Treatment

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