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Ask most people about their risk factors for heart disease and they will likely mention total cholesterol (TC), LDL-C (“bad”) cholesterol and HDL-C (“good”) cholesterol. Sometimes people even include triglycerides (TG). Chances are very good they have never heard about lipoprotein(a) aka Lp(a) or had it measured. It is also referred to as “Lp little a.”
This cholesterol-protein particle is rarely monitored by physicians, but it is a key player in heart disease. It could be contributing to many preventable heart attacks. A new study to be published on March 5, 2024 in the Journal of the American College of Cardiology reveals that even relatively small increases in Lp(a) levels can lead to clogged coronary arteries, heart attacks, strokes and premature cardiovascular death. Such heart problems are abbreviated MACE (major adverse cardiovascular events).
Some People Get Heart Attacks Who Shouldn’t:
When you read about an unlikely candidate for heart disease–someone who is very fit, eats healthy food, has low cholesterol levels and doesn’t smoke–but ends up with a heart attack at age 54, consider lipoprotein(a) as a potential culprit. That’s especially true if there is a history of heart disease in the family.
We continue to get messages from people who did everything right, took statins for many years and still suffered a heart attack. Here is a link to just such a situation. Statins probably won’t prevent this kind of cardiovascular “accident.” In fact, statins might make matters worse if people have elevated Lp(a) levels.
Many healthcare professionals are unfamiliar with lipoprotein(a). They rarely test for it. And yet this independent risk factor was identified six decades ago as a key player in coronary heart disease (Clinical Biochemist Reviews, Feb. 2004).
Fast Forward to 2024:
The study in the Journal of the American College of Cardiology (March 5, 2024) reveals that levels of Lp(a) greater than 53 mg/dL or 112 nmol/L pose a risk for clogged coronary arteries and heart attacks. OK…I can hear you complaining already. Why two different metrics?
Cardiologists have been told that lipoprotein(a) is an independent risk factor for heart disease. But they have also been told that there is “no generalized consensus on Lp(a) risk thresholds.” The American College of Cardiology/American Heart Association suggests thresholds below 50 mg/dL or 125 nmol/L. The reason for these two different numbers is because of separate measurement techniques. We have read expert opinions that recommend the immunoassays that rely upon nmol/L is the desired metric.
Another study published in JAMA Cardiology, Feb. 14, 2024 also confirmed that elevated Lp(a) levels are linked to peripheral artery disease (PAD), heart attacks and major adverse cardiovascular events (MACE).
As if that weren’t enough evidence, there was a systematic review and meta-analysis published in Clinical Research in Cardiology (Feb. 26, 2024) that demonstrated a causal association between Lp(a) levels and coronary artery disease.
When readers learn about this risk factor, they naturally have concerns.
What Can You Do About High Levels of Lp(a)?
Q. I inherited very high Lp(a) levels. Despite a healthy lifestyle, I had a heart attack and stroke. Although it is a significant cardiac risk factor, I had to convince my doctors to test for Lp(a). They don’t do so routinely.
I’ve done my own research to learn how to lower Lp(a). It involves vitamin C, the amino acids lysine and proline and prescription-dose niacin. My doctor monitors my progress. So far, I am doing well with this regimen.
A. Lipoprotein a, also known as Lp(a), is a serious risk factor for heart attacks and strokes. One fourth to one fifth of the population has elevated levels due to genetic factors. Statins may raise levels of Lp(a) (European Heart Journal, June 21, 2020).
Here’s a similar story about heart disease and a “bad family history”:
Q. I have a bad family history of cardiovascular disease. My brother died at age 45 of a heart attack. Consequently, I have tried to lower my own risk.
A preventive cardiologist I consulted prescribed statins, which gave me terrible leg cramps and brain fog. After a few years of that, I gave up on those drugs. I was still struggling with the low-fat high-carb diet the dietician recommended. On it, I gained weight and felt tired. Eventually, I quit that too.
A diet with good-quality fats helped me lose 15 pounds. Even better, my Lp(a) levels dropped significantly and are no longer too high. I get my fats from grass-fed meats, free range eggs, avocados, olive and avocado oil, though I sometimes cheat with a little peanut butter or chocolate. Reading actual medical research on Lp(a) has been enlightening.
A. High levels of lipoprotein(a) or Lp(a) are now considered a major risk factor for atherosclerosis, heart attacks, strokes and heart valve calcification. Statins lower LDL cholesterol, but there is growing evidence that these medications may increase Lp(a) levels.
Another “bad” history story:
Q. Heart disease runs in my family. As a result, my doctor started me on atorvastatin. Shortly thereafter I developed joint pain, high blood sugar and elevated creatinine. I also developed muscle pain and fatigue that interfered with my daily walks.
When blood tests showed that I was on the verge of becoming diabetic, I asked for a test that you have discussed, Lp(a). My level was 248 nmol/L, while normal is 75. I have read that statins can increase Lp(a) levels, but that niacin and aspirin might be helpful for someone like me. Thoughts?
A. We spoke recently with one of the country’s leading experts on lipoprotein a, Dr. Sam Tsimikas. Elevated levels of Lp(a) often run in families and might explain your family history of heart disease. Here is a link to that podcast:
Rather than controlling Lp(a), statins may raise the level. Since this compound increases the risk for blood clots and clogged arteries, doctors sometimes prescribe aspirin for patients like you (JACC: Advances, Dec. 6, 2023).
You should ask your doctor if that would be appropriate. Niacin may also be helpful. To prepare for the meeting, you might want to read our eGuide to Cholesterol Control and Heart Health. This online resource can be found under the Health eGuides tab.
A study involving over 42,000 patients found that:
“The use of statins was associated with an increased risk of Lp(a) elevation compared with non-statin use counterparts” (European Journal of Medical Research, July 1, 2023).
Diet is not supposed to lower Lp(a) levels, but a study in the American Journal of Clinical Nutrition (Jan. 2022) suggests that a low-carb diet can be helpful. You can learn much more about Lp(a) and other strategies to lower this often-ignored risk factor for heart disease in our eGuide to Cholesterol Control and Heart Health. This online resource may be found under the Health eGuides tab.
Lowering Lipoprotein a:
It is not easy to lower Lp(a), but one approach that has been shown to be effective utilizes high-dose niacin (Metabolism, Nov. 2016). It should only be taken under medical supervision, though. In addition to uncomfortable flushing, niacin can boost blood sugar and increase the risk for an attack of gout.
To learn more about Lp(a) and other cardiac risk factors, you may wish to read our eGuide to Cholesterol and Heart Health.
Lowering Lp(a) with Niacin:
Q. Long ago, a doctor friend sent me a scientific article showing that high Lp(a) levels contribute to cardiac problems. My physician was not aware of Lp(a) or its significance. But after reviewing the article and doing some additional research, he prescribed slow-release niacin.
I have been taking this for the last 20 years. A daily dose of 1500 mg brought Lp(a) below 50, but even 1000 mg seems to keep the level reasonable. A baby aspirin about half an hour before taking niacin helps keep the side effects of flushing and itchiness to tolerable levels.
