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The first is that it is a genetically determined marker of cardiovascular risk that cannot be significantly modified with lifestyle changes, the second is that we do not have easily accessible or tolerable therapies to lower Lp(a) levels. The third reason is that medications that lower Lp(a) levels also lower LDL levels, so it has proven difficult to attribute clinically important effects — like a reduction in heart disease and strokes — to Lp(a) lowering alone.