.

Sources
Scientific sources and medical references. The information on this page about lipoprotein(a), cardiovascular risk, and its relevance in men is based on the following scientific publications and consensus documents:

Kamstrup PR, Benn M, Tybjærg-Hansen A, Nordestgaard BG.
Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population.
Circulation, 2008.
https://pubmed.ncbi.nlm.nih.gov/18086931/

Kamstrup PR, Tybjærg-Hansen A, Steffensen R, Nordestgaard BG.
Genetically elevated lipoprotein(a) and increased risk of myocardial infarction.
JAMA, 2009.
https://pubmed.ncbi.nlm.nih.gov/19509380/

Berman AN, et al.
Atherosclerotic cardiovascular disease risk and elevated lipoprotein(a) among young adults with myocardial infarction: the Partners YOUNG-MI Registry.
European Journal of Preventive Cardiology, 2021.
https://pubmed.ncbi.nlm.nih.gov/32539451/

Burgess S, Ference BA, Staley JR, et al.
Association of LPA variants with risk of coronary disease and aortic valve stenosis.
JAMA Cardiology, 2018.
https://pubmed.ncbi.nlm.nih.gov/29926099/

Kronenberg F, Mora S, Stroes ESG, et al.
Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement.
European Heart Journal, 2022.
https://pubmed.ncbi.nlm.nih.gov/36036785/

European Society of Cardiology.
Guidelines on cardiovascular disease prevention and lipid management, including lipoprotein(a).
ESC Guidelines, last updated 2021–2023.
https://www.escardio.org/Guidelines

Erasmus MC – Vascular Medicine (laboratory specialty).
Information and clinical context on lipid research and lipoprotein(a) within Erasmus MC.
https://www.erasmusmc.nl/nl-nl/patientenzorg/laboratoriumspecialismen/vasculaire-geneeskunde