Fatty plaque accumulation in your blood vessels can lead to heart disease, heart attack, and stroke. Lp-PLA2 is linked to the amount of plaque in the blood and can act as an early warning sign. Find out if your Lp-PLA2 level is normal and what you can do to improve it.

What is Lp-PLA2?

Lp-PLA2, short for lipoprotein-associated phospholipase A2, is an enzyme produced by the inflammatory cells in your blood vessels [1].

High concentrations of fat and cholesterol in the blood can cause a buildup of fat called a plaque, the hallmark of atherosclerosis. This plaque can trigger inflammation and activate white blood cells such as macrophages and mast cells. In the course of their duties, these inflammatory cells produce and secrete Lp-PLA2 [1, 2].

What does Lp-PLA2 do? The enzyme produces oxidized fatty acids and other pro-inflammatory compounds that promote inflammation and worsen plaque buildup. It also binds to LDL (bad) cholesterol, allowing it to travel through the bloodstream [1, 2].

Because of the link between Lp-PLA2 and plaque concentration in the blood, Lp-PLA2 levels can help predict the risk for heart disease and stroke. Lp-PLA2 may also be a target for new drugs for the treatment of atherosclerosis [1].

Lp-PLA2 levels reflect the amount of plaque in your blood vessels. High Lp-PLA2 levels can increase your risk of heart disease and stroke.

Lp-PLA2 Testing

Your doctor may order an Lp-PLA2 test (also called a PLAC test) to help determine your risk of developing heart disease or stroke. Based on the results of this test, your doctor may start treatment or increase the dose of any current medications to prevent future heart issues [3].

The test is typically performed for people who are already at a moderate to high risk for developing heart disease due to risk factors like [1, 4]:

  • Diabetes
  • Metabolic syndrome
  • Smoking
  • Advanced age (65 and older)

There are two types of Lp-PLA2 tests:

The Lp-PLA2 test measures the amount of the enzyme in your blood, reported in units of nanograms per mL (ng/mL).

The Lp-PLA2 activity test measures the activity of your enzymes, reported in units of nmol/min/mL. While these units look complex, they simply describe the amount of substance that Lp-PLA2 converts each minute.

There’s some evidence that the Lp-PLA2 activity test is more accurate and it is becoming the more common test of the two [5, 6].


The connection between high Lp-PLA2 and plaque buildup is well-established. In clinical practice, however, it’s not entirely clear how helpful testing is, especially since many other lab markers are also used to evaluate heart disease. Currently, Lp-PLA2 tests are often added to complex panels for people with multiple heart disease risk factors [3, 7].

Lp-PLA2 tests are usually performed in people with risk factors for heart disease. Based on your test results, your doctor may modify or add to your treatment.

Normal Lp-PLA2 Levels

For the Lp-PLA2 test, levels below 200 ng/mL are normal [3].

For the Lp-PLA2 activity test, levels below 225 nmol/min/ml are normal [8].

However, these numbers may vary depending on the laboratory performing the test.

Some health organizations consider levels between 200 and 235 ng/mL as borderline. This means the doctor will have to closely evaluate additional factors, such as family history and other test results, before making clinical decisions [3].

If your Lp-PLA2 levels are above the normal range, you may be at an increased risk for coronary heart disease, stroke, and heart attack. In the following section, we’ll dive deeper into the consequences of high Lp-PLA2 [3].

Negative Health Effects of High Lp-PLA2

So what happens if your Lp-PLA2 levels are above normal?

Lp-PLA2 reflects the amount of plaque and inflammation in your blood vessels. Plaque buildup can narrow your blood vessels, which puts stress on your heart and increases your risk of blood clots [3].

Many studies have shown that people with elevated Lp-PLA2 levels are at a significantly greater risk of developing heart disease or experiencing a stroke in the future [9].

1) Heart Disease

Heart disease, also known as coronary heart disease or coronary artery disease, is one of the leading causes of death in the world. It occurs when plaque accumulates in the coronary arteries, the blood vessels that supply oxygen to the muscles of the heart [10, 11].

This plaque buildup, also known as atherosclerosis, hardens and narrows the blood vessels, which reduces the oxygen supply to the heart. A lack of oxygen will damage heart tissues and can lead to a heart attack [11, 12].

One large observational study of 12,819 healthy adults found that people with Lp-PLA2 levels greater than 422 ng/mL have about double the risk of developing heart disease compared to people with levels below 422 ng/mL [13].

Based on a large review of 32 studies including over 79,000 participants, Lp-PLA2 is linked to risk of heart disease, stroke, and death from heart-related issues [9].

High Lp-PLA2 increases your risk of developing heart disease, almost doubling your risk in some cases.

2) Stroke

A stroke occurs when blood flow to the brain is disrupted either because of a clot or a ruptured blood vessel. Strokes require immediate medical attention and can lead to permanent brain damage and death. Because they pose such extreme danger, stroke prevention is imperative for those with risk factors [14].

In a large study of 12,762 healthy middle-aged men and women, those with Lp-PLA2 levels above 422 ng/mL were about twice as likely to experience a stroke compared to those with lower levels [15].

Strokes are of particular concern in postmenopausal women; the hormone changes associated with menopause can increase the risk of stroke. A study of 1,864 postmenopausal women (who were not on hormone therapy) found that those with Lp-PLA2 levels above 353 ng/mL are 1.6 times more likely to suffer a stroke compared to those with levels below 234 ng/mL [16].

Elevated Lp-PLA2 levels can increase your risk of suffering a stroke.

Causes of High Lp-PLA2

1) Diet

Your diet has a huge effect on your Lp-PLA2 levels and your heart health in general. Large amounts of fat and cholesterol in the blood contribute to plaque formation and Lp-PLA2 production [17].

