United States: A sad truth has come to light that millions of Americans are born genetically predestined to have extremely high levels of a type of cholesterol that will cause the early onset of lethal heart attacks and strokes by middle age. At the same time, almost all are unaware of the lingering danger.
The Cholesterol lipoprotein(a) (or Lp(a)) is like a low-density lipoprotein- LDL, or bad cholesterol, which leads to the formation of plaque in arteries.
But as per the experts, the more dangerous effect of Lp(a) is that it causes blood clots!
However, unlike LDL, it is genetic, meaning diet and exercise do not affect its levels.
It resulted in a high chance of getting lethal heart disease, which runs through generations in a family in their 40s and 50s.
Dr. Steven Nissen, chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, said, “Everybody in their family has had a heart attack or stroke or bypass surgery or stent in their 40s,” while talking about his patients with high Lp(a), and added further, “They’re scared to death,” reported by NBC News.
As per the data, more than 64 million Americans have high Lp(a) levels. It is said that anyone can have one, but it is currently most common among African and South Asian descent.
How can Lp (a) be cured?
Routine blood cholesterol tests available could measure Lp(a). However, there are no effective treatments present for it.
Similarly, like other forms of high cholesterol, there are no symptoms in people with high Lp(a).
While several effective drugs have started coming for clinical trials, doctors warned that people should be aware of their risks.
Dr. Erin Michos, an associate professor of medicine and director of Women’s Cardiovascular Health Research at Johns Hopkins University School of Medicine in Baltimore, stated that her patients’ Lp(a) screening is done as preventive care, as reported by NBC News.
Michos added, “To me, it doesn’t make any sense that I’m not going to measure it just because I can’t bring the number down,” and “I measure it in all my patients at least once to just find out who’s high because we can do things to lower their risk.”
Cardiologist Dr. Sahil Parikh, a director of endovascular services at Columbia University Irving Medical Center in New York, said there should be more comprehensive testing for Lp(a).
And added, “The challenge has been, if you test for something and don’t have a treatment for it, are you doing the patient any favors?”
Parikh said, “I used to not test for things that I couldn’t treat. But now I do because I know on the horizon, we’re going to have good treatments. It gives patients hope,” NBC News reported.
Know more about those drugs under clinical trials for Lp(a) treatment
One such experimental drug is called pelacarsen, by the drugmaker Novartis. Studies in the past have shown that the drug considerably lowered the Lp(a) levels in 98 percent of people taking it.
As per the researchers, what is yet to be solved is whether a lower Lp(a) reduces early and potentially deadly heart attacks and strokes. It’s already established that medications such as statins can protect against heart disease by lowering LDL.
An example to show a positive effect of pelacarsen drug
A 51-year-old resident of Ohio confirms that the pelacarsen is an effective drug. According to her, high Lp(a) level was running in her family for years, with a devastating effect.
She said, “If you go back five generations in my mom’s family, everybody died of a heart attack or stroke. Nobody made it past the age of 54,” and added further, “I was driving down a six-lane highway in Columbus, Ohio, and I felt pressure in my chest. My hands went numb,” NBC News reported.
Moreover, she had a 90 percent blockage in the biggest artery in her heart- the lower anterior descending artery. This condition of the heart is known as “widow-maker.”
She mentioned in a statement, “You go from a perfectly healthy person on a Monday, have a heart attack on a Tuesday, and Wednesday, you have a heart history that you didn’t have before,” and “Then you find out that there’s no easy fix for this,” NBC News reported.
At Ohio University’s Wexner Medical Center, she is participating in a clinical trial for pelacarsen, which would be one of hundreds of sites nationwide.
According to her, she has not felt any side effects since enrolling in the trial.
There are four other drugs that target Lp(a) and are in various stages of research. First is Eli Lillu’s drug, lepodisiran, whose early results showed that the drug could push Lp(a) down by more than 94 percent.
Secondly, Amgen’s drug, olpasiran, has shown the same results. Thirdly, Silence Therapeutics is doing trials for its drug Zerlasiran. All of these drugs, including pelacarsen, are administered through an injection.
However, Eli Lilly is also testing an oral drug called muvalaplin.
More about pelacarsen drug
The results tested on real-world situations for pelacarsen are not expected until next year.
Therefore, until the drugs are proven to work, doctors can only treat patients’ other heart disease risk factors, such as blood pressure management and statins, to bring down different forms of cholesterol.
Dr. Wesley Milks, a cardiologist and clinical assistant professor of internal medicine at The Ohio State University College of Medicine, said he sees patients “who are aware of their family history and are trying to prevent a first heart attack or stroke,” NBC News reported.
According to him, in those cases, the doctors might begin patients on “statins earlier in life that we might otherwise.”
Nissen, who is an investigator for clinical trials of lepodisiran, said. He and other cardiologists are calling for widespread Lp(a) screening. They said, “The hope is that we can keep them safe until we can get one of these drugs on the market,” NBC News reported.
The test must only be given once during a person’s life because the level always stays the same.
Michos of Johns Hopkins said, “Why wait for those new drugs?”
Measuring Lp(a) now “identifies a high-risk patient. We can be proactive about prevention. We can take action.”
Michos mentioned that maintaining an average weight, exercising regularly, stopping smoking, and eating a diet rich in fruits, vegetables, and whole grains are effective ways of managing heart risks, even for people with elevated Lp(a).