I’m taking 10mg atorvastatin.
Any ideas what I could add to lower Lp(a)?
Any other blood or imaging tests to possible try?
I’ve read some stuff that might lower it such as a pcsk9-i, or some hormones.
Though I don’t want to possibly risk shutting down Hypothalamic-Pituitary-Gonadal axis.
Thanks!
*please move this thread if there is a better thread to move it to.
I would lower apoB / LDL further if I were you, to 30 mg/dl or lower. Look for clinical trials to lower Lp(a). Have family members tested. Gil Carvalho have spoken about this. Make sure to have perfect blood pressure, weight, and insulin sensitivity.
Thanks for the recommendations! Never tested apoB before, so I’ll try to add that to next test.
Ok, will talk to my practitioner about getting LDL lower (probably raise statin dose), and for clinical trials to lower Lp(a).
I can’t get any family members tested unfortunately.
Will try to keep the blood pressure, weight, and insulin sensitivity as good as I can.
Unfortunately there is little you can do about it other than living a healthy lifestyle.
"Lp(a) levels are largely determined by genetics — specifically, variations in the LPA gene, which encodes apolipoprotein(a). Studies suggest that genetics account for roughly 70–90% of the variation in Lp(a) levels between individuals, making it one of the most heritable cardiovascular risk factors known.
Because of this strong genetic influence, Lp(a) levels tend to remain relatively stable throughout a person’s life and are largely unresponsive to lifestyle changes like diet and exercise — which sets it apart from LDL cholesterol, for example, where lifestyle modifications can make a meaningful difference.
This also has a practical implication: Lp(a) typically only needs to be measured once in adulthood, since the result is unlikely to change substantially over time."
Are there any drugs that can lower Lp(a)?
Established/partially effective:
Niacin (vitamin B3) can lower Lp(a) by around 20–30%, but clinical trials failed to show it actually reduces cardiovascular events, and it has significant side effects. It’s largely fallen out of favor.
PCSK9 inhibitors (evolocumab, alirocumab) — primarily used to lower LDL — can also reduce Lp(a) by roughly 20–30% as a secondary effect. Not enough to normalize very high levels, but meaningful.
Hormone therapy (estrogen) lowers Lp(a) but isn’t prescribed for this purpose specifically.
Largely ineffective:
Statins, diet, exercise, and most lifestyle changes have little to no impact on Lp(a), which reinforces the genetic nature of the condition.
Emerging/promising:
Pelacarsen — an RNA-targeted therapy (antisense oligonucleotide) that has shown dramatic reductions in Lp(a) of 70–90% in trials. It was in late-stage clinical trials as of my knowledge cutoff and generated significant excitement in cardiology.
Olpasiran and zerlasiran — small interfering RNA (siRNA) drugs that have also shown very large reductions (80–90%+) in early trials.
I imagine you know this, but as an alternative to raising your statin dose, or in addition to, you can also consider adding ezetimibe and bempedoic acid. EZ is cheap in the US, BA is expensive unless you have good insurance. I get BA from India.
I don’t know what the exact numbers are, but at some level of statins, you are getting most of the benefit and a higher dose is not adding very much.
If I recall, my lp(a) was in the 190s an went to 170s after repatha.
I’m on EZ/BA and repatha and can’t get my LDL lower than 37 (I don’t feel well on statins). My apob is in the 40’s.
@A_User I emailed someone whose name was shared here about being in a study for the lp(a) drug but never heard back
Welcome to the club. Mine is 288 (reduced to 224 on a PCSK9-i). I added the latter to reduce my LDL-C even further. It took me from 79 to 35. Essentially, you want to reduce every other risk factor, and you probably should regard yourself as a secondary patient in terms of risk whether or not your GP shares that view. Here’s a great lifetime risk calculator accounts for lp(a). Some people will claim reductions from diet although it’s unclear whether those are sustained. The people that do the modeling for the new drugs viewed a reduction of greater than 80% as necessary to get approval.
@desertshores Thanks!
I’ve tried Niacin before but never huge dosages over 1 gram. I think some of the dosing was 1000mg 3x a day if I recall correctly.
