How Do You Manage High Lipoprotein(a) Levels?

A visit to your primary care provider will often include a cholesterol test. This includes your LDL (low-density lipoprotein), HDL (high-density lipoprotein), and triglyceride levels. But people who are at increased risk for cardiovascular disease may have an additional test called lipoprotein(a), or Lp(a). 

Lp(a) is a type of “bad” LDL cholesterol that raises your risk for heart disease, blood clots, and stroke. But it’s not as easy to treat as other types of cholesterol. So we’ll talk about what you can do if your level of Lp(a) is high.

Why does high lipoprotein(a) need to be treated?

Lp(a) is a type of cholesterol that is especially “sticky.” This means it can stick to the walls of blood vessels. As a result, cholesterol plaques can form. This can lead to: 

• Clogged arteries, like the kind that cause heart attacks and strokes

• Blockage in one of the heart valves (aortic stenosis)

• An increased risk for blood clots

So treating high Lp(a) could potentially lower someone’s risk of one of these conditions. 

But researchers know less about it than other types of cholesterol. And a high level of Lp(a) is usually out of your control because it’s due to genetics. Things like diet and exercise don’t affect this number. There are a few other factors that can affect Lp(a):

• Inflammatory conditions like rheumatoid arthritis may raise Lp(a).

• Some chronic infections, such as gum disease and HIV, have been linked to high Lp(a). In these cases, treatment of the infection may lower the number.

• Kidney disease sometimes causes high levels of Lp(a). This is more likely if you are on peritoneal dialysis or if you have nephrotic syndrome. 

How do you treat lipoprotein(a)? 

Currently there is no FDA-approved medication for Lp(a). But researchers are working to develop treatments. Here we’ll go over what doesn’t work, what might work, and what does work to treat the problem.

Here’s what does not work for Lp(a):

• Common medications that are used for high cholesterol — like statins or ezetimibe — will not affect Lp(a) levels.

• Niacin may reduce levels slightly, but it does not lower the risk for artery blockages. And because it can have serious side effects, niacin is not recommended.

What might work for Lp(a):

• Medications called PCSK9 inhibitors — like Repatha and Praluent — show some promise, but more research is needed. 

• Researchers are testing several new drugs for the treatment of high Lp(a). So you are likely to have treatment options in the future.

What does work for Lp(a):

• If your level is high due to inflammation (see above), treating these problems might lower your number.

• In severe cases, the blood can be “cleaned” with apheresis. This treatment is usually done only in specialized centers like a university hospital. Someone is hooked up to a machine that removes the blood, cleans it, and infuses it back into the body. It has to be done at least weekly for life, and each session takes several hours. For these reasons, as well as cost, it’s not a practical option for most people.

What can you do if your lipoprotein(a) level is high?

Lifestyle factors, including diet and exercise, do not commonly affect Lp(a) levels. But remember that heart disease is often caused by a combination of factors. Most heart disease isn’t just genetic. Common risk factors include:

• High cholesterol

• High blood pressure

• Smoking

• Diabetes

So, if your Lp(a) is high, it helps to pay attention to your other risk factors. To keep your risk for cardiovascular disease low, you can:

• Track your blood pressure and work with your provider to keep it in the normal range.

• Get your cholesterol checked regularly.

• Get screened for diabetes with a blood sugar test.

• Avoid all forms of tobacco.

• Exercise regularly.

• Choose a heart-smart diet.

• Keep your stress levels down.

If you have any conditions that cause inflammation — like rheumatoid arthritis, HIV, or gum disease — work with your healthcare team to make sure you are getting the right treatment.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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