When managing high Lp(a) with an unfavorable family history or positive calcium score, the best approach is to maximally lower all other apob risk factors and optimize metabolic parameters, including blood pressure, uric acid, and homocysteine.

“well again historically our best bet would be remove all other risk to the extent that it is possible so we lower all other apob maximally pharmacologically we optimize completely all of the metabolic parameters that we've discussed briefly here but touched on in greater detail elsewhere and that includes everything from modulating blood pressure as aggressively as it needs to be to controlling all of these other factors that don't get enough attention in my book the uric acids the homocysteine things like that”