Lp(a) levels are largely resistant to lifestyle interventions because synthesis rate is the primary factor.

“it seems like with LP little a doesn't seem like it can be modified all that much by lifestyle is that right that's correct thinking no that's absolutely correct and probably the reason for that is as we just learned from the pcsk9 statin comparisons directionally speaking there are two things that are driving LP little a how much you make and how much you clear but the game seems to be won and lost under how much you make front but how much you clear seems to be a second-order thing”