Objective: Unfiltered coffee raises serum LDL cholesterol in humans, owing to the presence of the diterpenes cafestol and kahweol. Norwegians with a chronic high intake of unfiltered coffee also had elevated serum levels of lipoprotein(a), an LDL-like particle which is insensitive toward dietary interventions. We now experimentally studied the influence of coffee diterpenes on lipoprotein(a) levels. Design: Four randomised controlled trials. Subjects: Healthy, normolipidemic volunteers. Interventions: Coffee, coffee oil, and pure diterpenes for 4-24 weeks. Main outcome measures: The circulating level of lipoprotein(a). Results: In 22 subjects drinking five to six strong cups of cafetiere coffee per day, the median fall in lipoprotein(a) was 1.5 mg/dL after two months (P=0.03), and 0.5 mg/dL after half a year (P>0.05), relative to 24 filter coffee drinkers. Coffee oil doses equivalent to 10-20 cups of unfiltered coffee reduced lipoprotein(a) levels by up to 5.5 mg/dL (P<0.05) in two separate trials (n=12-16 per group). A purified mixture of cafestol and kahweol, as well as cafestol alone, were also effective in reducing Lp(a) levels (n=10). Averaged over the four trials, each 10 mg/d of cafestol (plus kahweol)?the amount present in two to three cups of cafetiere coffee?decreased Lp(a) levels by 0.5 mg/dL or 4% from baseline values after four weeks (n=63). Conclusions: Coffee diterpenes are among the few dietary exceptions shown to influence serum lipoprotein(a) levels. However, the Lp(a)-reducing potency of coffee diterpenes may subside in the long run, and their adverse side effects preclude their use as lipoprotein(a)-reducing agents. Sponsorship: Supported by the Netherlands Heart Foundation through grant No. 900-562-091 of the Netherlands Organization of Scientific Research (NWO), plus supplemental funding by the Institute for Scientific Information on Coffee.