Lipoprotein(a): Unique Treatments for a Unique Risk Factor

Health Professional

In the last blog post, I described the experiences of Patty and Karen, two women in their 40s who had to undergo major procedures for their coronary and carotid disease. The cause: A little talked about risk for coronary and vascular disease called lipoprotein(a), or Lp(a).

Because Lp(a) is inherited from a parent and then passed onto children, with each child exposed to 50% likelihood of inheritance, many dismiss Lp(a) as hopeless, assuming that gaining control over this powerful genetic coronary risk is impossible.

But there's plenty you and your doctor can do to reduce, even eliminate, the risk posed by this genetic pattern.

First of all, if it's genetic, how can it possibly be affected? Do we have to change your genes?

No, thankfully, we do not. With current technology, it is not yet safe nor feasible in living humans to replace one gene with another, such as the gene that codes for Lp(a). (Perhaps in 20 or 30 years, this will be possible not just for Lp(a), but with other genetically-determined conditions.)

What factors have a substantial effect on reducing Lp(a) and making it less harmful? Here are a few:

Diet - Contrary to conventional "heart healthy" diet advice, a low-fat diet increases Lp(a), while also worsening small LDL particles. Combine Lp(a) with small LDL particles, and you've got a really potent combined risk factor for heart attack. Conversely, many oils and fats reduce Lp(a). In my clinic in which we treat many people with Lp(a), we advise patients to favor a diet more heavily in favor of healthy oils and fats and to not purposely restrict them.

Niacin - Niacin is vitamin B3. Taken at higher doses than that required to treat deficiency, niacin can reduce Lp(a). The effect generally begins at a dose of 1000 mg per day, with greater effects at higher doses of up to 4000-5000 mg per day. However, such high doses, far more than used to treat other abnormal patterns like low HDL, has potential for more side-effects, such as liver abnormalities, rash, and stomach upset. Therefore, niacin at doses of 500 mg per day or more should be taken with the assistance of your healthcare provider. Although responses can vary, Lp(a) is usually reduced by 25-30%, occasionally more.

Omega-3 fatty acids - The omega-3 fatty acids from fish oil can reduce Lp(a), though much more than the usual dose is required. This observation, interestingly, originated with the Bantus of Tanzania who are fishermen and consume fish up to several times per day. Compared to non-fishing Bantus, the fishermen had Lp(a) levels 50% lower. We have applied this high-dose fish oil concept with good results, reducing Lp(a) in approximately 60% of people using this approach.

DHEA - The adrenal hormone, DHEA (an abbreviation for dehydroepiandrosterone, not to be confused with DHA, or docosahexaenoic acid, from fish oil) is an over-the-counter supplement in the U.S. DHEA is a hormone of strength, vigor, and assertiveness present in plentiful quantity during our younger decades, declining into our 40s, 50s and onwards. It is one of my favorite tools to help reduce Lp(a). While, by itself, DHEA usually reduces Lp(a) only about 10-20%, it is, in my experience, among the most consistent ways to reduce Lp(a).

DHEA should only be taken by men and women 40 years old or older, or if your healthcare provider has documented a low DHEA blood level if you are younger than 40. Having a baseline blood level also provides guidance on how much is safe to take. We generally begin with 10-25 mg in the morning, increasing to 50-100 mg over several months. One side-effect that occurs in about 20% of people: excessive short-temperedness or assertiveness.

Beyond this, testosterone in men and estrogens in women can also be prescribed by your healthcare provider to reduce Lp(a). The effect is not as consistent as with DHEA, but is occasionally helpful. Maintaining normal thyroid function is also an important facet of Lp(a) treatment; should hypothyroidism develop (low thyroid hormone evidenced by fatigue, weight gain, and feeling cold), Lp(a) increases and aggressively adds to heart disease risk. Correction of hypothyroidism can contribute to better control over Lp(a).

Some other everyday foods and supplements can also reduce Lp(a), though the effects are generally modest:

  • Almonds
  • Ground flaxseed
  • Alcohol
  • Coenzyme Q10
  • Vitamin C
  • Gingko biloba

Lp(a) also has the unique ability to magnify the dangers of other risk factors for heart disease, such as high LDL cholesterol or small LDL particles. Thus, an indirect means to further impair Lp(a)'s ability to do its dirty work is to make other factors as perfect as possible.

The point here is that, should you have Lp(a) identified, please do NOT accept comments like "There's nothing you can do about it," or "Genetic factors can't be changed," or "Don't worry about it. You feel fine, don't you?" You should insist on a full explanation and a thoughtful assessment of how this fits into your overall program of heart disease prevention. If you don't get the answers you need, it's time to find a new healthcare provider.