Lipoprotein(a), or Lp(a), is almost entirely determined by your genes.
About 90% of a person’s Lp(a) level is inherited. Unlike LDL cholesterol—which is strongly influenced by diet, lifestyle, thyroid function, exercise, and medications—Lp(a) is produced in the liver according to a genetic “instruction set” you were born with.

Main Causes:

1. Genetics (dominant inheritance).

If you have one parent with high Lp(a), there’s a high chance you will also have elevated levels.

Levels stay relatively constant throughout life.

2. Family history of early heart disease.

High Lp(a) often clusters in families where people have premature coronary artery disease or strokes.

3. Certain conditions can raise Lp(a) further (but aren’t the primary cause):

Kidney disease.

Uncontrolled hypothyroidism.

Inflammation / acute illness.

Menopause (levels naturally rise).

What's known to control Lp(a)?

Very few things—Lp(a) is stubborn.

Effective options:

1. PCSK9 inhibitors (Repatha, Praluent) has reduced Lp(a) by 20–30% on average.

2. Apheresis (in severe cases)
Can drop Lp(a) by 50–70% but requires repeated treatments.

3. The upcoming Lp(a) antisense drugs:

(Pelacarsen and Olpasiran):

Currently in phase-3 trials, shown to lower Lp(a) by 80–95%. Expected to be approved in a few years, possibly sooner.

What does not lower Lp(a):

Diet

Exercise

Statins

(Studies show that statin therapy can lead to an average increase in Lp(a) levels of approximately 10–20%).

Niacin (lowers it mildly but doesn’t improve outcomes, so no longer recommended).

Vitamin C, lysine and proline (no proven effect on Lp(a) levels).

Vitamin C doesn’t lower Lp(a), but studies show it supports vessel health, which may indirectly reduce plaque formation.

Vitamin C improves endothelial function by acting as an antioxidant to protect blood vessels from oxidative stress and by boosting nitric oxide production, which leads to vasodilation. It is also a cofactor for enzymes involved in collagen synthesis, which is essential for blood vessel integrity. Research shows that vitamin C supplementation can improve endothelial function in patients with conditions like heart failure, hypertension, and hypercholesterolemia.

The above information is based solely on valid Epidemiological studies over the past few years.

Hopefully, this will clarify some of the aspects of LP(a).