What You Should Know About Lipoprotein(a) and Cholesterol-Lowering Drugs
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Lipoprotein(a), or Lp(a), is a type of cholesterol that many people haven’t heard about. But it’s gaining attention because it may increase the risk of heart problems—even in people with normal cholesterol levels. A new study looked at whether common cholesterol-lowering medicines can reduce Lp(a). Let’s break it down in simple terms.
What is Lipoprotein(a)?
Lp(a) is a type of “bad” cholesterol, like LDL (low-density lipoprotein), but it's different in structure. High levels of Lp(a) in the blood can raise the risk of heart attacks and strokes. Unlike regular cholesterol, Lp(a) levels are mostly determined by your genes, not your lifestyle. So even if you eat well and exercise, your Lp(a) level might still be high.
Why Does Lp(a) Matter?
Studies show that higher Lp(a) levels mean higher risk of heart disease. For example, someone with very high Lp(a) could be more than twice as likely to have a heart attack compared to someone with low levels. Doctors are starting to see Lp(a) as an important heart risk factor, especially for people who have a family history of heart disease.
Can Medications Lower Lp(a)?
A large study reviewed 147 clinical trials with over 145,000 people to find out if popular cholesterol-lowering drugs reduce Lp(a). Here's what they found:
- Statins (like atorvastatin or simvastatin), which are widely used to lower LDL cholesterol, had little to no effect on Lp(a).
- Omega-3 supplements, ezetimibe, and fibrates also showed no real impact on Lp(a).
- Bempedoic acid, a newer medicine, did not lower Lp(a) levels either.
But there were some medications that helped:
- PCSK9 inhibitors lowered Lp(a) by about 29% on average. These are injectable medicines used in people at high risk of heart disease.
- Inclisiran, a similar injectable, lowered Lp(a) by about 22%.
- CETP inhibitors, not yet approved for wide use, cut Lp(a) levels by around 46%.
- Niacin, a type of vitamin B3, reduced Lp(a) by 37%, but it comes with side effects like flushing and stomach discomfort.
Does Lowering Lp(a) Actually Help the Heart?
This is the big question. Even though some drugs lower Lp(a), it's not clear if that always leads to fewer heart attacks or strokes. One reason is that most drugs don’t reduce Lp(a) by enough to make a major difference. Experts believe much bigger drops in Lp(a)—possibly 60 to 100 mg/dL—are needed to really protect the heart. So far, most current medicines don’t reach that level.
What About Future Treatments?
Researchers are working on new drugs made just to lower Lp(a). Some of these are already showing promise in early studies:
- Pelacarsen, olpasiran, and zerlasiran are newer types of drugs (called gene-silencers) that can reduce Lp(a) by 80% or more.
- These are still being tested, but they might become available in a few years if they prove safe and effective.
What Can You Do Now?
Here’s some practical advice if you’re concerned about Lp(a):
- Get tested: A simple blood test can check your Lp(a) level. Most people only need to test once since levels stay steady throughout life.
- Talk to your doctor: If your Lp(a) is high, your doctor may take that into account when deciding how aggressive to be with cholesterol and blood pressure treatment.
- Focus on what you can control: Even if you can’t lower Lp(a), you can reduce your overall risk by not smoking, staying active, eating healthy, and managing diabetes or high blood pressure.
The Bottom Line
Lipoprotein(a) is an important but often overlooked piece of the heart health puzzle. While most current cholesterol medicines don’t lower it much, a few like PCSK9 inhibitors and niacin can help. More powerful treatments are on the way. In the meantime, knowing your Lp(a) level and managing your overall heart health is a smart step.