Although not as well-known as its cousins LDL and HDL, lipoprotein(a) may be just as important for health. Like LDL cholesterol, high levels are linked to an increased risk of heart disease and stroke. Find out what causes your levels to spike and how to reduce them naturally.

What is Lipoprotein(a)?

Lipoproteins are a mesh of proteins and fats that help carry cholesterol in the blood. Examples include low-density lipoprotein (LDL) and high-density lipoprotein (HDL) [1].

Lipoprotein(a), or Lp(a) is very similar to LDL, except it contains another compound called apolipoprotein(a). Like LDL, it’s made in the liver and carries fats and other lipids such as cholesterol around the body [1, 2].

The exact function of Lp(a) is still an active area of research. We know high levels pose health risks, but it’s uncertain if low levels can be dangerous as well [3, 4, 5, 6, 7, 8].

Researchers think Lp(a) is involved in wound healing, tissue repair, immune response, and inflammation. However, people with nonexistent or very low Lp(a) levels do not appear to be at an increased risk of diseases or dying [9, 10, 11].

Originally, it was believed that Lp(a) levels are determined only by genetics and remain stable, independent of a person’s lifestyle [12, 11, 13].

Today we know that certain lifestyle, supplemental, and dietary interventions can help reduce lipoprotein(a) levels. On the other hand, hormonal imbalances, inflammatory diseases, and drugs can increase them [12, 11, 13].

Lipoprotein(a) Test

Lipoprotein(a) levels are measured with a blood test. You don’t need to prepare for the test. However, you will need to fast for 9-12 hours before getting a blood draw if you are doing a lipid panel along with lp(a).

Your doctor may order a Lp(a) test to get a better idea of your risk of heart disease, especially if [14]:

  • Heart disease runs in your family
  • You have a genetic condition that causes high cholesterol levels (familial hypercholesterolemia)
  • Your heart disease is worsening despite treatment with statins

Lipoprotein(a) Normal Range

The normal range for Lp(a) is 0-30 mg/dL, or 0-75 nmol/L [15].

About 70% of people fall within this range [14].

Lp(a) levels are 2- to 3-fold higher in people of African descent than in people of European or Asian descent [16, 17].

Causes of High Lipoprotein(a) Levels

1) Genetics

Given that Lp(a) levels are largely determined by genetics, mutations in the LPA gene can lead to high levels [11].

Mutations in this gene can result in different sizes of apolipoprotein(a), from which Lp(a) is made. Let’s zoom into the cell to understand why [11].

Your body can only make Lp(a) once apolipoprotein(a) leaves the cell and combines with apolipoprotein B. Larger forms of apolipoprotein(a) take longer to exit the cell. In turn, they lower Lp(a) production and blood levels. Smaller forms leave the cell quickly, Lp(a) is rapidly created, and its blood levels rise [11].

Human studies support the link: people with smaller apolipoprotein(a) particles have higher Lp(a) levels [11].

Familial Hypercholesterolemia

Familial hypercholesterolemia is a genetic disorder that results in high cholesterol levels, and frequently, high Lp(a) levels as well [18, 19, 20].

Your genes can increase your risk of having high lipoprotein(a) levels, and possibly high cholesterol too.

2) Pregnancy

Lp(a) levels temporarily increase during pregnancy but return to baseline levels following childbirth [21].

Preeclampsia

Preeclampsia is sudden high blood pressure during pregnancy that can damage the liver or kidneys. Lp(a) levels increase even further, possibly as the body’s attempt at injury repair. In severe cases of preeclampsia, Lp(a) drop, likely because its reserves are emptied [21, 22].

Lp(a) normally slightly rises during pregnancy. But Lp(a) that drops too high or too low can signal a pregnancy complication called preeclampsia.

3) Underactive Thyroid

People with an underactive thyroid often have high lipoprotein(a) levels, possibly because they produce more Lp(a) while breaking down less. Treatment with thyroid hormones restores their levels to normal [23, 24, 25, 26].

4) Low Testosterone Levels

Men with low testosterone levels have higher Lp(a) levels and are at an increased risk of heart disease. Testosterone replacement therapy, even in men with normal testosterone levels, decreases Lp(a) [27, 28, 29, 30, 31].

5) Low Estrogen Levels

Low estrogen levels can also raise Lp(a). In women, estrogens are mainly produced in the ovaries. One study found that Lp(a) increased by 90% three months after surgical removal of the ovaries [32, 33].

Turner syndrome is a genetic condition that can severely damage the ovaries and drastically reduce estrogen levels. Lp(a) levels are frequently high in women with Turner syndrome [34].

In menopause, Lp(a) levels increase due to the large drop in estrogen. In a study of 1.4k women, those in menopause had 8% greater Lp(a) levels. Estrogen replacement therapy reduces Lp(a) levels in menopausal women [35, 36, 37, 38, 39, 40].

Women with low estrogen–due to menopause, genetic conditions, or ovary removal–have higher lp(a) levels.

6) Autoimmune Diseases

Inflammation is common to both autoimmune diseases and heart disease. Inflammatory compounds such as IL-6 can increase Lp(a) levels [41, 42. 43].

