Managing Lipoprotein(a) and Cholesterol - Doctor Q&A

“What should I do if my blood levels of lipoprotein(a) are very high?”

“Is my family history of ischaemic heart disease linked to my own lipid levels?”

Lipoprotein(a), or Lp(a), is an often overlooked but significant genetic risk factor for cardiovascular disease.

Studies have shown that 1 in 5 people worldwide have elevated Lp(a), and locally, 1 in 6 individuals who experienced a heart attack were found to have elevated Lp(a). Despite this, awareness and testing for Lp(a) remain low.

Unlike common cholesterol markers, Lp(a) levels are largely inherited and remain relatively stable throughout life. As Lp(a) is genetically determined, lifestyle changes alone may not be sufficient to manage the risk.

Lp(a) is structurally like low-density lipoprotein (LDL), but with an added protein component that makes it more likely to stick to blood vessel walls, contributing to plaque build-up. This increases the risk of heart attacks, stroke, and other cardiovascular complications.

The good news: early detection of Lipoprotein(a) allows for better risk stratification and targeted management.

As cardiovascular disease remains a leading cause of death in Singapore and globally, individuals with a family history of heart disease, or those who have experienced unexplained cardiovascular events, are encouraged to undergo at least one Lp(a) test in their lifetime.

Individuals can take proactive steps to protect their heart health with the right combination of:

• Monitoring,
• Lifestyle optimisation, and
• Medical interventions

Have questions about Lipoprotein(a), genetic cardiovascular risks and management strategies, don't miss this chance to ask Dr Loh! This Q&A is for a limited time only.

Dr Loh Wann Jia is a Senior Consultant with the Department of Endocrinology at Changi General Hospital (CGH).

She is actively involved in research and teaching, with clinical and research interests in obesity, diabetes mellitus, lipid disorders, and broader metabolic conditions.

To deepen her sub-specialty expertise and foster international collaborations, Dr Loh completed fellowships at hospitals affiliated with Imperial College London in 2017, and at Royal Perth Hospital, Australia, in 2022.

Dr Loh is particularly passionate about advancing the understanding of genetic lipid disorders such as Lipoprotein(a), and works closely with multidisciplinary teams to improve early detection and long-term cardiovascular outcomes for patients.

1. Question by Janice

Hi Dr,

I have high lipoprotein(a) and cholesterol.

What lifestyle optimisation and medical interventions should I take? Thank you for your advice.

Answer by Dr Loh Wann Jia

Hi Janice, thank you for your question. Each patient requires individualised medical therapy and prescription. For individuals diagnosed with elevated Lp(a) levels, CGH adopts the LILAC approach, which underscores five key interventions:

L: Recognise Lp(a) as a cardiovascular risk factor. Learn about Lp(a) and your other lipid (cholesterol) profile for appropriate risk factors.

I: Improve all cardiovascular risk factors.

L: Lower LDL cholesterol level first, and in severe cases, consider lowering Lp(a) levels.

A: Assess for related conditions associated with elevated Lp(a), while considering aspirin.

C: Consider cascade testing to identify at-risk family members. “C” also stands for Care and Compassion.

Following the LILAC approach can help patients to reduce cardiovascular risks associated with elevated Lp(a) levels. Emphasis remains on the letter “I”- improving one’s lifestyle, including diet and exercise, controlling blood pressure and glucose levels, and avoiding obesity, as these are still the first steps.

On Saturday, 25^th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

2. Question by Effendy

Hi Dr,

If already have borderline high LDL, and following diet and medication to reduce the LDL, is it still necessary to test for Lp(a)?

And, if Lp(a) is genetic and high, is there anything else can be done to lower it? (especially if already trying to lower the LDL). Thank you.

Answer by Dr Loh Wann Jia

Hi Effendy,

Having high levels lipoprotein(a), otherwise called elevated lipoprotein(a) disorder, is quite common but underdiagnosed, with many people unaware they have it.  Depending on whether someone is already at high risk for cardiovascular disease or stroke, it may be more important to be tested earlier rather than later.

There are ways to lower cholesterol, whether its LDL cholesterol or lipoprotein(a) levels.

Learn about LILAC. It’s a simplified approach that we use to manage patients with genetic lipid conditions including lipoprotein(a). Emphasis remains on the letter “I”- improving one’s lifestyle, including diet and exercise, controlling blood pressure and glucose levels, and avoiding obesity, as these are still the first steps.

On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

3. Question by Tracy

Hi Dr,

My questions are:

a) Why does my body produce so much LDL cholesterol? Even with healthy lifestyle optimisation (healthy weight, regular exercise, plant-based diet, increased soluble fibre intake, no sugar/ultra-processed foods etc) levels are still elevated. Is there inflammation going on in my body that can/should be addressed vs taking a statin that brings LDL down but does not treat the cause?

b) Can HDL levels be too high and if so, how do you bring it down.

Thank you for taking the time to answer my questions. Look forward to hearing from you.

