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Treatment

Last edited 17 Aug 2019. Last reviewed 10 Dec 2020

Lipoprotein (a) (Lp(a)) is an independent risk factor for coronary heart disease. If LDL-cholesterol is greater than 3 then often the treatment of choice is a statin.

With respect to specific treatment of Lp(a):

fish oils seem to reduce Lp(a) concentrations (1), but more work is needed to confirm this
statins do not reduce Lp(a) levels (2)
- statins, fibrates or ezetimibe are without effect on Lp(a) levels
nicotinic acid is effective in reducing Lp(a) concentrations (3). However the flushing, hepatotoxicity and ototoxicity associated with this treatment must be considered
PCSK9 inhibitors reduce Lp(a) (6)

Other factors that reduce Lp(a):

L-Carnitine, which is a naturally occurring compound playing a role in fatty acid metabolism, seems to moderately decrease Lp(a) concentrations by about 20%. It is well tolerated (4)
tibolone, a synthetic steroid with weak estrogenic, progestagenic, and androgenic properties, has been shown to decrease Lp(a) levels(4)
androgenic anabolic steroids have been shown to decrease Lp(a) levels (4)
hormone replacement therapy (5)

Diet and exercise also do not appear to significantly influence Lp(a) concentrations.

Reference:

Shinozaki K et al. The long-term effect of eicosapentaenoic acid on serum levels of lipoprotein (a) and lipids in patients with vascular disease. J Atheroscler Thromb. 1996;2(2):107-9.
Kostner GM, Gavish D, Leopold B, Bolzano K, Weintraub MS, Breslow JL: HMG CoA reductase inhibitors lower LDL cholesterol without reducing Lp(a) levels. Circulation 1989, 80:1313-1319.
McKenney JM, Jones PH, Bays HE, Knopp RH, Kashyap ML, Ruoff GE, McGovern ME: Comparative effects on lipid levels of combination therapy with a statin and extended-release niacin or ezetimibe versus a statin alone (the COMPELL study). Atherosclerosis 2007, 192:432-437
Berthold HK1, Gouni-Berthold. Hyperlipoproteinemia(a): clinical significance and treatment options. Atheroscler Suppl. 2013 Jan;14(1):1-5.
Howard BV1, Rossouw JE. Estrogens and cardiovascular disease risk revisited: the Women's Health Initiative. Curr Opin Lipidol. 2013 Dec;24(6):493-9.
O'Donoghue ML et al. Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk.Circulation. 2019 Mar 19;139(12):1483-1492

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