Knife Down
"Knife Down" is what a surgeon says in the OR when she puts her scalpel down so no one gets hurt — and it’s the mission here: put the knife down, long before anyone needs to use it.
Knife Down is a podcast about how to actually invest in your health so you can live longer, stronger, and with less time in doctors’ offices. The core focus is the world’s leading cause of death—cardiovascular disease—and what to do about it before it shows up as a catastrophe.
Hosted by a vascular surgeon on a mission to put herself out of business, the show translates cutting-edge science on prevention, metabolic health, and longevity into real-world strategies you can use in clinic or at your kitchen table. Expect evidence, nuance, and zero wellness hype—plus the occasional dark joke about the state of modern medicine.
Knife Down
High Lp(a)? Here's What Works (And What Doesn't)
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High Lp(a) cholesterol is common—and frustrating—because there’s no single drug that fixes it (yet).
In this video, I walk through how I manage elevated lipoprotein(a) today, using the tools we actually have: metabolic health optimization, LDL/ApoB lowering, statins, PCSK9 inhibitors, aspirin (in select patients), and menopausal hormone therapy where appropriate.
If you’ve been told your Lp(a) is high and then… nothing else, this video is about what does matter right now—and what doesn’t.
This is Part 2 of my Lp(a) series.
▶️ Part 1: What Lp(a) is, how to test it, and how to interpret your number
▶️ Part 3: The Lp(a) drug pipeline—what’s coming and what we still don’t know
Key Studies:
Statins & Lp(a)--
Khera AV, et al. Circulation. 2014.
Lipoprotein(a) concentrations, rosuvastatin therapy, and residual vascular risk: an analysis from the JUPITER trial
PubMed: https://pubmed.ncbi.nlm.nih.gov/24243886/
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Berg K, et al. Clin Genet. 1997.
Lp(a) lipoprotein level predicts survival and major coronary events in the Scandinavian Simvastatin Survival Study
PubMed: https://pubmed.ncbi.nlm.nih.gov/9520115/
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MacDougall DE, Tybjærg-Hansen A, Knowles JW, Stern TP, Hartsuff BK, McGowan MP, Baum SJ, Wilemon KA, Nordestgaard BG. Lipoprotein(a) and recurrent atherosclerotic cardiovascular events: the US Family Heart Database. Eur Heart J. 2025 Nov 21;46(44):4762-4775. doi: 10.1093/eurheartj/ehaf297. PMID: 40331569; PMCID: PMC12634116.
PubMed: https://pubmed.ncbi.nlm.nih.gov/40331569/
Menopausal Hormone Therapy & Lp(a)--
Kim CJ, et al.
Effects of hormone therapy on lipoprotein(a) and lipids in postmenopausal women.
Atherosclerosis. 2001.
https://pubmed.ncbi.nlm.nih.gov/8305420/
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Anagnostis P, et al. The effect of hormone replacement therapy and tibolone on lipoprotein(a): a systematic review and meta-analysis.
PubMed: https://pubmed.ncbi.nlm.nih.gov/28364865/
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Shlipak MG, et al. Estrogen and progestin, lipoprotein(a), and the risk of recurrent coronary heart disease. PubMed: https://pubmed.ncbi.nlm.nih.gov/10770146/
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Sign up for more information on my own practice here: https://corsighthealth.com/
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🧬 About Dr. Lily Johnston
Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.