Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
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Lipoprotein(a) [Lp(a)]

Lipids · specimen: blood

Indicated as standard

Also called: Lp(a), lipoprotein a, lipoprotein little a, Lpa

Chart note

Pick Ordered or Not ordered to see the note.

Indicated when

  • Once in a patient's lifetime, as part of initial lipid and cardiovascular risk screening in adults who have not previously been measured, per the 2021 Canadian Cardiovascular Society guideline and the 2022 European Atherosclerosis Society consensus statement [1, 2]
  • Personal or family history of premature atherosclerotic cardiovascular disease, familial hypercholesterolemia, or a family member with known very high Lp(a), where cascade testing has added value [2]

Not indicated when

  • Repeat testing once a lifetime Lp(a) measurement is already on record; both the CCS and EAS frame Lp(a) testing as a once-in-a-lifetime measurement rather than a level to be rechecked [1, 2, 7]

Why not

Testing is recommended; the caution is about what a high result means. No approved therapy targets Lp(a) directly. The first large outcomes trial of an Lp(a)-lowering drug (pelacarsen, Lp(a)HORIZON, topline results September 2026) lowered Lp(a) but did not reduce cardiovascular events [8]. So a high result is used to intensify management of the other, modifiable risk factors [2]. Explaining this before testing avoids anxiety over a number that can't yet be treated directly.

Better first step

If not yet measured in adulthood, Lp(a) is itself the appropriate first step as part of initial lipid screening; no preceding test is required [1].

Typical ND rationale

An ND may recommend Lp(a) testing because it is a largely genetically determined cardiovascular risk factor that standard lipid panels do not capture, and because a high result changes how aggressively the patient's other risk factors should be managed.

Where the ND is right

The ND is right here: Lp(a), measured once in adulthood, is now standard, guideline-recommended practice in Canada, was specifically made OHIP-insured for this reason in 2026, and is a test many patients who ask for it have simply never had done [1, 2, 3].

Ontario coverage & CONO orderability

OHIP status
insured
Listed by name in the 2026 Schedule of Benefits for Laboratory Services (L043 Lipoprotein a [Lp(a)], fee $24.75), newly added effective April 1, 2026 "as per the 2021 Canadian Cardiovascular Society (CCS) Guidelines." Insured when ordered by a physician, midwife, or NP who has clinically assessed the patient; the same test ordered by a naturopathic doctor is not an insured service and is billed privately (Reg. 552 s.22(1); SOB-LS 2026 preamble). The Schedule text itself carries no stated frequency restriction; the once-in-a-lifetime framing is clinical guidance from CCS/EAS, not an OHIP billing rule.
CONO orderable
No
Not on the CONO list under any code found this session. The closest item, 121 ('Total Cholesterol panel - HDL / LDL / lipoprotein phenotyping (includes sample appearance, cholesterol, triglycerides, Lipopro VLDL cholesterol [calculated estimate])'), names lipoprotein electrophoresis/phenotyping, a different analyte and method from an Lp(a) mass immunoassay, so it is not treated as covering Lp(a).

Linked conditions

Counselling script

“Lp(a) is a genetic cholesterol marker that guidelines now recommend checking once in every adult's lifetime, because a high result changes how closely we manage your other heart risk factors. If you haven't had it measured before, I'd like to order it today as part of your lipid screening, since it's now a covered test that only needs to be checked once.”

Revisit if

  • Cannot confirm whether a prior lifetime Lp(a) measurement exists
  • New family history of premature cardiovascular disease or known very high Lp(a) in a relative
  • New diagnosis of familial hypercholesterolemia
  • Full Lp(a)HORIZON publication or an updated CCS dyslipidemia guideline appears (content review trigger)

References

  1. [1]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkLp(a) measurement recommended once in a patient's lifetime as part of initial lipid screening
  2. [2]European Atherosclerosis Society (2022). Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. linkLp(a) testing recommended at least once in adults; no specific Lp(a)-lowering therapy yet exists, so management focuses on other risk factors
  3. [3]Ontario Ministry of Health (2026). INFOBulletin 260310: Update: 2026-27 schedule of benefits for laboratory services. linkLp(a) (L043) newly OHIP-insured effective April 1, 2026 as per the 2021 CCS Guidelines
  4. [4]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
  5. [5]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
  6. [6]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
  7. [7]Canadian Society for Medical Laboratory Science / Choosing Wisely Canada (2025). Medical Laboratory Science: Fourteen Tests and Treatments to Question. linkRepeat lab test ordering at a frequency not backed by evidence should not be routinely supported
  8. [8]Novartis (sponsor press release) (2026). Novartis announces Lp(a)HORIZON Phase III topline results for pelacarsen in patients with elevated Lp(a) and established cardiovascular disease (CVD). linkSept 2026 topline: pelacarsen lowered Lp(a) but did not meet its primary MACE endpoint; no approved targeted therapy
Evidence notes

No Canadian guideline update superseding the 2021 CCS dyslipidemia guideline was found for the Lp(a) recommendation. Whether OHIP's billing system would actually reject or flag a second lifetime L043 claim was not established; the 2026 Schedule text found in this session states only the clinical rationale ('as per the 2021 CCS Guidelines') with no explicit frequency-limit wording, unlike some other codes (e.g., NT-proBNP's explicit clinical restriction), so the once-in-a-lifetime framing is presented here as clinical guidance, not confirmed billing policy. Reviewer: the Lp(a)HORIZON topline (sponsor press release, 4 Sept 2026, not yet peer-reviewed) was added. It doesn't change the CCS 2021 once-in-a-lifetime testing recommendation, which is about risk stratification, but it does change counselling: patients shouldn't be told a drug for Lp(a) is imminent. Re-check when the full publication and any CCS update appear. Other Lp(a)-lowering agents (e.g. olpasiran, lepodisiran) have outcome trials still reporting; not checked in this batch.