A. Lipoprotein a, or Lp(a), is a recognized risk factor for heart disease. It runs in families and may be even more important than elevated cholesterol. Some cardiologists estimate that one fifth of the population has high levels of this cholesterol-protein particle. It can also increase the chance that heart valves will calcify.
Doctors have known about Lp(a) and its link to heart disease since the 1960s (Journal of Lipid Research, March 2016). There are relatively few drugs that lower this risk factor, but niacin is among them. Expect a couple of new pharmaceuticals to address this risk factor soon, though. Once doctors can prescribe a treatment, they may also start measuring Lp(a).
Could Dietary Supplements Help Lower Lp(a)?
Q. You’ve written that statins raise Lp(a). Do other drugs or supplements do the same? Hopefully, a research cardiologist is looking into this matter.
I am one of many who has stellar numbers (HDL=110, VLDL and triglycerides at the lower bound, 64.5 inches tall and 115 lb female runner). Despite proven heart disease among some older men in my family, I look and feel very healthy.
However, my Lp(a) is quite elevated at 142 nmol/L. I’ve set up an appointment with a local cardiologist, but I’m not sure what he will do.
You’ve had cutting edge researchers on your radio show. Perhaps a great investigator looking into Lp(a) will answer questions for the 20 percent of us with elevated Lp(a).
In checking PubMed, I found that elevated Lp(a) may be a risk factor for a worse case of COVID. Also, it seems that flaxseed might decrease the level of Lp(a). What can you tell us about this?
Could Flaxseed Make a Difference?
A. Thank you for the hint about flaxseed. When we checked PubMed for research articles, we found two recent meta-analyses on the effects of flaxseed supplementation (Alternative Therapies in Health and Medicine, May 2021; Phytotherapy Research, July 2020).
Both concluded that flaxseed supplementation may lower Lp(a) levels.
Lp(a) is short for lipoprotein a, an independent risk factor for heart disease. As you note, statins raise this lipid factor rather than controlling it.
Other Useful Supplements:
Drugs to lower Lp(a) are still under development; research suggests that nutraceuticals including l-carnitine, Coenzyme Q10 and an extract of red yeast rice called xuezhikang can reduce Lp(a) levels significantly (Journal of Cellular Physiology, Aug. 2019). As we noted above, niacin in the form of nicotinic acid also lowers this risk factor. You may want to consider adding flaxseed or one of these other supplements to your regimen.
As you mentioned, we do speak with leading researchers on our radio show. Dr. Sorios Tsimikas is one of the country’s foremost experts on Lp(a). You can listen to our interview with him in the podcast, “The Best-Kept Secret in Heart Disease” (Show 1306).
Lp(a) Is a Serious Risk Factor for Heart Disease!
Experts estimate that at least one fifth of the population has inherited high levels of lipoprotein( a) (Scientific American, Nov. 4, 2019). This independent risk factor is comprised of a lipid-protein compound. Part of it is like “bad” LDL-C and part of it is a combination of apo B100 and apo(a). The combo known as Lp(a) can be deadly.
That’s because levels greater than 50 mg/dl [>100 nmol/L] increase the risk of heart attacks and strokes. What makes this lipid fraction so toxic is its ability to clog arteries and promote the formation of blood clots. Lp(a) can also lead to calcification of the aortic heart valve. That is not good, as it reduces blood flow into the aorta and impairs circulation. Symptoms may include angina, dizziness, fatigue, shortness of breath and heart palpitations.
Learning About Lp(a) Could Save Your Life:
Q. You probably saved my life with your article about lipoprotein a [Lp(a)]. All four grandparents and both parents had a heart attack or stroke. I had never heard of Lp(a) and now I know it is an important risk factor for clogged arteries.
In Robert Kowalski’s book from 2002, The New 8-Week Cholesterol Cure, he quotes numerous studies where SR (sustained release) niacin lowers Lp(a). I have begun taking it. My husband has taken niacin for years under medical supervision.
A. Lp(a) is a serious genetic risk factor for heart disease and stroke. Cardiologists have known for almost 60 years that this blood lipid is probably as dangerous as LDL cholesterol.
Niacin is one of the few drugs that can lower Lp(a). Statins may actually raise this risk factor (European Heart Journal, June 21, 2020).
A traditional “heart healthy” low-fat diet does not change Lp(a) levels. New research shows, however, that a low-carb diet can reduce this worrisome risk factor (American Journal of Clinical Nutrition, Jan. 2022).
Why Have You Never Heard of Lp(a) Before?
This may sound cynical, but the reason we suspect that Lp little a has flown below the radar is because there is, as yet, no pricey pharmaceutical to lower this risk factor for heart disease. There has been no motivation for drug companies to encourage doctors to measure Lp(a) because there was no money in it. As a result, blood tests for this heart attack risk factor are rarely, if ever, performed.
The accepted dogma has been that diet and exercise have little to no impact on this risk factor. Perhaps that’s because cutting back on eggs, butter and red meat doesn’t reduce this cholesterol-transport protein.
That explains why some people who exercise regularly, follow a low-fat or vegan diet and take statin-type cholesterol-lowering drugs can still end up with heart disease. But there is one dietary intervention that might make a big difference! More about that shortly.
We suspect that many cases of hereditary heart attacks may be linked to Lp(a). Because many physicians have not been educated about this risk factor, it goes unmeasured, unreported and untreated.
This reader describes just such a situation:
“I forget where I first heard of Lp(a) but it worried me, so I had mine tested. I had to cajole my family doctor, who didn’t know about it. To get it covered by insurance, she referred me to a heart doctor for high-risk patients. He required an EKG before he would even speak with me, but then he was great.
“As it turns out, my Lp(a) is very high, despite years of good diet and lots of exercise. My LDL is borderline high, my HDL is high (good) and my triglycerides are low (also good). The cardiologist and I sat together at his computer researching Lp(a).
“I won’t take statins. He did recommend baby aspirin. He still evaluated my risk of heart disease at 3 percent over ten years. What else can I do?”
A. Lipoprotein(a) has been a recognized risk factor for heart disease for decades (European Heart Journal, Dec. 2010). It is associated with clogged coronary arteries and blood clots.
Bill also has elevated levels of lipoprotein(a):
“I inherited very high Lp(a) levels. Despite living a healthy lifestyle, I had a heart attack and stroke. (I think there is some correlation there.) My genetic predisposition led me to a PhD in Natural Health. I am now 78 years old and otherwise doing fine.
“My experience has been that most doctors do not have a clue about Lp(a). You have to educate them. Furthermore, despite it being a significant cardiac risk factor, they do not test for Lp(a) in lipid panels. They have to special order the test. One approach that has worked for me involves both niacin and vitamin C.”
Can You Control Lp(a)?
A. People who inherit high levels of Lp(a) are at significant risk for heart attacks and strokes. Statins that lower LDL cholesterol may actually raise Lp(a) levels (European Heart Journal, June 21, 2020). More about this momentarily!
A new study suggests that diet might be more helpful than most health professionals realize. A low-carb approach lowered Lp(a) by about 15 percent (American Journal of Clinical Nutrition, Jan. 2022).