Multiple studies have confirmed that dietary factors linked to high Lp-PLA2 levels include [3, 18, 19].

  • High LDL (bad) cholesterol
  • Low HDL (good) cholesterol
  • High total cholesterol
  • High triglycerides
  • High saturated fats
  • High carbohydrates
  • Low proteins

2) Physical Inactivity

Physical inactivity and body weight also play an important role in heart health and the amount of Lp-PLA2 in your blood [3].

One study found that if you are overweight (BMI greater than 25 kg/m2), you are likely to have high Lp-PLA2 [19, 18].

Another study found that physical inactivity is strongly associated with higher Lp-PLA2 levels. The study defined inactivity as less than 20 METS (metabolic equivalent of task) per week, which is equivalent to roughly 7 hours of walking or 2 hours of running per week [18, 20].

In other words, if you get less exercise than that, you are likely to have higher Lp-PLA2 levels.

3) Smoking

A study of 186 people found that average Lp-PLA2 levels in smokers are 75 ng/mL higher than in non-smokers. The study also found that people that are chronically exposed to second-hand smoke also experience elevations in Lp-PLA2 [21].

4) Gum Disease

There is increasing evidence that poor dental hygiene can have a negative effect on the rest of the body, especially the heart. One study found that people with a history of gum disease (also known as periodontal disease) are almost twice as likely to have Lp-PLA2 levels above 215 ng/mL compared to those who have never had gum disease [22].

5) Testosterone Deficiency

Hypogonadism is a condition whereby defects in the testes lead to reduced testosterone production. This lack of testosterone can increase cholesterol and fat levels in the blood, potentially leading to more Lp-PLA2 [23].

A study of 70 adult men found that those with hypogonadism have an average Lp-PLA2 level of 243 ng/mL, well above the normal range [23].

6) HIV Infection

Patients with HIV often have elevated Lp-PLA2 levels. This is because HIV treatments can interfere with the balance of cholesterol and fats in the blood, leading to increases in total cholesterol, LDL, and triglycerides [17, 24].

One study found that the average Lp-PLA2 level of 107 HIV patients was 389 ng/mL [17].

How to Lower Lp-PLA2 Levels

1) Diet

A proper diet is essential for a healthy heart. Eating the right foods can improve heart function and lower Lp-PLA2 [18].

Research shows that certain dietary changes can reduce Lp-PLA2 levels. Smart choices include [19, 18, 17]:

The American Heart Association also has several dietary recommendations to improve heart health in general. Although it’s not clear if these recommendations lower Lp-PLA2 specifically, they’re a good idea for anyone at risk for heart disease. These recommendations include [25]:

  • Eating a diet rich in vegetables and fruits
  • Eating whole-grain, high-fiber foods
  • Eating fish (especially oily fish) at least twice a week
  • Limiting saturated fats to <7% and trans-fats to <1% of total energy consumption
  • Limiting cholesterol to <300 mg/day
  • Minimizing the consumption of beverages and foods with added sugars
  • Choosing and preparing foods with little or no salt

2) Exercise

A little physical activity each week can go a long way in preventing or reducing risk factors for heart disease [18].

One study investigated the effects of diet and exercise on Lp-PLA2. The exercise consisted of aerobic and resistance training for 75-90 minute sessions 3 times a week. They found that Lp-PLA2 levels dropped an average of 65 ng/mL after 24 weeks of the program. However, it’s important to note that the study focused solely on patients with HIV [17].

How much should you exercise? The American Heart Association recommends [26]:

  • At least 30 minutes of moderate aerobic activity at least 5 days per week
  • OR 25 minutes of vigorous aerobic activity at least 3 days per week
  • PLUS moderate- to high-intensity muscle-strengthening activity at least 2 days per week

3) Quit Smoking

Besides diet and exercise, quitting smoking is one of the best things you can do for your heart and your health in general [18].

As mentioned earlier, smokers have significantly higher (about 75 ng/mL more on average) Lp-PLA2 levels compared to non-smokers [21].

Even if you don’t smoke, you may still want to avoid environments where smoking is present. Second-hand smoke can significantly increase Lp-PLA2 as well [21].

4) Good Dental Hygiene

People who have a history of gum disease have significantly higher Lp-PLA2 levels, suggesting that good oral hygiene can reduce your risk of high Lp-PLA2 and heart disease [22].

What can you do to avoid gum disease? Most people know that daily brushing and flossing are important to good oral health along with regular professional teeth cleaning. However, some other, less obvious factors may also contribute to gum disease, such as [27]:

  • Smoking
  • Medications (birth control, phenytoin, cyclosporine)
  • Poor nutrition
  • Stress

If possible, avoid these factors – or, if you can’t avoid them, take extra steps to protect your gums from their influence.

5) Supplements

Studies show that several supplements can help bring down Lp-PLA2 levels, including:

Irregular Lp-PLA2 Levels?

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Lp-PLA2 is linked to plaque buildup in the blood vessels. High levels can put you at risk for heart disease and stroke.

Luckily, there are steps you can take to lower your Lp-PLA2 levels, including proper diet and exercise, quitting smoking if you’re a smoker, and maintaining good oral hygiene.

Some supplements can also help, like omega-3 fatty acids, probiotics, vitamin D, and a blend of red yeast rice and olive extract.

About the Author

Mathew Eng, PharmD


Mathew received his PharmD from the University of Hawaii and an undergraduate degree in Biology from the University of Washington.

Mathew is a licensed pharmacist with clinical experience in oncology, infectious disease, and diabetes management. He has a passion for personalized patient care and believes that education is essential to living a healthy life. His goal is to motivate individuals to find ways to manage their chronic conditions.

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