An MD-PhD explains five ways to manage cardiovascular risk from Lp(a), a genetically determined particle more harmful than LDL. Statins raise Lp(a) while PCSK9 inhibitors lower it. A low waist-to-hip ratio, high-dose vitamin C, and low-carb diets can reduce its damage.
I'm an MD-PhD scientist obsessed with heart health, and here are 5 things you need to know about Lp. 1. Lp is a genetically determined risk factor that's far more atherogenic than LDL particles on a per-particle basis. It sounds scary, but that's where the bad news ends and the good news begins. Because you can reduce risk associated with Lp by lowering your waist-hip ratio, a proxy for abdominal or visceral fat. In fact, people with a low waist-to-hip ratio have little to no added risk with high Lp. 3. Medications matter. Statins tend to increase Lp, while PCSK9 inhibitors tend to decrease it, so if you're on a medication, be mindful. 4. If there's one supplement that might help Lp, it's vitamin C. There's an evolutionary argument that Lp acts as a surrogate for vitamin C, and doses of vitamin C around 1,000 mg per day or above may help reduce Lp's impact on cardiovascular health. And finally, 5, low-carb ketogenic diets may also reduce risk associated with Lp, not by changing the absolute number, but by changing the environment within the artery to increase levels of protective cofactors, one called—brace for it—tetrahydrobiopterin, basically to blunt the damage of Lp. Bottom line, you may not control your Lp, but you can control how much it matters. Now, if you're curious and I've got your heart pumping, check the caption for a deep dive to make smarter choices about your heart health.