The authors of this randomized controlled feeding trial suggest that a low-carbohydrate diet:
“…promotes insulin sensitivity and protects against atherogenesis. In addition, we found a potentially novel dietary effect on Lp(a), a major independent and causal risk factor for atherosclerosis.”
Statins Raise Levels of Lipoprotein(a)
Many healthcare professionals are unaware that statins can raise levels of Lp(a). Here is what the authors of the article in the European Heart Journal wanted to know:
Aims:
“Lipoprotein(a) [Lp(a)] is elevated in 20–30% of people. This study aimed to assess the effect of statins on Lp(a) levels.”
Discussion:
“This individual-patient-data analysis demonstrates that Lp(a) levels increase significantly in patients started on statin therapy and that the findings were directionally consistent among most statins studied. Cell culture studies revealed a time and dose-dependent, statin-mediated increase in LPA mRNA expression and apolipoprotein(a) production, suggesting the mechanism is at least in part related to increased Lp(a) production. Whether statin-mediated increases in Lp(a) contribute to residual risk in patients treated with statin therapy should be evaluated in future studies.”
A review in the journal Biomedicines (Aug. 9, 2021) states:
“Statin treatment does not lower but may even increase the level of Lp(a) by 10-20%”
This is not welcome news. That’s because many physicians believe that statins are one-stop-shopping when it comes to heart health. The idea that drugs such as atorvastatin, pravastatin, rosuvastatin or simvastatin could actually raise a cardiac risk factor like lipoprotein(a) comes as a total shock. It’s a little like driving with your foot on the brake as well as the accelerator.
Please do not take our word for this. The review in the European Heart Journal, (June 21, 2020) notes that:
“This meta-analysis reveals that statins significantly increase plasma Lp(a) levels.”
An article in in the European Heart Journal (Jan. 1, 2020) was titled:
“Statins and Increases in Lp(a): An Inconvenient Truth That Needs Attention”
Just as many physicians find it hard to believe that statins could raise blood glucose levels and/or make it harder to control diabetes, so to it is hard from them to imagine that statins could raise the risk for MACE. And yet a study published in BMC Cardiovascular Disorders (Nov. 8, 2022) reported that statin therapy raised Lp(a) levels about 19.3% and that:
“Patients with a severe increase in Lp(a) after statin therapy have a higher risk of MACE [major adverse cardiovascular events] than those without an increase in Lp(a).”
We suspect that most cardiologists as well as other physicians don’t know what to make of the statin-Lp(a) problem.
Drugs to Lower Lp(a)?
Many cardiologists discount the clinical importance of this effect. They are absolutely convinced that if they just lower LDL cholesterol with a statin that patients are home free. But even after LDL is lowered significantly, high levels of lipoprotein(a) contribute to persistent risk for cardiovascular events (Current Cardiology Reports, July 1, 2021). What’s more, these researchers report that this forgotten risk factor is implicated in “atherosclerotic and calcific aortic valve disease.”
Some people have heart attacks despite taking statins. When that happens, health care providers may not have an explanation. But elevated Lp(a) levels could be to blame.
Niacin and Aspirin:
Scientists have known for decades that niacin can lower this cholesterol-protein particle (Atherosclerosis, June, 2010). But many doctors discourage its use (Progress in Cardiovascular Diseases, May-June 2020). They worry that niacin has been associated with adverse effects such as flushing, itching, dizziness, headache, nausea or vomiting. It can raise blood sugar and liver enzymes, although statins can too. Some doctors may also prescribe aspirin for people with high levels of Lp(a) (Drugs in Context, Sept. 4, 2019).
Niacin and aspirin may be two of the cheapest drugs in the pharmacy. We won’t say that is the reason there is little excitement about them, but no drug company is promoting their use to lower lipoprotein(a). There are no commercials on television describing the pros and cons of medicines to reduce this risk factor for heart disease.
ASOs to Lower Lipoprotein(a):
That will soon change. Drug companies are developing medicines to lower Lp(a). Clinical trials are currently underway to test an entirely new class of medication for lowering Lp(a). The HORIZON trial is testing the safety and effectiveness of “antisense oligonucleotides” (ASO). Results are expected in 2024.
We suspect that the new ASO drugs will be quite pricey. Once they hit the market, you will be hearing a lot more about the dangers of high levels of lipoprotein(a). As soon as the ASOs are on drugstore shelves, we are willing to bet a month’s salary that doctors will be inundated with ads for these meds and you will see commercials on TV.
In the meantime, some cardiologists prescribe alirocumab (Praluent) or evolocumab (Repatha) for ultra-high-risk patients. Although these PCSK9 inhibitors were designed to lower LDL cholesterol, they also modestly lower Lp(a). Perhaps this risk factor will soon get the attention and respect it deserves.
As we have already pointed out, eating a very healthy diet doesn’t seem to make much of a difference in controlling levels of lipoprotein(a). Neither does exercise. Even though both niacin and aspirin seem to lower Lp(a) levels, it is not clear if doing so prevents heart attacks or strokes.
Do Statins Really Raise Lp(a)?
Does this question seem heretical? Shortly after statins were introduced in the U.S. in the late 1980s, a drug company researcher contacted us. He had been involved in statin research and was concerned that these drugs might raise a little-known lipid fraction called lipoprotein(a).
He was in favor of lowering LDL cholesterol with a statin. But he thought that also raising Lp(a) with a statin might be a little like pushing a boulder up a steep mountain. Remember the Myth of Sisyphus?
Here is a question about this issue from a reader of our syndicated newspaper column.
Q. I inherited very high levels of Lp(a), and I have known for years there is little I can do to reduce it. Although I tried niacin, I can’t tolerate it.
In Germany where I grew up, doctors test for this routinely. In the US, I have had difficulty getting it tested.
My cholesterol is around 220, with HDL over 60. Since my LDL is high (around 140), I am now on Crestor.
My doctor said lowering my LDL is vital, because it will also lower the Lp(a). Is that true? I have read a lot about this problem over the years to educate myself. Everything I read says there are no medications to date that lower lipoprotein(a).
I am 69 years old and worked hard for years following a healthy diet so as NOT to take a statin. (I ate tons of oat bran.) The more I read about high lipoprotein(a), the more scared I got. My mother had a stroke. Can a statin drug like the Crestor I now take really lower Lp(a)?
LDL vs Lp(a):
A. Lipoprotein(a) is a particle in the blood that contains fat, protein and cholesterol. In the US, cardiologists have focused primarily on LDL cholesterol as the bad actor in the development of heart disease. Statins are very effective at lowering LDL.
On the other hand, lipoprotein(a) is also an important risk factor for heart disease. High lipoprotein(a) levels can contribute to calcification of aortic valves (Biomolecules, Dec. 2019).
Surprisingly, statins may actually raise levels of Lp little a (European Heart Journal, May 20, 2019). A meta-analysis of statin trials found that even when LDL cholesterol levels are lowered, people run a substantially higher risk of heart disease if statins raise their Lp little a above 50 mg/dl (Lancet, Oct. 13, 2018). Some cardiologists are recommending levels below 30 mg/dl.
