Twenty per cent of the global population carries a genetic risk for cardiovascular diseases (CVD), such as heart attacks, strokes, and aortic valve stenosis. The culprit? A lipid particle called lipoprotein(a) [Lp(a)], which is now recognized as one of the most common genetic causes of CVD, says a recent review in The Lancet has revealed that 20.
LIPOPROTEIN(A) AND ITS ROLE IN CARDIOVASCULAR DISEASE
Lipoprotein(a) is a type of lipid particle that circulates in the blood. While many are familiar with cholesterol’s role in cardiovascular health, Lp(a) levels are often overlooked. According to the review, elevated Lp(a) is a direct cause of cardiovascular diseases, much like smoking is for lung cancer. Despite this, most people with high Lp(a) levels remain unaware of their risk.
Professor Børge Nordestgaard, the lead author of the study, compares the danger of Lp(a) to smoking: “Lipoprotein(a) is the direct cause of cardiovascular diseases much like cigarettes cause lung cancer.” This highlights the importance of screening and awareness.
LIPOPROTEIN(A) TESTING: A MISSED OPPORTUNITY
The good news is that testing for Lp(a) is both accessible and straightforward. However, the challenge lies in awareness. Most health systems do not routinely test for Lp(a) levels, despite the fact that simple blood tests can detect elevated levels.
With new medications under development that significantly lower Lp(a), early detection could lead to proactive treatment. As Professor Nordestgaard points out, expanding Lp(a) testing globally is key:
“By expanding testing, we can figure out who carries it and would benefit from lipoprotein(a)-lowering medication.”
HOW LIPOPROTEIN(A) INCREASES CARDIOVASCULAR RISK
To better understand the risks associated with Lp(a), it’s important to know how it contributes to atherosclerosis—the buildup of fats and cholesterol in arteries. Elevated Lp(a) promotes the formation of plaque, narrowing arteries and increasing the likelihood of heart attacks or strokes. High Lp(a) can also lead to aortic valve stenosis, where the aortic valve narrows and obstructs blood flow, straining the heart.
PROMISING TREATMENTS FOR LOWERING LIPOPROTEIN(A)
Five new drugs are currently under development that can reduce Lp(a) levels by 65% to 98%. Three of these drugs are in phase 3 clinical trials, meaning they are close to receiving regulatory approval. Some of the most promising treatments involve gene silencing therapy.
Gene silencing therapy works by inhibiting the production of Lp(a) in the liver. The medication is injected and absorbed by liver cells, where it blocks the creation of lipoprotein(a) particles. This significantly lowers Lp(a) concentrations in the blood and is expected to reduce cardiovascular risk. The first conclusive results demonstrating a reduction in CVD risk through Lp(a) lowering are expected in 2026.
STEPS TO TAKE WHILE AWAITING NEW TREATMENTS
While we await the new medications, there are still important steps individuals can take to manage their cardiovascular risk. Professor Nordestgaard advises that people with high Lp(a) levels should focus on healthy lifestyle habits to reduce other risk factors. These steps include:
- Exercise regularly to maintain cardiovascular health.
- Adopt a heart-healthy diet, rich in fruits, vegetables, and whole grains.
- Avoid smoking, which exacerbates cardiovascular risks.
- Manage cholesterol levels through diet and, if necessary, medications.
- Maintain a healthy weight, as obesity contributes to heart disease.
Though these lifestyle changes cannot lower Lp(a) directly, they can help reduce overall cardiovascular risk.
WHY TESTING FOR LIPOPROTEIN(A) MATTERS
One of the major points the Lancet review emphasizes is the importance of early detection. Even though routine cholesterol tests are common, Lp(a) is often ignored, despite its significance. By identifying those with elevated Lp(a) early, healthcare providers can take preventive measures and recommend treatments, once they become available.
Professor Nordestgaard advocates for wider testing, explaining that expanding Lp(a) screening would help identify individuals who could benefit from the forthcoming treatments. With the ability to detect high levels of Lp(a) already available, governments and healthcare systems should consider including Lp(a) tests in routine cardiovascular risk assessments.
LOOKING AHEAD: A NEW ERA OF CARDIOVASCULAR TREATMENT
The development of Lp(a)-lowering drugs marks a significant advance in cardiovascular medicine. Given the high prevalence of elevated Lp(a) levels globally, these treatments have the potential to prevent millions of heart attacks, strokes, and other cardiovascular events. The long-term hope is that by reducing Lp(a) levels, individuals genetically predisposed to cardiovascular disease can lower their risk significantly, leading to fewer fatal heart conditions and improved public health outcomes.
