Show Notes
This week, we get in-depth information on Lp(a), the heart risk no one talks about. You have heard of cholesterol, and you may even know what your cholesterol level is. The compound lipoprotein a may be equally dangerous when it is elevated, but you have probably heard very little about it.
At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.
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You could listen through your local public radio station on Sept. 5, 2026, or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 7, 2026.
What Is Lp(a)?
Lipoprotein a, or L-P-little a for short, circulates in the bloodstream, where it picks up and carries cholesterol and oxidized phospholipids. Scientists believe that blood levels are determined mostly by genetics and change very little over the course of our lives. Roughly 20 percent of people have high levels of Lp(a), above 30 ng/dL or 75 nmol/L. The two different figures are because tests use different units to measure the blood concentration, either nanograms per deciliter or nanomols per liter.
While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level?
Is Lp(a) the Heart Risk Doctors Can’t Treat?
Perhaps doctors have been reluctant to measure or discuss lipoprotein a because they don’t have good interventions. That is beginning to change with the development of antisense oligonucleotides, a new category of prescription drugs that can cut levels sharply. The FDA has not yet approved any of these new medications, though. The first of these, pelacarsen, is still in Phase 3 trials needed before the agency can consider the evidence. However, it can bring down lipoprotein a by an estimated 80 percent.
Cardiologists’ favorite drugs, statins, do not help Lp(a) levels. In fact, Lp(a) the heart risk rises when people are taking statins to lower their cholesterol. Other cholesterol-lowering drugs such as evolocumab (Repatha) and alirocumab (Praluent) can bring Lp(a) levels down modestly. One really old cholesterol-lowering drug, high-dose niacin, also helps moderate Lp(a). Some people do not tolerate it, however, as it can cause very uncomfortable flushing. So far as we know, no scientists have run studies to see whether niacin reduces the risk of heart attacks and other complications because of its effects on Lp(a).
Other Complications of Lp(a):
Our guest, Dr. Sam Tsimikas, is among the country’s leading experts on lipoprotein a. We asked him whether Lp(a) the heart risk factor causes other problems as well. Dr. Tsimikas described heart failure, potentially resulting from a heart attack, as well as peripheral artery disease (PAD), which can make it painful to walk. Lp(a) seems to cause plaque in arteries throughout the body. As a result, it can increase the chance of a stroke. In addition, it contributes to calcification of the heart valves. This condition interferes with their ability to function properly.
What Can We Do If Lp(a) Is Too High?
Dr. Tsimikas runs a unique clinic for cardiology patients with
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