Don’t give up on exercise and diet just because you are taking rosuvastatin (Crestor). You may also want to ask your doctor about an alternate treatment for lowering LDL cholesterol. Evolocumab (Repatha) reduces both LDL and Lp(a) and in your case may be helpful against heart disease (Circulation, March 19, 2019).
You can learn about a wide variety of strategies to protect your heart by listening to our interview with preventive cardiologist Michael Blaha, MD, MPH. He is professor of cardiology and epidemiology at Johns Hopkins School of Medicine. He is the Director of Clinical Research for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Here is a link to our podcast:
Show 1232: What Should People Do to Protect Their Hearts?
People can use sensible approaches to protect their hearts, such as a Mediterranean diet and exercise. What risk factors matter?
Get Ready for Lipoprotein(a) and New Drugs:
We are reading a lot more in the medical literature about Lp little a. We strongly suspect that pharmaceutical companies are moving aggressively into this lipid-lowering arena. You will soon be reading about how important Lp(a) is once those drugs are marketed.
Why do we say this?
Here is an article that suggests our crystal ball might be surprisingly clear (Annals of Medicine, May 26, 2020):
“Lipoprotein(a) (Lp(a)) was discovered more than 50 years ago, and a decade later, it was recognized as a risk factor for coronary artery disease. However, it has gained importance only in the past 10 years, with emergence of drugs that can effectively decrease its levels.
“Lipoprotein(a) is an important risk factor in patients with cardiovascular diseases. Lipoprotein(a) has many functions, which include proatherosclerotic, prothrombotic, and pro-inflammatory roles. Treatment options to lower lipoprotein(a) levels are currently scarce, but new drugs are on the horizon.”
We only hope that they will be compared head-to-head with niacin and aspirin to see if the pricey new pills are more effective at reducing heart attacks and strokes compared to the old and inexpensive drugs.
Don’t hold your breath, though. We suspect that drug companies will test the new Lp(a) drugs with statins. That’s because the drug companies and the researchers are convinced that statins are the foundation of heart health and the new drugs are just the icing on the cake, to mix metaphors.
Until we have data proving that the new lipoprotein(a)-lowering drugs reduce the risk of blood clots, heart attacks, and calcification of the aortic heart valve, why not consider a balanced low-carb diet. It can also help people lose weight! You can read more about the latest research on this approach at this link.
Readers Comment:
What do you think? Have you ever had your lipoprotein(a) levels measured? Is there a strong family history of heart disease? Has your doctor ever mentioned that statins might raise levels of this important risk factor? Will you ask about getting a blood test for this lipid next time you see your doctor? Share your thoughts in the comment section below.
Did you find this information helpful? If so, please share it with friends and family. We suspect that most people have never heard of Lp(a). It might account for heart attacks in people who have a family history of heart disease, even if they are taking statins. Of course no one should ever stop taking a medicine without consulting the prescribing physician!
You can send this article by clicking on the email, Twitter or Facebook icon at the top of the page and thank you for helping us keep readers up-to-date on new health information. You can learn more about many other risk factors for heart disease in our eGuide to Cholesterol Control and Heart Health at this link.
Kathleen
Hmmm, I recently posted about my more than 2000 lp(a), and how healthy I am. This site refused to post, I guess b/c it doesn’t fit the narrative. Have known about it for six years. Quit the doc who wanted to put me on statins for it. Recent EKG and ECHO test show NO heart disease. I am 83, walk garden and dance.
Joe Graedon
Kathleen,
We would love to know if you are describing Lp(a) levels in mg/dL or nmol/L. Laboratories use both metrics.
People who may not know what the “normal” levels are, here is the general standard:
Normal is considered less than 30 mg/dL or less than 75 nmol/L
An article published in the International Journal of Cardiology: Cardiovascular Risk and Prevention states:
“Extremely elevated Lp(a) levels are associated with an approximately 2.5-fold increased risk of ASCVD [atherosclerotic cardiovascular disease] compared with normal range Lp(a) levels.”
“Lp(a) levels were tested in 3900 adults ≥20 years between the years 2015–2021. Of these, we identified 53 patients (1.3%) with extreme Lp(a) levels >430 nmol/L. The median concentration of the extreme Lp(a) group was 472 nmol/L.
“In this cross-sectional case-control analysis, we demonstrated that extreme Lp(a) concentration is associated with an excess risk for myocardial infarction [heart attack] and CAD [coronary artery disease], with an odds ratio of up to 2.5, compared to age- and sex-matched individuals with normal range Lp(a).
We are delighted that you are so healthy!
Jeanni
Please refer your readers to your newsletter from March 28 2025 titled “Does a Nonagenarian need to worry about Cholesterol” reading this article was a real eye opener for me regarding statins. After reading this I would never take a statin drug although with the side effects I have read about from people who are taking statins this article just reinforced my decision to not take a statin drug.
Jessica
In time we’ll see LDL was not the culprit
But, because of all the lawsuits that would ensue, no one reading this will be alive to see the shift from LDL to lp(a) as the real culprit of heart disease.
I’m a 63 y/o female with deceased father who had 2 heart attacks. Ergo, I’m at high risk.
I eat all animal protein (dairy, eggs, meat, fish). I’m otherwise low carb and zero added sugar.
I recently had my lp(a) checked with my annual check-up. It was 31 nmol.
Folks, it’s not hereditary.
In my opinion, it’s sugar and carbs (bread, pasta, sweets), processed foods.
My internist anointed me “superiorly healthy” at the end of our visit.
I’m nothing special, but my strict abstinence of sugar and most carbs is.
Tina
I had a heart attack at age 54 (female), no risk factors except a paternal family history. I started the baby aspirin/statin regimen. 10 years later my cardiologist decides to test my LP(a, and it was 123.4/high. He’s convinced that is culprit. He prescribed Repatha injections to get my LDL below 70. My LP(a) has fluctuated between 123 and 145 since starting the Repatha, and I’m still taking my statins. I have two daughters in their early 30s, and one of them inherited the high LP(a). My brother was negative. I do hope they come out with a drug soon, I feel like a ticking time bomb, despite my healthy diet and healthy lifestyle.
Jill
You can get a stand alone lp(a) at Labcorp for around $50
Lisa
I eat healthy food but not always, exercise (am a Nationally Certified Pilates Teacher), and have high cholesterol. I do have fluffy cholesterol. My husband, a retired cardiologist, wants me to go back on statins, but I will not. According to the ACC app for risk factors, and my PCP, put me at a low risk for a cardiac event. I tried the red yeast that you recommend but it increased migraine attacks, significantly, so I stick with a healthy diet and exercise.
I’d love to see some more information on fluffy cholesterol.
Joyce
My husband switched to a new primary care physician and she added Lpa to his list of labwork. I had read your article & was very happy to see it. When he went to Quest to have the labwork drawn, the phlebotomist told him that Medicare doesn’t cover this test. Why not & how does something like this get changed?
Ashma
I have tried all types of healthy diet and exercise over the past 15years. My total cholesterol is generally around 200, LDL is always above 100, HDL is always above 60, triglycerides and LLDL are always low.