Answer by Dr Loh Wann Jia

Hi Tracy, thank you for your questions.

Our liver makes cholesterol, which is carried around via various cholesterol particles, the most well-known being LDL particle. Hence it is called LDL cholesterol. When LDL cholesterol level or any other cholesterol levels are extremely high (excessive), this is usually related to a genetic cause (e.g. familial hypercholesterolaemia); otherwise, it could be secondary to medical causes.

Yes, it is strongly recommended to lower LDL cholesterol to avoid build-up of cholesterol plaques in the artery walls.

Please discuss with your doctor on whether you need further investigations, including genetic testing, and what medication would be best for you. The most common initial treatment after diet control, is to add a statin therapy.

On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

4. Question by Esther

Dear Dr Loh,

Is Lp(a) level directly related to LDL level? In other words, if I have high LDL, is it likely that I will have high Lp(a)? Am I able to get Lp(a) test at government polyclinics? Thank you.

Answer by Dr Loh Wann Jia

Lp(a) blood particles are not at all related to LDL blood particles. However, when someone has extremely high levels of Lp(a) (e.g. 300 nmol/L, 400 nmol/L), this can cause the LDL cholesterol level to appear falsely higher than it is. While the test helps us estimate levels, it is not perfect yet, although this is expected to improve over time.

For now, government polyclinics have not made this test available. However, Lp(a) testing is offered in most hospitals and medical centres in Singapore now.

On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

5. Question by Robin

Hi Dr,

When is the recommended period for testing of LP(a)?

Can this be done in a Polyclinic or must go to a specialist? Thank you.

Answer by Dr Loh Wann Jia

For individuals suspected to be high or very high risk for cardiovascular disease, such as those with family history of heart attack in parents before the age of 55, or if the individual himself had a heart attack or stroke before, or those with familial hypercholesterolaemia (very high LDL cholesterol), it is recommended for them to get tested in early adulthood.

For individuals who are well and have no cardiovascular risk factors, the timing of testing is more flexible. Testing earlier allows for you to take necessary precautions such as eating healthy, exercising regularly, not smoking, and controlling blood pressure.

For now, government polyclinics have not made this test available. However, Lp(a) testing is offered in most hospitals and medical centres in Singapore now.

To learn more: 
On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

6. Question by Simon

Hi Dr,

I read with interest your article and found it intriguing because I had requested my Polyclinic doctor for a follow up LP (a) blood test, but was told there was no such protocol in place for him to do so.

For context, I turn 65 this year. I had a STEMI, PCI stents, in 1st Dec 2024, then a Midcab, LIMA LAD at NHCS on 5 March 2025; now just routine follow up.

Seem to have family history; older brother had bypass at 58, his son has had a stent in LAD at 39. Question: Even if I do the above test privately, what good is that I managing the disease, given diet and lifestyle do not alter the risk factor significantly?

Let me know your take. Thank you.

Answer by Dr Loh Wann Jia

Hi Simon,

For now, government polyclinics have not made this test available. However, Lp(a) testing is offered in most hospitals and medical centres in Singapore now.

Given your heart attack (STEMI) and strong family history of heart disease, I would strongly recommend you have your blood Lp(a) level checked.  You can go to Health Buddy to see if you have done this before. Otherwise, you can inform your doctor at your next appointment with NHC to request for this test. Most cardiologists are now aware of this condition. If the result is normal, you do not need to check this again.

For individuals diagnosed with elevated Lp(a) levels, CGH adopts the LILAC approach, which underscores five key interventions:

L: Recognise Lp(a) as a cardiovascular risk factor. Learn about Lp(a) and your other lipid (cholesterol) profile for appropriate risk factors.

I: Improve all cardiovascular risk factors.

L: Lower LDL cholesterol level first, and in severe cases, consider lowering Lp(a) levels.

A: Assess for related conditions associated with elevated Lp(a), while considering aspirin.

C: Consider cascade testing to identify at-risk family members. “C” also stands for Care and Compassion.

Following the LILAC approach can help patients to reduce cardiovascular risks associated with elevated Lp(a) levels. Emphasis remains on the letter “I”- improving one’s lifestyle, including diet and exercise, controlling blood pressure and glucose levels, and avoiding obesity, as these are still the first steps.

To learn more: 
On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

7. Question by Niru

Dear doctor,

I’m a 57-year-old woman of Indian origin. My father passed away at age 52 due to a heart attack.

I have high lipoprotein A-125mg/dL

I lead a relatively healthy lifestyle. Exercise 5 days a week. Walk more than 10,000 steps daily (mostly). Eat healthy most of the time- home cooked meals - less oil, salt, balanced.

Is there anything else i can do to lower my lipoproteinA levels.

Secondly is there any medication for this (had heard last year that there was a breakthrough in the U.S). Thank you.

Answer by Dr Loh Wann Jia

Hi Niru,

Thank you for your question and I’m sorry for your loss.