Various chronic inflammatory and autoimmune diseases are linked to high Lp(a), including [44, 45, 46, 47, 48, 49]:

  • Rheumatoid arthritis
  • Crohn’s disease
  • Lupus
  • Psoriasis

7) Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) have high testosterone levels, often along with high Lp(a). However, higher-than-normal testosterone is not what causes Lp(a) to rise. Instead, inflammation is the likely culprit [50, 51, 52, 53].

8) Tissue Damage

Lp(a) may rise in response to serious inflammation and tissue damage, such as after surgery or heart attacks. Within the first week after a heart attack or surgery, Lp(a) can be spike 10-fold. Levels may stay high for a month but return to normal within about 2 months [54, 55].

The rise in Lp(a) follows an increase in damaging inflammatory compounds. Lp(a) probably increases to aid tissue repair [54].

9) Certain Drugs

Although statins are effective for lowering LDL levels, they can actually increase Lp(a) levels [56].

Other drugs that increase Lp(a) levels include:

  • Anti-seizure drugs [57]
  • Insulin [58]
  • Pioglitazone (Actos), Troglitazone (Rezulin), and metformin (Glumetza, Glucophage), used to treat type 2 diabetes [59, 60]
  • Growth hormone [61, 62]
  • Finasteride (Propecia), used to treat an enlarged prostate (BPH) [63]

Health Effects of High Lipoprotein(a) Levels

Heart Disease

Importance

Like LDL, lipoprotein(a) can build up in blood vessels, leading to fatty plaques, calcium deposits, and hardened arteries (atherosclerosis). Lp(a)-hardened arteries cannot properly expand. As a result, high Lp(a) levels are linked with an increased risk of heart disease [64, 65, 66, 67, 4, 5, 6, 7, 8, 68]

Lp(a)-lowering strategies are a high-priority target in medicine. No known therapeutics affect lp(a) levels [1].

Another hazard is that Lp(a) is similar to a protein called plasminogen. The body converts plasminogen into plasmin, which dissolves blood clots that can lead to heart attack and stroke. Lp(a) interferes with the conversion, lowering plasmin [69, 70, 71].

Heart Disease Risk

Multiple studies have found that high Lp(a) levels are linked to an increased risk of heart disease. A meta-analysis of 31 studies found that levels above 50 mg/dL increased the risk of heart disease by 50% compared to levels below 5 mg/dL [3, 4, 5, 6, 7, 8].

Lp(a) is an independent risk factor: its link with heart disease still holds even after other risk factors–such as cholesterol, obesity, and smoking–are accounted for [72].

Heart Failure

In heart failure, the heart doesn’t pump blood as well as it should. Compared to Lp(a) levels below 8 mg/dL, people with levels above 68 mg/dL had a 50% increased risk of heart failure [73].

Heart Attacks and Stroke

Higher Lp(a) levels increase the risk of both milder and deadly heart attacks [74, 75].

In previous heart attack and stroke patients, those with higher Lp(a) levels were at an increased risk of suffering another heart attack, as well as of stroke, hospitalization, and death [76, 77].

Percutaneous coronary intervention (PCI) is a non-surgical procedure to open up blocked arteries in heart disease patients. In PCI patients, Lp(a) levels above 20 mg/dL increased the risk of death by 20% within a 5-year followup period. According to another study of PCI patients, levels above 16 mg/dL nearly doubled the risk of dying within the following 3 years [78, 79].

High lipoprotein(a) levels can strongly increase your risk of heart disease and heart-related complications.

Chronic Kidney Disease

Higher Lp(a) levels are linked to worse kidney function [80].

In one study of 560 people, those with Lp(a) levels above 31 mg/dL were at two times higher risk of chronic kidney disease than those with levels below 9 mg/dL [81].

How to Reduce Lipoprotein(a) Levels

Diet and Lifestyle

1) Exercise

High-intensity interval training (HIIT) can reduce Lp(a) levels [82]. HIIT involves short periods of intense exercise followed by short periods of rest.

You may not need to take up HIIT training, though. Just walking for 30 minutes a day for at least 5 days a week also lowered Lp(a) levels in a study of over 300 people with heart disease [83].

2) Diet

Aim to eat more vegetables, fruits, and nuts. A diet high in these foods reduced Lp(a) levels by 24% in 2-week study of 10 people [84].

Getting more flaxseed in your diet might also help. In one 6-week study of 38 people with high Lp(a) levels, 38 g/day of ground flaxseed lowered levels by ~7%. In another 10-week study of 62 people, 40g/day reduced Lp(a) by 14% – so you may need to be consistent with your intake [85, 86].

Eating pecans, almonds, and walnuts can also help reduce your Lp(a) levels [87, 88, 89].

On the other hand, you should avoid low-fat (<20% of calories), high-carbohydrate diets. Several studies revealed these diets increase Lp(a) levels [90, 91, 92].

3) Quit Smoking

Habitual smokers who stopped saw a 12% reduction in Lp(a) after a week [93].

4) Red Wine

Polyphenols in red wine called can decrease Lp(a) levels [94].

Supplements

5) Niacin

Multiple trials of over 29k people have found that 1.5-3 g/day of niacin (vitamin B3) decreases Lp(a) levels by up to 28% and on average 20%. The effect was greater in those with higher levels [95, 96, 97, 98, 99, 56].

Niacin works by blocking the production of apolipoprotein(a), which is needed to make Lp(a) [98, 95].

All of the trials used the extended-release version of niacin, which reduces side effects such as flushing and liver damage seen with the immediate-release and sustained-release versions [100].

6) Coenzyme Q10

CoQ10 is an antioxidant molecule used to make energy in the form of ATP. Lipoprotein(a) contains substantial amounts of CoQ10, which may help protect it from oxidative damage. CoQ10 may reduce the activity of the gene that makes Lp(a) while enhancing Lp(a) removal [101].

A meta-analysis of 7 trials and more than 400 people found that CoQ10 (100-300 mg/day) reduced Lp(a) levels by 3.5 mg/dL on average. Higher doses worked better, while people with Lp(a) levels above 30 mg/dL saw an impressive 11.7 mg/dL reduction in their levels [102].

7) L-Carnitine

L-carnitine supplements (500- 4,000 mg/day) reduce Lp(a) by about 8.8 mg/dL, according to a meta-analysis of 7 trials and 375 people [103].

L-carnitine may work by increasing fat breakdown in the liver, which limits Lp(a) production [103].

8) Turmeric

Curcuminoids are a group of bright-yellow compounds found in turmeric, curcumin being the main one. Curcuminoids taken with piperine (to increase their absorption) reduced Lp(a) levels by up to 16% [104, 105].

9) Vitamin D and Calcium

The combination of vitamin D (400-500 IU/day) and calcium (150 mg-1g/day) reduced Lp(a) levels by up to 25% [106, 107].

10) Mastic gum

In one study of 133 people with high Lp(a) levels (average: 52 mg/dL), 5g of mastic gum reduced Lp(a) by 60% over the course of 18 months. However, only women experienced the benefits, while the effect was barely noticeable in men [108].

Mastic gum works by reducing the production of apoB, a component of Lp(a) [108].

11) Red clover

Estrogen replacement therapy reduces Lp(a) levels in postmenopausal women. Isoflavones are estrogen-like plant compounds (phytoestrogens) with similar effects on the body. These compounds may reduce Lp(a) production and help clear it from the blood [109, 110, 111].

Isoflavones from red clover reduced Lp(a) levels by 63% in overweight postmenopausal women over 3 months (53 total people). Women with a healthy weight saw a more modest 15% reduction [111].

12) Vitamin B6, B9, and B12

Chronic kidney failure patients suffer from an increased risk of death from heart disease due in part to high Lp(a). In 21 people with kidney failure, the combination of vitamin B6 (150 mg/day), B9 (15 mg/day), and B12 (1 mg/week) reduced Lp(a) levels by 21% [112].

13) Ginkgo Biloba

Taking 240 mg of Ginkgo biloba extract daily for two months lowered Lp(a) by 23% and reduced plaque size in 8 patients at high risk of heart disease [113].

14) Inulin

In a 5-week study of 22 people, pasta enriched with the prebiotic fiber inulin decreased Lp(a) levels by 17% [114].

15) Red Yeast Rice

Red yeast rice extract reduced Lp(a) levels by 23% in a 6-week study of 60 people with heart disease and high Lp(a) [115].

16) Omega-3s fats and Vitamin E

Omega-3s do not reduce Lp(a) levels. However, the combination of omega-3 fats and vitamin E reduced the activity of the LPA gene, indicating that together they may help reduce Lp(a) levels [116, 117].

Other (Drugs)

Low-dose aspirin (81 mg/day) decreased Lp(a) levels by 20% in 70 people with heart disease. In another study of 25 stroke patients, 150 mg/day aspirin reduced Lp(a) levels by 46% over 4 weeks [118].

Aspirin decreases the activity of the LPA gene, reducing production in the liver [118].

Irregular Levels?

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Takeaway

Lipoprotein(a) or Lp(a) is similar to the “bad” cholesterol, LDL. High Lp(a) levels can strongly increase your risk of heart disease.

Your doctor will likely order the Lp(a) test to better assess your risk of heart problems, especially if heart disease and/or high cholesterol levels run in your family.

Your genes can have a large influence on your Lp(a), but your lifestyle and health status play a role as well. Factors that can increase your levels include hormonal imbalances, autoimmune and inflammatory diseases, pregnancy, and certain drugs.

To lower your levels, aim for regular exercise and eat a healthy diet rich in flaxseed, nuts, vegetables, and fruits. Supplements such as niacin and L-carnitine can also help.

About the Author

Will Hunter

BA (Psychology)
Will received his BA in Psychology from the University of California, Los Angeles. 
Will's main passion is learning how to optimize physical and mental performance through diet, supplement, and lifestyle interventions. He focuses on systems thinking to leverage technology and information and help you get the most out of your body and brain.

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