I am 66 years old and consider myself in good health. I have a family history of coronary disease including my father died at 59 years and my sister at 51 years, both with heart disease. I am genetically predisposed to coronary disease. My cardiologist recommended I test for Lp(a). The result was 284. He had never had a patient with that high Lp(a). I did try niacin, but I couldn’t tolerate it. I take red yeast rice, CoQ10 and planning to add l carnitine to my supplement list. I will also try further reduction of carbs even though I consume whole grain, all healthy complex carbs. I try to consume mostly vegetarian diet, without eggs and milk. I stay away from red meat and now moving away from seafood.
I do not like to take drugs since they come with many side effects. However, I am hoping there will be a breakthrough for something new for Lpa with minimal side effects.
Joe
I had my first LP(a) test this year at my request to my PCP.
It was reported to be 14 with a target range of “less than 70”.
I’ve been on blood pressure meds for 50 years now. I consider this as good news. I wouldn’t have known about this marker were it not for the People’s Pharmacy program and emails.
MP
Years ago an integrative physician included Lp(a) in a panel of tests, and mine was low. Unfortunately, I no longer live near that doctor, and I’ve also been on on a statin. The Lp(a) level could have changed, but my current primary care doctor declined to include it in my routine tests, saying he did NOT consider it a relevant factor for evaluating heart disease risk. Apparently I’ll have to order and pay for this test myself right now, but when the drug reps contact him in the future about a new Lp(a) drug at least he’ll be more educated!
Lawrence
If Niacin lowers LpA and statins raise it. If Lp(a) is supposed to be a more important risk factor than LDL cholesterol. When you look at the evidence of the relationship between Niacin and mortality and statins and mortality, why is there almost universal evidence that statins improve life expectancy while Niacin has a much more mixed result with many studies showing no benefit at all? I’m sticking with the statins, which I’ve been on for over 25 years and have done fine with. I do take CoenzymeQ10 to reduce any side effect risk from the statin.
Lisa H
Going on a low carb diet is a no-brainer. But sadly big Pharma rules and the statistics we see here will continue. Western Medicine is so off the radar from where it should be. I became my own advocate (I did years ago) and remain on no prescription drugs. I’m turning 61 next month. Even though people comment on my weight loss and low carb lifestyle, they keep kicking the can down the road. They eat crap and pop pills. What could possibly go wrong? David Diamond in Florida has done a lot of vlogs on lp(a) and has substantial research to back up exactly what we have read here.
Angela
Consider avoiding the material negative side effects of the pharmaceutical industry’s interventions for this condition, and look into the research on taking the supplement nattokinase to fight the Lp(a) promotion of clotting and inflammation as well as substituting Bromelain for low dose aspirin as Bromelain has the same mechanism of action but avoids the problem of causing bleeding. Vit D taken with Vit K2 to reduce calcium deposits in arteries. Also, low carb diets and exercise and anti-inflammatory supplements like NAC and Vit C.
Victoria
I read at the beginning of this article on LPa that a reader was using Vit C, Lysine and Niacin. While niacin was covered thoroughly in the article, neither Vitamin C nor Lysine were addressed. How much of each makes a difference, and are there abstracts to back it up?
Estuff@pobox.com
Linus Pauling, 2x Nobel Prize winning chemist, developed a supplement to lower Lp(a), which he determined was the cholesterol that was building up in arteries (NOT LDL). It built up to repair the damage caused by long-term vitamin C deficiency (low level scurvy). He showed that heart disease could be prevented or treated by taking vitamin C, together with Lysine & Proline. OptimaEarth Labs makes a supplement based on Pauling’s findings called Optima Heart.
DBanks
It seems anyone and everyone over 50 or 60 years of age should have their Lp(a) levels checked. I am now on Medicare. Will Medicare cover this uncommon test?
David
Why haven’t the drug companies tried to promote Praluent and Repatha for treatment of lipoprotein a. Is this similar to Apo E which is supposedly the same risk factor for Alzheimer’s disease?
Marcia
Thank you so much for this article. My maternal grandmother was diagnosed with angina and my mom with CHF. I am a 76yo female and after reading your article last year, I asked my primary care doctor for orders for this test to be taken the next time I had an endocrinologist appointment (thyroid, not diabetes) and recently had the results of 210mg/dl. Both the primary care and heart docs wanted to increase Crestor from 10mg daily to 40mg. I declined and am looking into diet. For the last several days I’ve been following a high-fiber diet (not necessarily low carb). After I told the cardiologist that I did not want to increase Crestor, he did give me a copy of the Mediterranean diet, also suggested I might want to try red yeast rice, and then scheduled a follow up in a year.
Thanks again for your information.
Jane
My wise family doctor in our home town in Texas began testing my Lp(a) in the early 2000’s. It was around 21. My other lipids were off, so he prescribed a combination statin with niacin. They eventually stopped making that medication. Then we moved, and I didn’t have it tested again until recently. I had to convince the NP to order it. She didn’t know what it was. It was 121! I couldn’t believe it. I’m been taking Simvastatin for years. All my other lipid numbers are good. I’m having a cardiac calcium scan soon (my third—the other 2 were 0). There is no history of heart attack or stroke on either side of my family. I’m perplexed.
Lina
In my experience, low carb foods can add a lot of extra dietary fat, which will definitely not lower your numbers. A whole food plant-based diet diet will help. The main problem with this is that people don’t want to do it long-term.
Nick
My mother had a mild MI age 73, so I wanted my Lp (a) checked. My PA said it wasn’t necessary. But she checked with cardiology, and they said my rosuvastatin would lower it anyway. This seems to be the party line. However, she did agree to order an Lp(a) level, and it was normal. While relieved, I’m concerned about the level of misunderstanding about this risk factor.
Lawrence
If Niacin was the secret to improving cardiovascular risk, studies would show improved mortality benefit. But they don’t. Niacin is not proven to improve mortality or reduce risk of heart attacks. On the other hand, statins are proven to improve mortality and reduce heart attacks. Google the research.
Mary
I am participating in a study being done to see if Leqvio will lower this lipoprotein(a). There is some suggestion that it might. There are some 40,000 people worldwide in the study. This drug is very new on the market and does seem to lower lipid levels in general.
Kathy
Regarding LPa and use of statins, I just wanted to share that when I tried statins my LPa went up significantly from 374 nmols to around 540 nmols. I was seeing one of the top lipid specialists who told me that my LpA would not change much. I insisted they do another test, and he was mad. When the results came back he was shocked. I don’t see him anymore. lol Its a lonely journey with this LPa and am very happy it is getting more attention
Judith
While I have a great interest in articles like this, I find some articles needlessly long, like this one, and I don’t always have time to finish. I think this info could have been presented in an article half this length. Still, I do appreciate the info very much. Thank you.
Nancy
I asked my doctor if I could have a LP(a) test since I have high cholesterol. She said she knows nothing about it.
A cardiologist takes care of that.
I had been on statins for 17 yrs. and went off for 5 yrs. I started taking Rosuvastatin in November. I haven’t had any blood work since.
Thank You for the fine article. I had read your articles previously and that is why I had asked my doctor about testing.
Lida
Should Lp-a be retested?
Mine was tested years ago. When I asked my doctor if I could be retested she said it was unnecessary since it was a genetic factor and would not alter. Is this correct?
Darlene
Because of your several articles on LP(a) I was finally able to convince my doctor to test me. I do not want to take statins and this article was very helpful. My score is 42.
Thank you so much for your wonderful information
George
Niacin, Instant release, lowers Lp(a).
Victoria
My liver doesn’t process LP(a) so I am on repatha. Neither of the insurance companies I have had since beginning repatha will cover advanced lipoprotein testing. They say “there is no proof or not enough proof it helps assess or manage health”.
Sharon
Thank you for highlighting Lp(a). Interestingly, my naturopath considers Lp(a) to be 2nd in importance as a heart health indicator. First is a test called TMAO (Trimethylamine N-Oxide). 3rd is the C-reactive protein (CRP) test, with the classic cholesterol test considered only to be of 4th importance.
I have high-ish cholesterol (240-280, though my ratios have always been good) and my regular GP keeps pressing me to take statins. Luckily my TMAO, LP(a), and CRP are all good so my naturopath is not worried about my heart!
Jane
I am even more cynical. It wouldn’t surprise me if drug companies already know about Lp (a)and not only know statins raise the level butdesigned them that way. Now that millions have been put on them, and they have brain-washed vast numbers of doctors that these marginally effective, side-effect heavy drugs are needed for everyone they can introduce NEW drugs that these millions will “need” to take to offset the problem. You can bet it will be “in addition to”, not a replacement for statins.
What a racket! Create serious problems with very iffy drugs, then create more drugs to address the problems you caused and on and on. The money just keeps pouring in, and the patients get sicker and sicker. This is how ” sick/treat” rather than healthcare works.
Carol
Various walk in labs allow us to order our own blood work and receive the results directly. They often run 15% off promotions. Go to their website, search for the test you want, choose one of the two well-known labs for the blood draw, pay for your lab work online, and show up at that lab to have your blood draw. No doc rigamarole. No extra testing. And yes, it’s out of pocket, but much more affordable than my”co-pays” were several insurance companies.
Shirley
It seems carbs, especially in the form of refined carbs and sugars, are deleterious to our health in general. I’ve kicked them to the curb long ago. I only consume a little very high fiber bread (as in one slice is 20 to 30% of the daily fiber recommendation). Flax cereal. Lots of fresh produce. Protein. Healthy fats, olive oil, avocado, fish oil, etc. Used to do presentations for Cigna – it’s lifestyle factors overwhelmingly that determine health. Diet and exercise. But no one gets rich from this formula. Big Pharma, for shame! Ditto doctors who collude with them.
Brooke
I called our clinic and had the test added to the blood panel our Dr was running on my husband. This was over 20 years ago. The doc was not pleased with me. It was 37 at the time. He has since had 3 angina episodes and had stents. Also on a statin Lp(a) has never been measured again.
YY
If you want to know why people were getting heart problems over many decades you can find out what 102 year old Dr. Fred Kummerow found out. I will give you a hint. Try not to consume any foods that were invented in the last 100 years.
Ellene
Tested about 15 years ago. Quick research indicated soy consumption contributed to it. At the time I was using soy protein powder and low carb bars with soy in them. Stopped that immediately and started C, lysine and proline. Level plummeted. Haven’t retested in several years. Should likely do that.
Jo A
I’m trying hard get off the statin I take. Doctor told me after 6 months on it, and much diet change, that it turned the high cholesterol around 100%. Still won’t take me off. But now I’m heading toward type II diabetes. My sleep is disrupted; my joints hurt; and I have to sometimes wear a hat indoors because within 2 months of starting this drug my hair thinned dramatically. I’m not so attached to my hair that I can’t do something different but my head gets cold, and hats don’t stay on when I sleep. I had chemo and lost all my hair 25 years ago, so I’m not as attached to it other than for keeping my head and neck warm. And of course the diet doesn’t go along well with the other 3 diets, plain weight loss, lowering glucose and keeping my blood thinning level (INR) on an even keel. At some meal prep times I just look at the food and throw my hands up into the air, and I don’t want to eat at all.
Shastri
About 20 years ago, a (Indian American) doctor friend of mine sent me (Indian American) a copy of an article published in a scientific journal published in Europe that highlighted the significance of Lp(a) in causing cardiac problems, especially among certain ethnic groups like (East) Indians. I showed the paper to my general physician, who is also an Indian American. He was not aware of Lp(a) or its significance. But, after reviewing the article and doing some research, he prescribed “Slow Niacin” brand of Niacin, which I have been taking for the last 20 years. A daily dose of 1500mg seemed to bring the Lp(a) to below 50, but even 1000mg seems to help keep the level at reasonable levels. Taking a baby aspirin about half hour before taking Slow Niacin helps keeping the side effects (flushing and itchiness) to tolerable levels.
Bill
I inherited very high LPa levels. Despite living a healthy lifestyle, I had a heart attack and stroke. (I think there is some correlation there.) My genetic predisposition led me to a PhD in Natural Health. I am now 78 years old and otherwise doing fine. Here are my findings:
My experience is that most doctors do not have a clue about LPa. You have to educate them. Furthermore, despite being a significant cardiac risk factor, they do not test for LPa in lipid panels. You have to special order the test. And, Medicare does not cover the cost of the test. I pay for them out of pocket.
My research has only found one treatment to lower (to some extent) LPa which your readers might seek: The Rath-Pauling protocol. Basically, mega amounts of Vita C, with Lysine and Proline. I also take a prescription dose of Niacin. Let it make you itch.
Bottom Line: I believe the wisest approach is to seek the best from both allopathic medicine and naturopathic traditions. Ignore the rest. We have come a long way, in medical evolution but have much farther to go. Take personal responsibility for your health and always think for yourself.
Fay
You probably saved my life with this article. I have 4 grandparents and 2 parents who had heart attack or stroke. I had never heard of Lp(a) and now I know to lower it. I discovered how from Robert Kowalski’s book from 2004 The New 8-Week Cholestrol Cure where he quotes numerous reputable studies where SR (sustained release) niacin lowers Lp(a) as much as 33% to 50%. pp.137-141. Only one specific brand works with no or hardly any flushing – Endur-acin (nicotic acid). I used to take and will start again. My husband has taken it for years. He told a cholesterol statin researcher about it, and he started taking it instead of a statin. Thank you!!!
Randy
Dr. Linus Pauling and Dr. Mathis Rath proved the body uses Lp(a) as a surrogate repair molecule to fix small cracks in the endothelium when the body has insufficient Vitamin C back in the 1990’s. Hence the treatment for an elevated Lp(a) is a high dose of Vitamin C on a daily basis, preferably the lypospheric or liposomal form for better absorption in the GI tract. I gave up trying to lower Lp(a) with various forms of niacin in my patients years ago because it just didn’t work. However since utilizing high dose Vitamin C in ALL my coronary artery disease patients over the last 20 years, their plaques have been stabilized and no cardia events have occurred. Testosterone replacement in my male patients is also a key factor in arresting the progression of atherosclerosis.
Sam
What dosages did these patients take? I do take 1500mg per day of Vit C.
Joseph
I really appreciate this information. Statins significantly damaged my quadriceps muscles. My physicians tried to talk me out of that fact, but I finally rebelled. While hiking in Guatemala two years ago, I was in so much pain, I threw the statins away that day. Forever. I demanded my physician face my truth vs Big Pharma propaganda, and I’ve been on Repatha ever since. I am currently trying diligently to rebuild my quadriceps muscles, ad I am pleased with the progress I’ve achieved now that the statin medication is out of my body. I will get my Lp(a) tested. But I remain very, very, very skeptical of the medical community’s competence. IMO, physicians mean well, and most may be 100% sincere. But Big Pharma has a primary agenda: profit, ad Big Pharma holds far too much sway over the medical community. Patient beware!
Dr. E
I was on the marketing team with the company that brought the first statins to market. It seemed then that their promise was somewhat “mystical.” Since then I have researched more about this class of drugs and do not take a statin myself because there are just too any unanswered questions for my comfort. I moved to & retired from a biotech company that is now marketing Repatha (PCSK9 inhibitor) & I believe that drug represents forward progress. It needs to be less expensive, however, for it to be more widely used. In the long run insurance companies would be better off paying for it (preventing the sequelae/morbidity of NOT using it) and perhaps preventing expensive angioplasty and bypass procedures. Current price of an angioplasty at our local health system: $24,000.00 (and that’s on an outpatient basis).
Dr Ellen, Clinical Pharmacist
Jane
You are so right. As soon as a drug has been manufactured, whether or not it works well, we will be bombarded with ads. You can also be sure it will be something to ADD to your growing shelf of pharmaceuticals. It will NOT be a better option replacing other less effective drugs. I will maintain that the ONLY concern of big pharma is getting as many as possible on as many drugs, ( for life preferably ) as possible. Oh.. and as expensive a drugs as possible, with no regard as to the safety and efficacy. As far as big pharma cares it could all be sugar pills. Maybe in many cases that could be a better safer option than the damaging chemicals they so freely dispense.
Libby
Beware of Repatha!…I was prescribed this because I could not tolerate statins. It did lower my cholesterol…But My urine stream was reduced to a trickle and 2 years later has not changed. Also at one injection site a large hard lump developed under the skin which still remains. No amount of rubbing has reduced it.
Susan
Quite a few years ago a popular online cardiologist and integrative medicine specialist brought up LP(a) in his newsletter, and I was able to get mine tested through a round about way. I had very high LP(a) and went on Niaspan that comes with its own flushing side effects that many people cannot tolerate when dosage rises to the level needed to lower LP(a). Then some test studies came out about Niaspan that caused me to discontinue it. I am 74. I have been on atorvastatin lowest dose and continue my normal lifestyle of walking, swimming, yoga and pilates and to date, thankfully I have had no cardiac events. But when I tested so high in LP(a) it was worrisome. I will listen to the interview with your guest.
Karen
I would like to know what “Lipoprotein(a) has many functions, which include proatherosclerotic, prothrombotic, and pro-inflammatory roles” means. Would tests for inflammation be high? Such as, sedimentation rate or C-reactive protein test?
Susan
Almost none of the articles I’ve read here mention any research that shows lowering LDL prevents stroke. I had an ischemic stroke 2 years ago. All my numbers indicated I should be on a high-dose statin. I’ve tried 5 different statins, at different dosages, and can’t tolerate any of them. I have severe myalgia-muscle pain and weakness in my extremities. My new neurologist insists that my LDL be at 90 or below. She’s prescribed Zetia, and I’m afraid I’m having the side effects of diarrhea, nausea, and muscle aches. I take a baby aspirin. I have familial hypercholesterolemia, and diet, exercise, and weight loss, have little effect on my numbers. Is there any research anyone can point me to that shows supplements that may lower risk? I really want to quit these unpleasant medications!
Helen
I have heart disease and have had a heart attack. My cardiologist has never mentioned or tested my Lp(a). On my next visit, I will request that my Lp(a) be tested. I have found that this newsletter is very informative. Thank you.
Kate
My LPA went up after starting statins. I am now in the red zone for LPA. My doctor said it was genetically driven but did not suggest anything to lower it.
Jeanne
I have been on Praluent, which is similar to Repatha, and is has changed my bad cholesterol number dramatically since bypass heart surgery.
Liz
What about whole food, plant based diet and Lp(a)? So far, this diet has dropped my cholesterol, my HDL and my LDL. Cholesterol/HDL ratio is now 2.7.
Anyone trying to lower cholesterol should look at WFPB diet.
Liz
My internist only orders traditional cholesterol tests which do not provide enough information for me. I went to a naturopathic doctor and was able to order a very thorough blood work-up that was really useful. She suggested tests but I had the ultimate say in which were done because insurance was not paying. My tests focused on information about lipids and inflammation markers, but I could also have had tests on metabolics and genetics. The downside was that I had to pay a few hundred dollars out of pocket for the visit and tests but, for me, it was worth it for the useful information I received (including Lp(a) levels) and the peace of mind.
Gregory
Dr. Ford Brewer has some good videos going over LPa – https://youtu.be/c8w6yI9MUyg
https://youtu.be/lUoMGIldo58
Betsy
My Lp(a) is very high, despite years of good diet and lots of exercise. LDL is borderline high, HDL is high (good), and triglicerides low. I forget where I first heard of Lp(a) but was concerned, and had mine tested. It took a little cajoling of my family doctor who didn’t know about it. To get it covered by insurance, she had to refer me to a heart doctor for high risk, who then required EKG to even speak with me, but then he was great, and we sat together at his computer researching Lp(a). I won’t take, and haven’t taken, statins. He did recommend baby aspirin. All said, he still evaluated my risk of heart disease at 3% over ten years. One thing not mentioned is that there are fluffy big types and smaller, denser types of LDLs. The latter are more dangerous. Mine is primarily the fluffy, which is gratifying. Thanks for writing about this!
Jessica
You begin your article by saying there is no known treatment to lower the little-known heart risk factor Lp(a), which I’ve never heard of and am sure I’ve never been tested for. Then, in answer to a reader’s question you say Repatha lowers both LDL and Lp(a), and so can aspirin and niacin. This advice seems contradictory to your first premise that nothing is effective against Lp(a). Am I the only one confused by this article?
Terry Graedon
Not that there is no known drug, but that there is no dedicated medication doctors prescribe for this (“no pricey pharmaceutical…”)
Some researchers are anxious to do studies on medicines that may lower Lp(a), whether that is Repatha or Praluent or something else.
Harlene
Great information. I am 81 with high cholesterol.
Do not take medication
Is the test for Lp(a) covered by medicare?
