09/30/2026
High Lipoprotein(a)? Here’s What You Need to Know
Lipoprotein(a), or Lp(a), is one of the strongest inherited risk factors for heart disease. Unlike traditional cholesterol, it is largely determined by genetics and is not significantly improved through diet and exercise alone. [lipidjournal.com]
Current strategies may include:
✅ Optimizing LDL cholesterol
✅ Reducing inflammation
✅ Controlling blood pressure and blood sugar
✅ Considering therapies that may modestly lower Lp(a), such as niacin in selected patients
✅ Aggressively addressing all cardiovascular risk factors
Current Integrative Approach to High Lp(a)
As a integrative and preventive medicine provider, I typically think about:
✅ Measuring Lp(a) at least once in adulthood
✅ Optimizing ApoB and LDL-C as aggressively as appropriate
✅ Reducing inflammation
✅ Addressing insulin resistance
✅ Considering niacin in select patients, recognizing that it may lower Lp(a) by about 20-30% but has not demonstrated clear cardiovascular outcome benefits.
✅ Watching the rapidly evolving field of therapies such as Pelacarsen and Olpasiran, which may soon change how we treat inherited Lp(a) risk.
One pearl I often tell patients:
“Lp(a) is the inherited risk you can’t change, but ApoB, LDL, blood pressure, glucose control, inflammation, exercise, sleep, and weight are the risk factors you can change.”