Imagine a hidden danger lurking in your blood, silently increasing your risk of heart attack and stroke. For millions of people, this danger is real, and it’s called lipoprotein(a), or Lp(a). Now, a promising new drug, lepodisiran, developed by Eli Lilly, is showing remarkable potential in tackling this little-known risk factor.
Lp(a) is a complex particle made up of proteins and fats. While most people haven’t even heard of it, roughly one in five Americans, or about 64 million individuals, have elevated levels. Unfortunately, standard cholesterol tests don’t reveal Lp(a) levels, meaning most people are unaware of this potential threat.
What is lepodisiran?
New research presented at a recent cardiology meeting and published in the New England Journal of Medicine revealed that a single dose of lepodisiran dramatically lowered Lp(a) levels by a staggering 94%. What’s more, this significant reduction lasted for six months, and the drug appeared to be well-tolerated, with minimal side effects reported.
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Experts are excited about these findings. Dr. David Maron, a preventive cardiologist at Stanford University, described the profound and long-lasting reduction in Lp(a) levels as “thrilling.” However, while these results are encouraging, more research is needed to confirm whether lowering Lp(a) directly translates to a reduced risk of heart attacks and strokes.
An ongoing lepodisiran clinical trial
Currently, a large-scale clinical trial for lepodisiran is underway, with results expected in 2029.
What is Lp(a)?
Lp(a) was first discovered in 1974, and unlike regular cholesterol, it’s primarily determined by genetics. Diet and exercise have little to no impact on its levels. Individuals with even slightly elevated Lp(a) face a 25% increased risk of heart disease, while those with very high levels, approximately 10% of the population, have double the risk.
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Doctors emphasize that Lp(a) is often the silent culprit behind heart attacks in young and otherwise healthy individuals. Dr. Steven Nissen, a preventive cardiologist at the Cleveland Clinic, who is leading some of the trials, highlights the importance of testing Lp(a) levels, especially in young heart attack patients. He also stresses the need for people with high Lp(a) to manage other heart disease risk factors, such as high cholesterol and blood pressure.
Despite the significant risk associated with high Lp(a), testing remains infrequent. Many experts believe that all adults should be tested at least once, as Lp(a) levels remain relatively stable throughout life.
Lp(a) and Black Americans
Research has consistently shown that Black people tend to have significantly higher Lp(a) levels compared to other racial groups. This increased prevalence elevates their risk of cardiovascular disease. This disparity underscores the importance of Lp(a) testing, especially within the Black community. Studies like the Atherosclerosis Risk in Communities (ARIC) study have demonstrated that Lp(a) levels are positively associated with cardiovascular disease events, and these associations are at least as strong, if not stronger, in Black Americans.
It is very important to note that even though the genetic heritability of Lp(a) may be lower in Black Americans than whites, the absolute levels of Lp(a) are higher in Black Americsans.
How dangerous increased Lp(a) is
One patient, 71-year-old Monte Wooden, had normal blood pressure and didn’t smoke, but still had a heart attack in 2006. It turned out his Lp(a) level was over 400 — far above the normal limit of 75, according to The Times.
The case of Wooden who suffered a heart attack despite having normal blood pressure and not smoking, illustrates the insidious nature of high Lp(a). His levels were significantly elevated, and while treatment and a clinical trial drug improved his condition, his symptoms returned when the trial ended, requiring a quadruple bypass.
While individual cases like Wooden’s are anecdotal, they underscore the potential of drugs like lepodisiran to prevent heart attacks. As research progresses, there’s growing hope that this new drug could offer a powerful tool in the fight against heart disease, protecting millions from the silent threat of high Lp(a).
