DEAR DR. ROACH: I’m a healthy 50-year-old woman. I asked my doctor to test me for Lipoprotein(a) after reading about it. My level was high, at 41 mg/dL. My doctor told me that it didn’t need to be treated since I don’t have any other risk factors for heart disease. When and how should a high Lp(a) level be treated? — K.P.

ANSWER: Lp(a) (called “lipoprotein little A”) is an independent risk factor for heart disease compared to total or LDL cholesterol. It is important to look for Lp(a) when a person has a personal or strong family history of heart disease without many other risk factors.

A level of 41 mg/dL is increased but does not put you at a very high risk for heart disease in absence of other factors. The risk increases as Lp(a) levels increase. Levels above 180 mg/dL place a person at a high risk for heart attacks and strokes.

Lp(a) does not have specific treatments. So far, the treatments that specifically lower Lp(a) have not reduced the risk of heart disease. Statin drugs do not reduce Lp(a); in fact, they can slightly increase Lp(a) levels, but they do reduce heart attack risk in people who are at a high risk for heart disease due to Lp(a) and other risk factors. PCSK-9 inhibitors like evolocumab (Repatha) reduce the risk of heart disease in people with high Lp(a) by about 25%.

A new medicine, inclisiran (Leqvio), is a small RNA molecule that reduces Lp(a) and LDL levels, but it is not yet clear that it reduces heart attacks and strokes. At least one early trial has yielded positive results.

I look at Lp(a) as an additional risk factor when deciding whether a person needs therapy. If a person is at borderline risk based on traditional risk factors, including LDL cholesterol, blood pressure, smoking history, or diabetes, then a moderate to high Lp(a) level will get me to recommend therapy. A very high Lp(a) level, especially in a person with a strong family history of heart disease, might get me to recommend treatment even if a person is otherwise at average risk.

In your case, I agree with your doctor that a modestly elevated Lp(a) level in a person with no other risk factors does not require treatment.

DEAR DR. ROACH: I have needed reading glasses for years. I started eating a lot of spinach, and now I don’t need reading glasses! My eye doctor didn’t believe me. — R.P.

ANSWER: Reading glasses are needed for people with presbyopia (literally “old eyes”). The lens gets stiffer with age, and the eye muscles simply aren’t strong enough to pull the lens into a position to focus close-up. Presbyopia is usually treated with reading glasses, which reduce the work that the lens need to do and allow people to see close-up.

Presbyopia can also be treated with eyedrops that constrict the pupils. Any photographer knows that the smaller the lens aperture (the opening that is controlled by the f-stop), the more objects are in focus (called an increased depth of field). The drops work the same way.

Spinach is good for the eyes in that it contains substances like lutein and zeaxanthin, which help prevent macular degeneration and can improve vision in people with retina problems. However, I don’t know of any mechanism where spinach can improve the ability of the eye to focus, so I am also at a loss as to why the spinach helped you.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved