Lipoprotein(a) — Lp(a)

Specialist

also lp little a, lpa

What it isLp(a) is an LDL-like particle with an additional "apolipoprotein(a)" tail attached. Its concentration is roughly 90% genetically determined and remains stable across a lifetime once set in early childhood.

DoesFunctions as an unusually atherogenic and pro-thrombotic particle — it deposits cholesterol in artery walls and promotes clotting at the same time.

GoodLow Lp(a) removes a major independent cardiovascular risk factor and the benefit is essentially "luck of the draw" inheritance.

BadElevated Lp(a) drives premature heart attack, stroke, and aortic stenosis independent of LDL. About 20% of the population inherits high levels.

Standard

<75 nmol/L (or <30 mg/dL) — assays vary.

Optimal

<10 nmol/L (lower is good)

Modifiers

Genetic — lifestyle and diet barely move it. Report in nmol/L for accuracy. Measure once in a lifetime.

How to optimize

Lifestyle: Doesn't move with lifestyle. If high, the response is aggressive ApoB lowering to compensate.
Diet: Doesn't move with diet meaningfully.
Supplements: No reliable supplement moves Lp(a). Don't waste effort here.
Peptides: —
Drugs: PCSK9 inhibitors (evolocumab, alirocumab) lower Lp(a) ~25%. Niacin lowers modestly. New RNA-based therapies (pelacarsen, olpasiran) in trials drop it 80%+; not yet available outside trials. Standard practice: lower ApoB aggressively to compensate for inherited Lp(a) burden.

within Cholesterol & Lipids