Biomarkers · Lipids & Apolipoproteins
Lipoprotein(a) [Lp(a)]
Lower values go with lower risk of death. Not measured in our NHANES panel. The curve is drawn from the published study (source below).
Lipoprotein(a) [Lp(a)] and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to the curve's reference value, drawn from the published study (source below).
Published risk of death1.09×top versus bottom tertile of Lp(a), general population (19 studies) (95% CI 1.01–1.18) · Meta-analysis of prospective studies (43 publications, 75 studies, 957,253 participants); general-population estimate pools 19 studies
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in Lipoprotein(a) [Lp(a)], study by study
9 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| pharmacologic | Novel RNA-targeting therapeutics (Pelacarsen, Olpasiran and other siRNAs) | Pelacarsen (ASO) reduced Lp(a) by up to 80%; siRNAs (olpasiran, lepodisiran, zerlasiran) by up to 80% to 95% | systematic review | Alebna PL, et al. Efficacy and tolerability of targeted lipoprotein(a)-lowering… |
| pharmacologic | siRNA inhibitor of Lp(a) synthesis (Olpasiran) | Placebo-adjusted Lp(a) change at 36 weeks: -70.5% (10 mg) to -101.1% (225 mg every 12 weeks) | RCT | O'Donoghue ML, et al. N Engl J Med. 2022;387:1855-1864. |
| pharmacologic | PCSK9 monoclonal antibody (Alirocumab) | Alirocumab reduced Lp(a) by 5.0 mg/dl (IQR 0 to 13.5) from median baseline 21.2 mg/dl | RCT | Bittner VA, et al. J Am Coll Cardiol. 2020;75:133-144. |
| pharmacologic | Niacin therapy (Extended release 1500-2000 mg) | Reduced Lp(a) by 22.90% (95% CI -27.32 to -18.48) vs placebo (14 RCTs) | meta-analysis | Sahebkar A, et al. Effect of extended-release niacin on plasma lipoprotein(a)… |
| pharmacologic | Inclisiran added to background lipid-lowering therapy in adults (RCTs >3 weeks) | Inclisiran lowered Lp(a) by 4.76 mg/dL (95% CI 3.69-5.83), a 22% reduction from baseline | meta-analysis | Xie S, Galimberti F, Olmastroni E, et al. Effect of lipid-lowering therapies on… |
| pharmacologic | Obicetrapib 10 mg once daily for 365 days in high-risk patients with ASCVD or heterozygous familial hypercholesterolaemia | Lp(a) changed -9.8 nmol/L (-32.5%) with obicetrapib vs 0 nmol/L (0%) with placebo over 365 days | meta-analysis | Nicholls SJ, Nelson AJ, Ray KK, et al. Impact of Obicetrapib on Major Adverse… |
| pharmacologic | Oral muvalaplin 240 mg once daily for 12 weeks in adults with Lp(a) >=175 nmol/L and ASCVD, diabetes or FH | Placebo-adjusted Lp(a) reduction of 85.8% (95% CI 83.1-88.0) at 12 weeks with 240 mg/day (intact Lp(a) assay); 68.9% by apo(a)-based assay | RCT | Nicholls SJ, Ni W, Rhodes GM, et al. Oral Muvalaplin for Lowering of… |
| pharmacologic | Subcutaneous lepodisiran 400 mg at baseline (pooled groups with or without a second 400 mg dose at day 180) in adults with elevated Lp(a) | Placebo-adjusted time-averaged Lp(a) change -93.9 percentage points (95% CI -95.1 to -92.5) from day 60 to 180 with 400 mg | RCT | Nissen SE, Ni W, Shen X, et al. Lepodisiran - A Long-Duration Small Interfering… |
| pharmacologic | Oral enlicitide decanoate 20 mg once daily for 52 weeks on top of statin therapy in adults with heterozygous familial hypercholesterolaemia | Median Lp(a) change -24.7% vs -1.6% with placebo at week 24 (between-group difference -27.5%, 95% CI -34.3 to -20.6) | RCT | Ballantyne CM, Gellis L, Tardif JC, et al. Efficacy and Safety of Oral PCSK9… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | LPA variants (rs10455872, rs3798220) linked to reduced KIV-2 copy number | Strongly associated with increased Lp(a) level (effect size not reported); coronary disease odds ratio 2.57 with two or more variants | cross-sectional | Clarke R, et al. N Engl J Med. 2009;361:2518-2528. |
| pharmacologic | Daily statin therapy (atorvastatin 10-80 mg, pravastatin 40 mg, rosuvastatin 40 mg or pitavastatin 2 mg) for 4-104 weeks | Ratio of geometric means for Lp(a), statin vs placebo, 1.11 (95% CI 1.07-1.14); mean change from baseline 8.5% to 19.6% on statins vs -0.4% to -2.3% on placebo | meta-analysis | Tsimikas S, Gordts PLSM, Nora C, et al. Statin therapy increases lipoprotein(a)… |
| physiological | Postmenopausal hormone depletion and estrogen deficiency | Women with intermediate Lp(a) (75-125 nmol/L) transitioning through menopause: median +34.9 nmol/L, ~fourfold more than pre/postmenopausal women | prospective cohort | Palmer CA, et al. Heterogeneity in Lipoprotein(a) Profile Changes Across the… |
What else moves this marker
They describe those study groups, not an individual, and an association is not a cause.
Diseases and conditions
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↓ Non-alcoholic fatty liver disease (nephelometric assay) · NAFLD patients vs controls, studies measuring Lp(a) by nephelometry | SMD -0.26 (95% CI -0.46 to -0.06) | NAFLD patients vs non-NAFLD controls · Adults with and without NAFLD (18 studies; nephelometry subgroup) | meta analysis · PMID 39417560 |
| ↑ Polycystic ovary syndrome · women with PCOS vs healthy women | SMD +1.1 (95% CI 0.7 to 1.4) | women with PCOS vs healthy control women · Women with PCOS and healthy controls (23 observational studies) | meta analysis · PMID 37284910 |
Sources
- Risk curve: Amiri 2023 (PMID 36708412): all-cause HR 1.09 (1.01-1.18) top versus bottom tertile of Lp(a), general population (19 studies). Scaled to published population values.
- Amiri et al. Circulating lipoprotein (a) and all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis. European journal of epidemiology. 2023;38:485-499.
Map Lipoprotein(a) [Lp(a)] against another biomarker.
Related markers: Apolipoprotein A1 (ApoA1) · Apolipoprotein B (ApoB) · HDL Cholesterol · LDL Cholesterol · Remnant Cholesterol · Serum Triglycerides · Total Cholesterol