George
LPa
Linus Pauling and fellow researcher Mathias Rath hypothesized that Lp(a) levels may be increased in some cases due to a vitamin C deficiency. They note that Lp(a) is found mostly in the blood of primates and the guinea pig, which have lost the ability to synthesize ascorbate (a component of vitamin C), but only rarely in the blood of other animals that still produce their own vitamin C. They also noted that the Lp(a) and ascorbic acid possess some similar properties, such as in the acceleration of wound healing and other cell-repair mechanisms, the strengthening of the extracellular matrix (e.g., in blood vessels), and the prevention of lipid peroxidation. Based on this, Pauling and Rath suggested that humans intentionally synthesize Lp(a) when it is lacking an adequate vitamin C.The next question is what causes these “fat” molecules to stick to the artery wall?” The Nobel prize winning answer turned out to be Lysine (and Proline) Binding Sites (LBS for short). The Lp(a) or “cholesterol” binding sites are amino acid residues of collagen protein that becomes exposed when blood vessels “crack” and expose these LBS to the blood, which then attracts the Lp(a) molecules. The result of Lp(a) binding is to create the atherosclerotic plaque. There are well over 1000 MEDLINE (US National Medical Database) references to Lp(a). These reports confirm that Lp(a) cholesterol molecules bind to blood vessel walls via the Lysine and Proline Binding Sites forming atherosclerotic plaques and occlusive cardiovascular disease.
George
Many years ago I read Linus Pauling’sadvice about LPa.
To quote:
“Plaque formation is an essential response to vascular injury. When a blood vessel has been damaged, repair is paramount. If benign materials are available, as vitamin C, to protect the vessel from injury and to participate in vascular repair, the need for Lp(a) is moot. Without adequate amounts of vitamin C, Lp(a) becomes indispensable.There is a vast difference between materials used to repair vascular injuries. For example, vitamin C repairs the wound, leaving the vessel wall smooth but stronger; Lp(a) repairs the injury, leaving residual trappings, i.e., a sticky compress, capable of continued growth. Although Lp(a) has an important function in the body, Matthias Rath, M.D., considers Lp(a) 10 times more dangerous than LDL cholesterol.
Studies suggest that diet can change Lp(a) levels. One study showed significant increases in Lp(a) levels of subjects consuming diets high in trans fats, but not in those consuming high levels of saturated fats (Journal of Lipid Research 1992 Oct;33(10):1493-501). Dr. Mary Enig maintains that saturated fats actually lower Lp(a) levels. In another study, researchers found a 24% reduction in Lp(a) levels with a diet high in vegetables, fruits, and nuts (Metabolism 1997 May;46:530-7). In a study published in Arteriosclerosis Thromb Vascular Biology (1999 May;19:1250-6) fish consumption was shown to reduce Lp(a) levels, most likely due to the omega-3 fatty acid content. In patients consuming large quantities of walnuts, Lp(a) levels were found to decrease an average of over 6%, as well as an almost equal decrease in LDL cholesterol levels (Annals of Internal Medicine 2000 Apr 4;132(7):538-46).
Mathias Rath hypothesized that Lp(a) levels may be increased in some cases due to a vitamin C deficiency. They note that Lp(a) is found mostly in the blood of primates and the guinea pig, which have lost the ability to synthesize ascorbate (a component of vitamin C), but only rarely in the blood of other animals that still produce their own vitamin C. They also noted that the Lp(a) and ascorbic acid possess some similar properties, such as in the acceleration of wound healing and other cell-repair mechanisms, the strengthening of the extracellular matrix (e.g., in blood vessels), and the prevention of lipid peroxidation. Based on this, Pauling and Rath suggested that humans intentionally synthesize Lp(a) when it is lacking an adequate vitamin C.
Ann
I have a very high lp(a) level. I lowered it 50% by following Linus Pauling’s protocol for vitamin c and lysine. I added taurine to the mix after reading a pubmed article that mentioned it. As Joe points out, it’s anyone’s guess as to whether that decreases my actual risk.
Lisa
How does one find out if they inherited high LPa?
Blood test or genetic test?
Although nothing can currently be done for it, I’d still like to know if I have it, so I can be aware.
Joe Graedon
Blood test, just like LDL cholesterol
Kerin
This perfectly explains why I don’t go to doctors and I keep myself informed.
James
Here we go again with another “wonder drug” that will prove in 20 years or so to be another collection of harmful side affects that will require yet another wonder drug that will… Of course the drug merchants keep on rolling along.
Kassandra
I have high cholesterol (especially LDL, but also high HDL which is good, triglycerides are ok) and was on different statins for years until my jaw started locking from Crestor. I now refuse to take a statin. You mention Evolocumab. Is that another statin, and does it have the same side effects as statins, or might it be something I should try?
Thanks for the very informative article. I will ask to have my Lipoprotein (a) tested.
Richard
The person stated TC 220 and HDL 60. The ratio 220/60 is less than 4. This ratio is much more important than LDL level. Less than 4 is good, more than 4 is not good. Also CRP(measure of inflammation) is also important since plaque deposits on artery walls due to inflammation. The plaque is trying to protect the arteries.
Peggi
I have high LP(a), above the European minimum for artery cleaning, and refused to go on statins to lower my LDL, which was around 100. I have been on HRT for a year, and my LP(a) came down 10 points. I used niacin first, which also lowered it but made me very flush and can damage kidneys. Aspirin, to prevent stroke, hurt my stomach and did not lower my LP(a). I take nattokinase now to keep my blood “thinner”. And, yes, there are some clinical trials going on.
This whole thing caught me by surprise. The only relative I know who had calcification was my aunt, who lived to 102. It’s scary to have this, very at times; but I’ve also read researchers think it could have a protective value against other conditions. Interesting… you might wish to look further, although the research is still scant compared to other areas.
David
My 50 yo. Physical is coming up and you bet I’ll ask in advance for this to be checked.
Kathleen
Great article. I have lipo little a and my cardiologist recommended one baby aspirin a day. He also recommended my 3 adult children be tested, 2/3 have it too. We need more education on this important topic. Thank you.
Robert
I was taking niacin for 2 decades to keep my cholesterol at an acceptable level (my ratios were always favorable). After a recent “suspected” cholesterol embolization event (blue toe syndrome) I was urged to stop the niacin and go on Crestor along with Zetia. I am due to go in soon for a follow up lipid panel which will include a test for LP(a). My PCP mentioned that in the early days of statins they often combined them with niacin, but have since stopped that practice. If I test with unfavorable levels of LP(a) would adding back niacin along with the Crestor be a reasonable approach given the latest medical information on this issue?
Tyler
Very informative. Didn’t know about the lipoprotein factor. My wife takes Crestor so now I’m concerned that her lpa is high. I’ve told her to get the level checked at her next doctor visit. At present I don’t take any cholesterol medication. Thanks for the heads up.
Joe
Niacin, aspirin, …. or $$$$RX!
Keep me updated!
Tom
The question still remains as to if high cholesterol causes heart problems to begin with. Many heart problems occur in people with “normal” cholesterol levels. I would never trust statins as being the fixer of possible heart problems. I think much heart disease is related to calcium overloads and other factors.
Jane
I seriously doubt any comparison to any currently existing drug will happen. I expect very expensive, marginally effective, side effect laden, drugs will be heavily pushed to everyone whether or not Lp a is elevated. THE prime (or since I am MORE cynical than you, only) motivation for this research is tons of money. I have doubts about the medical machine having more than monetary concern for patients, and no doubt at all about big pharma’s ONLY concern being huge money.
Kirk
Sounds like the perfect drug company profit maker. Keep people on statins, AND a drug to lower Lp(a). Especially since the statins are probably nearing the end of their patent protection.