New Guidelines: The Cholesterol Test You Only Need Once (Especially if you Have Diabetes)

If you have been managing your cholesterol for a while, you probably know the routine. Eat less saturated fat. Move more. Check your numbers once a year. Maybe take a statin if your LDL is high. All of that still matters. But the updated cholesterol guidelines are encouraging us to go one step further with a simple blood test that most adults have never heard of, and the results can shape how you protect your heart for the rest of your life.

That test is called Lipoprotein(a), or just Lp(a) for short. The guidelines now recommend checking it at least once in your lifetime. One blood draw. One number. Information you keep forever.

If you are living with type 2 diabetes, prediabetes, or you already know your heart risk is elevated, this is a conversation worth having with your care team.

So what is Lp(a), really?

Think of Lp(a) as a quieter, more stubborn cousin of LDL, the cholesterol number you have probably heard about. It is a particle that carries cholesterol through your blood. The difference is that your Lp(a) level is largely written into your DNA. You were born with your number, and it does not move much based on what you eat, how often you exercise, or whether you take a standard cholesterol medication.

About 1 in 5 people around the world have elevated Lp(a), and most of them have no idea. Higher levels are linked to an increased risk of heart attack, stroke, and narrowing of the aortic valve, and that your regular cholesterol panel can look great while a hidden risk factor is quietly at work in the background.

That is exactly why the updated guidelines encourage adults to check Lp(a) at least once. It is a small piece of the puzzle that can reshape the whole picture.

Why once in a lifetime is actually a gift

We are used to tests that need to be repeated. A1c every three months. Lipid panels every year. Blood pressure at every visit. Lp(a) is refreshingly different. Because your genes stay the same, your Lp(a) is essentially stable across your adult life.

When you get that number, you are not just checking a box. You are collecting a piece of information that will help your clinician and your future self. It can help you:

• See your true cardiovascular risk, not just what shows up on a standard lipid panel

• Decide how aggressively to manage the things you can change, like LDL, blood pressure, and blood sugar

• Have a heads-up for close family members who may want to check their own levels

• Prepare for upcoming treatment options as the science evolves

That last point matters more than most people realize, and it is where this story gets interesting.

What treatment could look like in the future

Here is the honest truth today. We do not yet have a medication that is specifically approved to lower Lp(a). Statins barely touch it. Diet and exercise do not meaningfully shift it either. For a long time, managing high Lp(a) has meant knowing your number and then working extra hard on every other heart-health lever you can control.

The good news is that the research pipeline looks promising. Several targeted therapies are in late-stage clinical trials, and early data shows they can lower Lp(a) by significant amounts. If those trials continue to show strong cardiovascular outcomes, we could be within a few years of having a real, specific tool for people with elevated Lp(a).

This is one of the reasons it is worth testing now, even before those medications are available. When new options do arrive, the people who already know their number will be the first in a position to make informed decisions with their healthcare team.

What this means for people living with diabetes

Here is where I want to speak directly to my diabetes community. Type 2 diabetes already raises the risk of heart disease, and that risk is amplified by insulin resistance, higher triglycerides, lower HDL, and chronic low-grade inflammation. Your cardiovascular system is already working overtime.

Now add elevated Lp(a) on top of that, and you have two strong, independent risk factors stacking on each other. That is not meant to scare you. It is meant to remind you that information is power. When you know your Lp(a), you and your care team can build a more honest, more personalized plan around the factors you can influence.

In practice, that usually looks like:

• Setting tighter, realistic blood sugar goals, because every point of A1c matters more when cardiovascular risk is higher

• Getting serious about LDL, since we can still lower it even when Lp(a) stays steady

• Building meals that support steady glucose, lower inflammation, and heart-healthy fats, using foods like fatty fish, olive oil, nuts, seeds, beans, and plenty of colorful plants

• Keeping blood pressure in a healthy range, which is often overlooked and incredibly impactful

• Adding purposeful movement, such as a 20 to 30 minute walk after meals, which supports glucose and your long-term heart health at the same time

• Protecting sleep and managing stress, both of which quietly shape blood sugar, cortisol, and blood pressure

None of this is flashy. It is the quiet, consistent work of daily habits, and it genuinely moves the needle on the things that elevated Lp(a) amplifies.

How to ask for your test

Getting tested is straightforward. At your next visit with your primary care clinician or cardiologist, you can simply say:

"I'd like to check my Lipoprotein(a) once, based on the updated cholesterol guidelines. Can we add it to my next lab draw?"

It is a single blood test, usually added to your regular lipid panel. Most insurance plans cover it, especially if you have diabetes, a personal history of cardiovascular disease, or a family history of early heart attacks. Once you have the result, write it down, keep it in your records, and make sure every member of your care team knows about it.

A quick word before you go

One of the things I love most about the direction of cardiovascular care is that it keeps expanding what we can see. We are no longer relying on one or two numbers to tell a very complicated story. Tests like Lp(a) help us understand the whole person, which is exactly how I believe care should work, especially for people living with diabetes.

You do not need to overhaul your life overnight. You just need a clear number, a thoughtful plan, and a team that sees you as a whole human being, not just a lab value.

Want support putting this into action?

If you are living with type 2 diabetes, prediabetes, or elevated cardiovascular risk and you are tired of piecing this together on your own, I would love to invite you into my signature program, Better Together: Blood Sugar Blueprint. It is a hybrid one-on-one and group coaching experience designed to help you make sense of your labs, fine-tune your food, and feel confident in the driver's seat of your health.

You can learn more and apply at www.russpowellnutrition.com/book. I would be honored to walk this next step with you.

This article is for educational purposes and is not a substitute for personalized medical advice. Always discuss testing and treatment decisions with your healthcare team.