An elevated Lp(a) is largely genetically determined and barely responds to lifestyle or diet changes. This makes treatment challenging. However, there are still effective ways to protect your heart and reduce overall cardiovascular risk. On this page, you’ll find an overview of current treatment options and promising new therapies under development.
Why treatment matters
A high Lp(a) level increases the risk of heart attack, stroke, and aortic valve calcification, even in people with otherwise normal cholesterol levels. Because Lp(a) is not affected by diet, exercise, or lifestyle, it’s important to understand how you can lower your overall cardiovascular risk in other ways. At present, Lp(a) cannot be directly reduced, but the associated risk can be managed effectively.
Current treatments for elevated Lp(a)
Although there are currently no medications that specifically target Lp(a), there are several ways to lower the total cardiovascular risk. Doctors focus primarily on reducing other risk factors, such as LDL cholesterol, blood pressure, and inflammation to minimize the harmful effects of elevated Lp(a).
Statins
Statins are the most widely used medications for lowering LDL cholesterol (the “bad” cholesterol). While they have no direct effect on Lp(a), they protect the arteries and significantly reduce the risk of cardiovascular disease.
PCSK9 Inhibitors
PCSK9 inhibitors are powerful cholesterol-lowering drugs used for people with persistently high LDL levels. They can lower LDL cholesterol by around 60% and may also reduce Lp(a) levels by 10–30%. These medications are often prescribed to patients with genetic predisposition or a high cardiovascular risk.
Niacin (Vitamin B3)
High doses of niacin can slightly lower Lp(a) levels. However, due to limited effectiveness and frequent side effects, this therapy is no longer recommended by European guidelines.
Lipoprotein Apheresis
For individuals with extremely high Lp(a) levels and recurrent cardiovascular events, doctors may consider lipoprotein apheresis. This treatment involves filtering the blood through a special device to remove fat particles, including Lp(a). The effect is temporary, but the procedure can be valuable in severe cases.
New and upcoming treatments to lower elevated Lp(a)
Researchers around the world are developing new medications designed specifically to lower Lp(a) directly. These therapies target the liver, where Lp(a) is produced, and block the production of the apolipoprotein(a) protein — the unique component that distinguishes Lp(a) from regular LDL cholesterol. The first results from clinical studies are very promising. Some treatments have shown the ability to reduce Lp(a) levels by more than 80%. One of the most studied candidates is Pelacarsen, developed by Novartis in collaboration with Ionis Pharmaceuticals. Large international trials are now underway to confirm whether this significant reduction in Lp(a) also leads to fewer cardiovascular events such as heart attacks and strokes. These medications are not yet available, but the first Lp(a)-targeted therapies are expected to reach the market within the next few years, once their safety and effectiveness have been fully confirmed. For people with very high Lp(a) levels, these new therapies offer real hope for targeted treatment, a major step forward in the future of cardiovascular prevention.
What you can do now if you have elevated Lp(a)
Even though you cannot change your Lp(a) level yourself, there are many ways to protect your heart and blood vessels.
1. Keep your cholesterol low – A healthy LDL level helps lower your overall cardiovascular risk. Your doctor can advise you on medication or lifestyle adjustments.
2. Monitor blood pressure and blood sugar – High blood pressure or elevated blood sugar increases the risk of arterial damage.
3. Stop smoking – Smoking accelerates arterial calcification, especially in combination with high Lp(a).
4. Eat a healthy diet – Choose vegetables, fruits, whole grains, fish, nuts, and unsaturated fats. Limit saturated fats and processed foods.
5. Stay physically active – Aim for at least 150 minutes of moderate-intensity exercise per week — such as walking, cycling, or swimming — to support healthy circulation.
6. Maintain a healthy weight – A stable weight helps keep your lipid metabolism in balance.
7. Be aware of family history – If cardiovascular diseases run in your family, discuss with your doctor whether extra checkups or Lp(a) testing may be beneficial.
Although you cannot change your genes, regular physical activity and a healthy lifestyle can have a positive impact on your heart health and help counteract the effects of elevated Lp(a).
When is treatment advisable?
Treatment or additional monitoring is especially recommended if:
- Your Lp(a) level is significantly elevated (>125 nmol/L or >50 mg/dL).
- Heart or vascular diseases run in your family, particularly at a young age.
- You have already experienced heart problems, despite having normal cholesterol levels.
In these cases, your general practitioner or cardiologist may recommend a combination of cholesterol-lowering therapy, lifestyle adjustments, and ongoing monitoring. For individuals with high Lp(a) and a family history of cardiovascular disease, it may be useful to regularly check a full lipid profile. This helps ensure that any changes in cholesterol, LDL, or triglyceride levels are detected early — allowing for timely intervention and better overall risk management. Promising developments in the fight against Lp(a) The medical field is making rapid progress in treating elevated Lp(a). What was once considered untreatable is now within reach. New therapies that directly block the production of Lp(a) are showing remarkable results in clinical trials. Within the next few years, these medications could fundamentally change how we prevent cardiovascular disease. Until then, one thing remains essential: taking good care of your heart. By keeping your cholesterol, blood pressure, and lifestyle in balance, you are already laying the foundation for the treatments of tomorrow.
Sources
Scientific sources and medical references. The information on this page about current and future treatment options for elevated lipoprotein(a) levels is based on the following scientific publications.
Tsimikas S, Stroes ESG.
The dedicated “Lp(a) clinic”: A concept whose time has arrived?
Atherosclerosis, 2020.
https://pubmed.ncbi.nlm.nih.gov/32234580/
European Atherosclerosis Society Consensus Panel (Kronenberg F, Mora S, Stroes ESG, et al.).
Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: A European Atherosclerosis Society consensus statement.
European Heart Journal, 2022.
https://pubmed.ncbi.nlm.nih.gov/36036785/
Tsimikas S, Karwatowska-Prokopczuk E, et al.
Lipoprotein(a) Reduction in Persons with Cardiovascular Disease.
New England Journal of Medicine, 2020.
https://pubmed.ncbi.nlm.nih.gov/31893580/
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