From the Guidelines
There are no specific medications that need to be held before checking lipoprotein(a) [Lp(a)] levels. Unlike other lipid tests such as LDL cholesterol, Lp(a) levels are relatively stable and not significantly affected by most medications or fasting status. Patients can continue taking their regular medications, including statins, PCSK9 inhibitors, and other lipid-lowering therapies before the test. This stability is because Lp(a) levels are primarily determined by genetics rather than diet or medication effects. Approximately 80-90% of Lp(a) concentration is genetically determined, with levels typically remaining consistent throughout a person's lifetime after reaching adulthood. The test can be performed as part of a standard lipid panel, and results are typically reported in nmol/L or mg/dL. For clinical decision-making, it's worth noting that while some lipid-lowering therapies may have minor effects on Lp(a) levels, these changes are usually not clinically significant enough to warrant medication discontinuation before testing, as supported by studies such as 1.
Some medications, such as niacin, may reduce Lp(a) levels by up to 35% 1, while others like statins may have inconsistent effects on Lp(a) levels, sometimes even causing an increase 1. However, these effects are generally not significant enough to require medication discontinuation before testing. The most recent and highest quality study, 1, suggests that PCSK9 inhibitors can reduce Lp(a) levels by up to 27%, but this effect may not always parallel the reduction in LDL levels.
Key points to consider:
- Lp(a) levels are relatively stable and not significantly affected by most medications or fasting status
- Patients can continue taking their regular medications before the test
- Lp(a) levels are primarily determined by genetics rather than diet or medication effects
- Some lipid-lowering therapies may have minor effects on Lp(a) levels, but these changes are usually not clinically significant enough to warrant medication discontinuation before testing
- The test can be performed as part of a standard lipid panel, and results are typically reported in nmol/L or mg/dL, as noted in studies such as 1.
From the Research
Medications to be Held Before Checking Lipoprotein(a) (Lp(a)) Levels
- Niacin: This medication can affect Lp(a) levels, and it is recommended to hold it before checking Lp(a) levels 2.
- Ezetimibe: Although it has been shown to lower Lp(a) levels, it is not clear if it should be held before checking Lp(a) levels 2.
- Hormone replacement therapy (HRT): HRT can lower Lp(a) levels, but it is not recommended to initiate it solely for Lp(a) reduction 2.
- Statins: These medications have neutral or detrimental effects on Lp(a) levels, but it is not specified if they should be held before checking Lp(a) levels 3.
- PCSK9 inhibitors: These medications can reduce Lp(a) levels, but it is not clear if they should be held before checking Lp(a) levels 3.
Other Considerations
- Lipoprotein apheresis: This treatment can lower Lp(a) levels, but it is typically used for patients with high-risk familial hypercholesterolemia and documented coronary or peripheral artery disease 4, 3.
- Antisense oligonucleotides (ASO): These medications can specifically lower Lp(a) levels, but they are still under investigation and not widely available 3.