How to Treat High Lipoprotein(a)
Lifestyle has little or no impact on lipoprotein(a), also known as Lp(a) levels. Still, diet and exercise can help reduce the risk of cardiovascular disease, and those with high Lp(a) levels will want to consider making some changes.
Reducing All Cardiovascular Risk Factors
Even though there are no current medications to lower Lp(a) levels, you can and should work to reduce all other risk factors if you have high Lp(a). If you are overweight, try to get to a healthier weight. If you smoke, quit. These are not easy changes to make, but the sooner you do it – the better. If you have other risk factors, like high blood pressure or diabetes, take all prescribed medications for these conditions.
Anyone who has an elevated Lp(a) should work on lowering their LDL cholesterol as much as possible. People with no history of cardiovascular disease should aim for less than 100 mg/dl. People with cardiovascular disease strive for levels less than 70 mg/dL. And if you have heart disease and other cardiac risk factors, aim for an LDL-C less than 55 mg/dL.
Lipoprotein apheresis is currently the only therapy approved by the Food and Drug Administration (FDA) for lowering Lp(a) in the United States. It is only approved for people with all three of the following:
- Heterozygous familial hypercholesterolemia (FH)
- LDL cholesterol higher than 100 mg/dL andLp(a) higher than 60 mg/dL
- Either coronary artery disease or peripheral artery disease.
Estrogen, niacin, and PCSK9 inhibitors are known to lower Lp(a) levels. However, estrogen and niacin have not been shown to protect you against developing heart disease if you have high Lp(a). Preliminary evidence suggests that the cardiac benefit seen with PCSK9 inhibitors is because of both LDL and Lp(a) reduction, but more evidence is needed at this time. Studies specifically looking at PCSK9 inhibitors and Lp(a) are underway.
Knowing What’s Ahead
There are several promising Lp(a) medications that are now in clinical trials. Visit our clinical trials page to learn more about Lp(a) clinical trials.
In time, we’ll learn if these medications are safe and reduce cardiovascular events.
For now, you should ask your healthcare practitioner to test your Lp(a) level. If it’s elevated, your first-degree relatives should also be screened, and you should work to reduce all risk factors within your control — especially your LDL cholesterol.