Lipoprotein(a)

Lipids marker

Lp(a)

Lipoprotein(a)

Category: Lipids
Unit: nmol/L

Genetically determined lipoprotein particle. Elevated levels are an independent risk factor for cardiovascular disease, aortic stenosis, and stroke. Levels are ~90% determined by genetics and largely unaffected by lifestyle.

PED Notes

Lp(a) is almost entirely genetic -- AAS, diet, and exercise have minimal effect on levels. However, it is a critical cardiovascular risk marker that every PED user should know once. If elevated (>75 nmol/L or >30 mg/dL), it compounds the already elevated cardiovascular risk from AAS-worsened lipids. Test once -- if normal, no need to retest as levels are stable throughout life.

When high

Limited options (genetically determined):

  • Niacin -- 1-2g/day may reduce levels by 20-30% (limited clinical evidence)
  • PCSK9 inhibitors -- show promise but prescription-only

Key strategy: Focus on aggressively managing modifiable risk factors (LDL, ApoB, HDL, blood pressure) if Lp(a) is elevated

Pharmacological options (emerging and established):

  • PCSK9 inhibitors (alirocumab, evolocumab) -- 75-150mg subQ every 2 weeks; currently the most accessible pharmacological option for Lp(a); reduces Lp(a) by ~25-30% alongside substantial ApoB reduction; very expensive, specialist prescription, usually reserved for FH or ASCVD
  • Pelacarsen (TQJ230) -- hepatic antisense oligonucleotide targeting LPA mRNA; Phase 3 HORIZON trial; reduces Lp(a) by 80%+ in trials; not yet approved but closest to market
  • Olpasiran -- siRNA targeting LPA mRNA; Phase 3 OCEAN(a) trial; competitor to pelacarsen with similar efficacy
  • Niacin (extended-release) -- 1-2g/day; modest 20-30% Lp(a) reduction; outcome trials (AIM-HIGH, HPS2-THRIVE) did not show cardiovascular benefit despite lipid changes; not first-line
  • Lifestyle -- essentially unmoved by diet, exercise, or weight loss; Lp(a) is ~90% genetic and largely fixed for life
  • The actionable strategy: aggressive ApoB reduction (statin + ezetimibe + PCSK9i to target ApoB <0.7 g/L), rigorous BP control, smoking cessation, and Lp(a)-aware coronary imaging (CAC score, CTA) rather than attempting to lower Lp(a) itself with current tools
  • All pharmacological Lp(a) reduction requires physician/cardiologist oversight; test Lp(a) once in a lifetime, retesting is rarely useful

History Chart

Reading History

Frequently Asked Questions

Reference Ranges

Standard Range

0 - 75 nmol/L

Statistics