It seems it is something I’d have to take everyday. I’ve read it can interfere with statins (possible rhabdomyolysis), so I dropped the niacin.
Just take a small dose of niacin 10mg with 15mg niacinamide that is in my multi vitamin & mineral product.
Gotta get me one of those trials!
@Beth Thanks for the insights!
That stinks repatha didn’t lower Lp(a) that much for you.
The issue where I live is that my doctor likes my blood work, and didn’t want to prescribe me anything else when I asked last such as EZ or BA.
It will be a challenge to get a higher statin dosage.
My last pack from overseas was seized, so I’m hesitant to rely on that option for a daily use year round product.
Might have to look into private doctor/clinic, which will cost much more.
Or those clinic trials.
@zazim Appreciate the help! Your Lp(a) is the highest I’ve seen here.
Cheers to your 1st post in 2 years!
I’ll ask my GP about a referral to a specialist (secondary patient). As I might be able to get more medications that will be covered by my insurance. As my GP does not seem to want to prescribe me anything else at this time. I’ve never seen a specialist for lipids/cardiovascular issues.
Thanks for the link. I tried it out.
Ok, I think I made a mistake… I noticed the test in your link had nmol or mg/dl for the Lp(a).
My lipid blood test was in nmol and I had to change to mg/dl here and the Lp(a) number I wrote above in first post was in nmol and not mg/dl.
It didn’t show nmol beside the number but was mentioned on the next page.
So, I’ll edit that to: Lp(a) 83mg/dl.
Which is still in the high range.
Definitely consult a preventative cardiologist or lipidoligist. I had to convince my GP to prescribe a statin since my LDL-C was only 108 at the time (previously it had been much higher). I had to push the specialist for Repatha. 10mg of the statin reduced my ApoB to 80 and I wanted it below 60. He was happy with 80. But he was key in getting my insurance to cover Repatha. They will definitely deny your coverage initially. That is guaranteed unless you are a secondary patient. So you will have to have a doctor that will appeal. My insurer wanted to see another six months on the statin, but they finally approved it. If they keep denying coverage, you can appeal to the state board, which is not widely known but may make the difference. It does reduce lp(a) in many cases 25%? or so if you’re lucky. But no insurer will ever approve it for that reason. So you need to make the case on different grounds.
@zazim Interesting story about how you were able to get the Repatha. Glad you were able to get it.
Exactly, even if it’s up to 25%, that is better than nothing.
Did not know about possible appeal to the state board.
Will ask for a referral on my next appointment to a cardiologist (specialist).
@AustraliaLongevity No. But thinking of trying one soon. Either retatrutide and tirzepatide.
Any thoughts on those?
I hadn’t tested my Lp(a) or ApoB before starting tirzepatide but I had tested my HDL and LDL cholesterol before that. I had a significant reduction in LDL, and I had very low Lp(a) and ApoB levels on my first blood test after starting tirzepatide. I am convinced it helps lower cholesterol.
I was also taking psyllium husk nightly in that period which I believe does somewhat function like ezetimibe by stopping reabsorption of bile or something like this.
No experience with reta but that might do something similar.
Right on. That’s great to hear you had positive results with tirzepatide, plus very low Lp(a) and ApoB.
The glp1’s are easier for me to get than statins, pcsk9i or other cardio medications to possibly help the situation.
So using a GLP1 might be able to get my LDL down closer to the 30mg/dL which was mentioned above.
I do have some psyllium husk, but have not used it a long time as I usually get around 40g/fiber per day from my meals. But if you think it’s still worth adding it in, I can try doing a nightly drink.
Yea look into psyllium I believe it is quite effective.
I’d be interested to see where my cholesterol is at now since I’ve been eating a lot more eggs and red meat. That will be an interesting test of what I’m taking.
Will do, thanks!
Indeed. Depends on if you do 8+ hours fasted blood test or testing 1 to 3 hours after eating. As that will probably be quite a bit difference in numbers.
I’ve been straining & rinsing the fat off ground beef if it’s over 10% fat. Then add in a little olive oil, or some pufa fat when ready to eat.
Putting the ground meat into a strainer in the sink after cooking it, then rinsing the meat using hot water to remove the fat through the strainer. Making the ground beef much leaner.
