I wrote here on lipoprotein(a) generally—what it is (a cholesterol analogue) and why it is far more concerning from a cardiovascular standpoint than elevated cholesterol by itself. Essentially the concern comes down to the fact that Lp(a) both decreases the breakdown of clots and acts as a strong adhesive in blood vessels, attracting additional cholesterol and calcium for plaque formation.

Plaques in and of themselves are not bad; as I wrote here, they’re like a band-aid for the arteries, repairing damage. (The real problem is the damage itself.) But the need for more and bigger plaques can be mitigated if some of the other building blocks necessary for repair are present.

Vitamin C and Vascular Repair

Vitamin C helps to increase production of the protein collagen. We mostly think of collagen as the foundation for skin, from an aesthetic standpoint—but it is also the primary substance from which blood vessels are made. So when Vitamin C is present in adequate amounts, it’s easier for your body to repair all kinds of collagen damage—including that to your blood vessels. This decreases the body’s need for the “band-aid” plaques formed by Lp(a). This study also shows that Vitamin C lowers LDL as well.

Collagen is made of four main amino acids: Glycine, Proline, Hydroxyproline, and Arginine. Since proline is the foundation for two of them (and the only one found just in meat), it is usually the amino acid recommended along with Vitamin C, if you’re going to take just one. So proline can also help this process along. But there’s another reason to take proline if you’re trying to lower high Lp(a), along with another amino acid, lysine.

Proline, Lysine, and Lp(a)

When the blood vessels incur damage, binding sites that were previously buried inside the collagen are suddenly exposed. Their purpose is to bind to passing cholesterol (including Lp(a)) in the bloodstream, thus initiating the creation of a clot. These binding sites primarily expose two amino acids: proline, and lysine.

Nobel Laureate Linus Pauling’s theory is that we can use this information to decrease Lp(a) essentially by competition: lysine and proline supplementation can bind circulating Lp(a), thus preventing it from binding to the exposed binding sites in damaged blood vessels. Meanwhile, the Vitamin C can go to work healing the damage.

The Upshot

While the reference range for Lp(a) is considered normal below 30 mg/dl, ideal is under 10.

I mentioned here a few approaches to lowering Lp(a) including L-carnitine, estrogen therapy for women, and a high fat diet. But in some cases, the latter two are not feasible, and I haven’t found L-Carnitine by itself to be quite as helpful clinically as Vitamin C, lysine, and/or proline supplementation.

These are some of the products mentioned above that I most commonly prescribe. Dosing for all three is ideally 1000 mg: