LDL-C can look fine. The particle still drives risk.
Board certified in Clinical Lipidology & Obesity Medicine · Licensed in all 50 states & DC
Lp(a) is set at birth. One accurate measurement is usually enough. It does not track LDL-C, and diet does not move it in a clinically useful way.
Treat ApoB to a hard target, screen first-degree relatives, and use a PCSK9 inhibitor when residual risk and access justify it. This is adult telemedicine specialist care, not a refill mill.
Lp(a)HORIZON did not meet its endpoints, so pelacarsen will not be a treatment option. There is currently no approved therapy that lowers Lp(a) and changes outcomes.
There is no approved Lp(a)-specific therapy. Care is ApoB, residual risk, and family cascade — with named drugs only when they are indicated.
Lp(a) rides on apoB-containing particles. Lowering apoB remains the proven lever while Lp(a)-specific drugs are still in trials.
Evolocumab (Repatha) and alirocumab can lower Lp(a) modestly as a secondary effect. They are prescribed for LDL/ApoB indication, not as an Lp(a) cure.
Because Lp(a) itself cannot yet be treated, the work is to drive down everything that can: ApoB to an aggressive target, blood pressure, insulin resistance, visceral fat, and smoking — with imaging to track what the arteries are actually doing.
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Direct-pay lipidology. Cancel anytime. Licensed in all 50 states and DC. Labs and imaging are billed to your insurance; medication is billed at your pharmacy.