Dr Mike MacDonald

Heart Health Unveiled: The Importance of Lowering Lipoprotein (a)

Table of Contents

High levels of lipoprotein (a), Lp(a) have been linked to an increased risk of heart disease. Understanding how to lower Lp(a) has become an important priority for specialists and people alike as medical research into the complexities of heart health continues.

We shall examine many strategies for reducing lipoprotein(a) in this article, supported by data from research and recommendations from experts. We will also explore the advantages of keeping Lp(a) levels low as we get older and how this promotes general heart health.

Understanding the Effects of Lipoprotein(a) on Heart Health

Apolipoprotein(a) is a protein that is coupled to an LDL cholesterol (low-density lipoprotein) particle to form the complex molecule known as lipoprotein(a). Although Lp(a) is different from other cholesterol particles in that it includes an extra protein, it is otherwise structurally identical to LDL cholesterol.

Heart disease, stroke, and atherosclerosis have all been linked to having high levels of Lp(a) in the bloodstream. Even in the absence of other traditional risk factors like high LDL cholesterol levels, research investigations have shown that people with raised Lp(a) levels are more likely to acquire cardiovascular disorders. 

Do we know if lowering Lp(a) prevents heart disease?

The short answer is NO. Although we know that higher Lp(a) is associated with higher rates of cardiovascular disease, there have been no trials examining whether lowering Lp(a) lowers your risk of heart disease.

There are currently some trials using agents that lower Lp(a) but they will not be finished until 2024 or later. So until then we do not know if any strategy to lower it will be beneficial. 

Despite this, we will still discuss the different strategies you can use to try and lower it. It is debatable currently if you need to do any of these.

Methods to Reduce Lipoprotein(a)

  1. Lifestyle Modifications

  • Dietary Modifications: Eating a heart-healthy diet can help to reduce Lp(a) levels in a big way. Put an emphasis on eating a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats, and cut out on added sweets, saturated fats, and trans fats. A Mediterranean-style diet high in fish, olive oil, nuts, and whole grains has been linked in studies to a reduction in Lp(a) levels. 
  • Regular Physical Activity: Physical activity has positive effects on heart health and can help lower Lp(a) levels. Exercise has been demonstrated to speed up the removal of Lp(a) from the bloodstream and enhance its breakdown, potentially lowering its concentration.
  1. Medications

  • Niacin (Vitamin B3): Niacin (Vitamin B3) is a B vitamin that has been shown to significantly reduce Lp(a) levels. It is available by prescription and is frequently combined with other cholesterol-lowering drugs, such as statins, to treat a variety of heart disease risk factors. However it is often very poorly tolerated. 
  • Lipoprotein apheresis: Lipoprotein apheresis may be an option for people with exceptionally high Lp(a) levels and a history of cardiovascular problems. Using specialized equipment, Lp(a) is removed from the blood during this treatment. Despite being a successful strategy, because of how invasive it is, it is normally rarely used. 
  • Statins: Statins, which are frequently recommended to decrease LDL cholesterol, may also have some effect in lowering Lp(a) levels. However, in comparison to other drugs, their impact on Lp(a) lowering is minimal.
  • PCSK9 Inhibitors: These more recent drugs are mostly used to decrease LDL cholesterol, while they may also be useful in lowering Lp(a) levels. They function by accelerating the removal of LDL and Lp(a) from the circulation.  They can reduce Lp(a) by around 20%.
  • Estrogen Replacement Therapy: Estrogen replacement therapy has been linked to lower Lp(a) levels in postmenopausal women. Due to other health factors, this therapy is not suggested only for lowering Lp(a).
  • Antisense Oligonucleotides (ASOs): These more recent drugs try to inhibit the RNA responsible for apolipoprotein(a) production, hence lowering Lp(a) levels. These drugs are very effective at reducing Lp(a) but as yet are not available. Over the next few years their trial data will eventually be published and they may become available. 
  • Ezetimibe: Ezetimibe is a drug that decreases the intestinal absorption of cholesterol and has a negligible impact on Lp(a) levels.
  • Fibrates: Fibrates, a group of drugs used to treat high triglyceride levels, may also help lower Lp(a) levels in some cases. (SOURCE: https://pubmed.ncbi.nlm.nih.gov/28153024/)
  • Aspirin: Despite being largely used to thin the blood, aspirin has also been discovered to have a negligible impact on reducing Lp(a) levels.

New medications that aim to lower Lp(a) are actively being researched, including RNA-based treatments and innovative Lp(a)-lowering medications. These offer hope for future Lp(a) management that is more focused and successful.

Studies and Expert Advice on Lowering Lipoprotein (a) Levels

There are lots of studies linking Lp(a) with cardiovascular risk.  For instance, a study that was published in the New England Journal of Medicine looked into the relationship between Lp(a) concentrations and the risk of coronary heart disease.

Independent of other cholesterol levels and risk variables, the researchers discovered that persons with high Lp(a) levels had a markedly elevated chance of developing atherosclerotic cardiovascular disease (ASCVD).

It is advised by experts that people with excessive cholesterol, a family history of early heart disease, or a personal history of cardiovascular events have their Lp(a) levels checked. Early detection of elevated Lp(a) levels enables focused therapies to reduce the risk of heart disease.

Positive Effects of Low Lipoprotein(a) Levels as We Age

As we get older, maintaining low Lp(a) levels can significantly affect our heart health and general wellbeing. Here are a few advantages:

  1. Reduced Cardiovascular Risk: Lower Lp(a) levels are linked to a lower risk of developing cardiovascular illnesses, including heart attacks and strokes. An individual’s long-term cardiovascular results can be considerably improved by addressing and regulating Lp(a) levels early in life.
  2. Maintaining Heart Function: Atherosclerosis, a condition marked by the accumulation of plaque in the arteries, has been linked to high Lp(a) levels. People can reduce the development of atherosclerosis and maintain heart function as they age by lowering their Lp(a) levels.
  3. Enhanced Quality of Life: Heart disease can have a significant negative influence on a person’s quality of life by restricting their capacity to participate in physical activities and fully enjoy life. Lower Lp(a) levels reduce the chance of developing heart disease, enabling people to live active, satisfying lives as they age.
  4. Longevity and Healthy Aging: Maintaining normal Lp(a) levels promotes healthy aging, allowing people to live longer lives with lower chances of cardiovascular problems.

What should you do if you have a high Lp(a)?

First step is discussing with your cardiologist. At the moment we don’t know if lowering Lp(a) reduces risk. As clinicians we currently ensure that all the other risk factors are managed aggressively  – LDL-C, blood pressure, smoking, blood glucose etc. 


Lp(a) management is currently a big question mark. Know your number and then target all your other cardiac risk factors. In a few years we will know more about how to manage it.

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