Millions of Americans may be unknowingly living with a genetic predisposition to dangerously high levels of lipoprotein(a) or Lp(a), a form of cholesterol that significantly increases the risk of heart attacks and strokes. Unlike other forms of cholesterol, Lp(a) is entirely genetic, meaning that it is independent of lifestyle factors such as diet and exercise. This poses a significant challenge for individuals who are born with elevated Lp(a) levels and find themselves at an increased likelihood of life-threatening heart disease at a young age.

According to Dr. Steven Nissen, chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, many patients with high Lp(a) have a family history of heart disease, with parents, aunts, uncles, and siblings suffering from heart attacks, strokes, bypass surgeries, or stent placements in their forties. The fear and anxiety that come with this genetic predisposition are palpable.

It is estimated that as many as 64 million Americans have elevated Lp(a) levels. While it can affect anyone, it is more common among individuals of African and South Asian descent. However, there is hope on the horizon as several promising drugs, including pelacarsen from Novartis, have shown significant potential in lowering Lp(a) levels. In previous studies, pelacarsen successfully reduced Lp(a) levels in 98% of participants.

The critical question now is whether lowering Lp(a) levels can effectively reduce the risk of early and potentially fatal heart attacks and strokes. It has long been established that medications such as statins can lower LDL cholesterol and help protect against heart disease. Dr. Erin Michos, an associate professor of medicine at Johns Hopkins University School of Medicine, highlights the importance of screening for Lp(a) as part of preventive care, as it can help identify high-risk individuals and take measures to lower their overall risk.

The effectiveness and potential impact of other drugs targeting Lp(a), such as lepodisiran from Eli Lilly, olpasiran from Amgen, and zerlasiran from Silence Therapeutics, are also being studied. These drugs, including pelacarsen, are administered through injections. In addition, Eli Lilly is testing an oral drug called muvalaplin.

While these drugs are yet to be proven effective, doctors can still focus on treating other heart disease risk factors, such as managing blood pressure and prescribing statins to control LDL cholesterol. Dr. Wesley Milks, a cardiologist and clinical assistant professor at The Ohio State University College of Medicine, acknowledges the importance of proactive prevention for individuals with a family history of heart disease and emphasizes the need to keep them safe until these new drugs become available.

In the meantime, maintaining a healthy weight, engaging in regular exercise, quitting smoking, and adopting a diet rich in fruits, vegetables, and whole grains are recommended strategies to manage overall heart risks, even for those with elevated Lp(a) levels.

One patient, Lori Welsh, has experienced firsthand the devastating effects of high Lp(a) levels within her family. After suffering a heart attack at the age of 47, Welsh joined a clinical trial for pelacarsen at The Ohio University Wexner Medical Center. She believes in the potential life-saving benefits of knowing her Lp(a) levels, even without access to specific drugs targeting it.

Cardiologists and researchers are advocating for widespread screening of Lp(a) as a proactive measure to identify high-risk individuals. By taking action early, there is an opportunity to be proactive about prevention and potentially save lives. As researchers continue to investigate the effectiveness of these groundbreaking drugs, individuals can play their part by adopting healthy lifestyle habits and staying informed about their genetic predisposition to elevated Lp(a) levels.