Yes, there are few things that may be specifically necessary for your case, because of your strong family history and severely elevated lipoprotein(a) level. Lp(a) blood level of more than ≥ 120 nmol/L (or 50 mg/dL) is considered high.

As far as we know, developing Lp(a)-lowering medications are currently undergoing further trials. The multidisciplinary team at the CGH Lipid Clinic is dedicated to uncovering insights and approaches to manage elevated Lp(a) levels. This includes the current use medications such as PCSK9 enzyme inhibitor which is prescribed to lower LDL by 50-70% primarily, which has an added benefit of lowering Lp(a) by 20-30% as a result. CGH is currently conducting research on the prevalence of elevated Lp(a) levels amongst the working-age population in Singapore.

In the meantime, for individuals diagnosed with elevated Lp(a) levels, CGH adopts the LILAC approach, which underscores five key interventions:

L: Recognise Lp(a) as a cardiovascular risk factor. Learn about Lp(a) and your other lipid (cholesterol) profile for appropriate risk factors.

I: Improve all cardiovascular risk factors.

L: Lower LDL cholesterol level first, and in severe cases, consider lowering Lp(a) levels.

A: Assess for related conditions associated with elevated Lp(a), while considering aspirin.

C: Consider cascade testing to identify at-risk family members. “C” also stands for Care and Compassion.

Following the LILAC approach can help patients to reduce cardiovascular risks associated with elevated Lp(a) levels. Emphasis remains on the letter “I”- improving one’s lifestyle, including diet and exercise, controlling blood pressure and glucose levels, and avoiding obesity, as these are still the first steps.

To learn more: 
On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

8. Question by Ms Kwek

Hi Dr,

I would like to know how I can check for lipoprotein a levels. The usual health screening tests only for LDL. Is this test available at Healthier SG clinics?

If my mother has high lp(a), does it mean that I am also at risk. If so, what should I look out for or do to mitigate my risks? Thank you.

Answer by Dr Loh Wann Jia

Hi Ms Kwek,

For now, the government polyclinics have not made this test available.

However, Lp(a) testing is offered in most hospitals and medical centres in Singapore now.

For individuals diagnosed with elevated Lp(a) levels, CGH adopts the LILAC approach, which underscores five key interventions:

L: Recognise Lp(a) as a cardiovascular risk factor. Learn about Lp(a) and your other lipid (cholesterol) profile for appropriate risk factors.

I: Improve all cardiovascular risk factors.

L: Lower LDL cholesterol level first, and in severe cases, consider lowering Lp(a) levels.

A: Assess for related conditions associated with elevated Lp(a), while considering aspirin.

C: Consider cascade testing to identify at-risk family members. “C” also stands for Care and Compassion.

Following the LILAC approach can help patients to reduce cardiovascular risks associated with elevated Lp(a) levels. Emphasis remains on the letter “I”- improving one’s lifestyle, including diet and exercise, controlling blood pressure and glucose levels, and avoiding obesity, as these are still the first steps.

To learn more: 
On Saturday, 25th April, we will be having a Lipid Disorders and Lipoprotein(a) Support and Awareness Day at CGH. You can sign up for this by registering via the QR code on the CGH website here.

We have also made a family-friendly informative cartoon video on LILAC for Lipoprotein(a), which you can view here.

9. Question by James

Hi Dr,

I'm on statin, and doing annual blood test to check Cholesterol level.

If Lp(a) is more likely to cause plaque build-up, why Polyclinic doctor does not prescribe this test?

Can the Polyclinic which do my Cholesterol test also check my Lp(a).

How much does it cost? Thank you.

Answer by Dr Loh Wann Jia

Hi James,

For now, government polyclinics have not made this test available. However, Lp(a) testing is offered in most hospitals and medical centres in Singapore now.

At CGH, the fee for Lp(a) testing varies depending on patient subsidy.

10. Question by WF

Dear Dr Loh, 

My husband is 54 years old and with family history increased CVD risk, on low dose Lipitor due to mildly elevated LDL and Lipo(a).

His doctor friend in Australia recommended Leqvio, so he is wondering if it is available in Singapore.

Also wondering how helpful is it in terms of lowering LDL or Lipo(a) and does lowering the number actually translates to a better clinical outcome? Thanks!

Answer by Dr Loh Wann Jia

Hi WF,

Leqvio (medical name: inclisiran) is a 6-monthly injectable that is very good at lowering LDL cholesterol by 50% and Lp(a) by about 25-30%.

In Singapore, we also have the 2-weekly injectable (self-injection) called Repatha (medical name: evolocumab), which works equally well for a much lower price.

Both medications are available in all hospitals, and evolocumab is now available at some polyclinics.

The aim to lowering severely elevated cholesterol levels early and consistently, is to reduce the cholesterol plaques that will eventually build in arteries wall if left untreated.

Every patient needs individualised therapy and discussions with their own doctor on the risk versus benefit of each treatment. Not everyone requires medications, but everyone should practice eating healthy, exercise regularly and control blood pressure and glucose.

Ref: F26