Can You Lower Your Lipoprotein(a) Level With Diet and Weight Loss? A Look at the Research

You probably know that high levels of “bad” LDL cholesterol can put you at risk for heart attack or stroke. Getting a cholesterol blood test is often part of your yearly physical exam. But there are other forms of cholesterol that are also harmful. Lipoprotein(a), known as Lp(a), is one of these. 

Most of the time, high Lp(a) is caused by your genetics. Currently there are no medications approved to treat it. And while your diet and activity level can impact other forms of cholesterol, their effect on Lp(a) is a little different.

What is Lp(a)?

Lp(a) is a type of LDL cholesterol that is especially “sticky” and harmful. High levels of Lp(a) can cause inflammation of the blood vessels and the aortic valve. This means that it can increase your risk for heart disease, blood clots, and strokes.

High Lp(a) tends to run in families. That’s why people with a family history of heart attacks early in life — before age 60 in women and before age 50 in men — are often advised to get their levels checked. And unlike other types of cholesterol, your Lp(a) level stays fairly consistent throughout your life. It does not vary with diet and weight changes the way HDL and LDL do.

How does diet affect Lp(a)?

Because high Lp(a) can be risky, you may be wondering what you can do to get your levels lower. One problem with Lp(a) is that the research does not clearly show that diet has an impact. But research interest in Lp(a) is growing.

A diet low in saturated fat can bring down LDL cholesterol levels. There is some evidence that this kind of diet may actually raise Lp(a). More research is needed, though. Researchers have also looked at whether a low-carb diet will affect Lp(a), but so far there is no clear evidence that it does. 

There is evidence that if you have been diagnosed with obesity, weight loss surgery can lower your Lp(a) level. One analysis of 13 studies found that Lp(a) drops after weight loss surgery. But other studies looking at diet have had different results: 

• One study found that weight loss with a plant-based diet lowered Lp(a). 

• Another study of severe calorie restriction found that people had higher levels of Lp(a) with weight loss. 

So as the research currently stands, it is unclear how dietary changes — like decreased saturated fats and carbohydrates — affect Lp(a). The same is true for weight loss. And even if these things do make a difference, the impact appears to be small.

Do vitamins or supplements lower Lp(a)?

At this time, there are no approved medications for Lp(a). Some studies have looked at supplements to see if they might be useful. 

At one time, niacin seemed promising. But research has found that even though niacin lowered the Lp(a) number, it did not reduce the likelihood of heart disease. And niacin can have significant side effects, including: 

• Liver problems

• Flushing

• High blood sugar

• Nausea

• Diarrhea

Some small studies have found a possible benefit of coenzyme Q10. But more research is needed before this supplement can be recommended. 

Can you lower Lp(a) with exercise?

Exercise is an important way to lower your risk for heart attack and stroke. It also has many other health benefits. But exercise does not affect Lp(a) levels. 

Some scientists believe that exercise may reduce the impact of Lp(a) by helping your body to protect itself against this form of cholesterol. But like the other lifestyle changes, there is still a lot they don’t know. 

What else affects Lp(a)?

Your level of Lp(a) is mainly determined by your genetics. In fact, 70% to 90% of your number can be traced back to your genes. But several conditions can also affect your numbers.

Conditions that raise Lp(a):

• Chronic kidney disease

• Menopause

• Hypothyroidism

Factors that lower Lp(a):

• Liver disease

• Hormone replacement after menopause

• Hyperthyroidism

It’s important to note that hormone replacement for menopause is not considered treatment for Lp(a). That’s because experts still don’t know enough about how it might impact heart health.

Are there treatments for Lp(a)?

Currently, the only approved treatment for Lp(a) is a blood-cleaning procedure called apheresis. Unfortunately, this procedure is time consuming and expensive. With apheresis, you are hooked up to a machine that removes and filters your blood. The process takes several hours, and it’s only offered in a small number of centers. 

But the good news is that there are several medications currently in development or in clinical trials. So, new drugs that target Lp(a) are on the horizon.

When should you talk to your healthcare provider about Lp(a)?

Lp(a) is not usually included in your cholesterol blood test. But if you have a family history of early heart disease, it may be helpful to get your Lp(a) levels checked. And if you have experienced a heart attack or stroke without any known risk factors, checking your Lp(a) could give you important information. 

Unlike cholesterol, Lp(a) doesn’t usually change over time. So it doesn't need to be checked yearly, unless you are being treated for high levels.

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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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