Lipoprotein (a) (Lp(a)) has been described as an important component of the lipid profile and a significant coronary risk factor when elevated. Controversy surrounds the importance of this lipoprotein variant, and its management is often challenging for clinicians. Important issues relate to the control and management of high Lp(a) levels, especially in patients at intermediate risk of cardiovascular disease. Clear guidelines are lacking on who needs Lp(a) measured, and when. We review practical points on investigating and managing Lp(a).