Summary: A review in The Lancet finds that 20% of the global population carries a genetic risk for cardiovascular diseases due to high levels of lipoprotein(a), which can be tested for and potentially treated with upcoming medications.

Takeaways:

  1. Elevated lipoprotein(a) levels, a major genetic risk factor for heart attacks, strokes, and aortic valve stenosis, affect one in five people worldwide.
  2. Testing for lipoprotein(a) is simple and accessible, allowing early identification of individuals who could benefit from future lipoprotein(a)-lowering therapies.
  3. New medications, including gene silencing therapies, are in development to reduce lipoprotein(a) levels by up to 98%, with clinical results expected by 2026.

A review in The Lancet finds that one in five globally are at risk of contracting cardiovascular diseases, because they carry a genetic risk of high levels of a specific lipoprotein, which can be tested for and possibly treated.

Testing for Lipoprotein(a)

Approximately 20% of the world population carries a genetic risk factor for cardiovascular diseases such as heart attacks, strokes, and aortic valve stenosis: Increased levels of a lipid particle called lipoprotein(a). It is the most common genetic cause of cardiovascular diseases.

“Lipoprotein(a) is the direct cause of cardiovascular diseases much like cigarettes cause lung cancer. Yet most people that carry an increased amount of lipoprotein(a) are unaware. With new medication under way that lowers the amount of the lipid particle significantly, it is high time we identify individuals who would benefit from it,” says first author Professor Børge Nordestgaard, Clinical Professor at University of Copenhagen and Chief Physician at Copenhagen University Hospital – Herlev-Gentofte Hospital, who wrote a comprehensive ABC on lipoprotein(a) in cardiovascular disease, just published in The Lancet.

Expanding Testing Globally

The technology used for testing for lipoprotein(a) is readily available and easy to use, so while the clinical trials are under way, it makes sense to expand testing globally.

“By expanding testing, we can figure out who carries it and would benefit from lipoprotein(a)-lowering medication,” says Nordestgaard. “And until the medication becomes available, we can use this knowledge to take better care of individuals with high concentrations of lipoprotein(a) in their blood. The main factors here are making sure to exercise, eating healthy, avoiding smoking and being overweight, and treating high cholesterol levels.”

Five drugs are currently in development that can lower the amount of lipoprotein(a) by 65 to 98 %, three of which are in phase 3 clinical trials. Some of the new medication under development is so-called gene silencing therapy.

“The medication is injected and then absorbed by the liver cells, inhibiting the production of the lipoprotein(a) and significantly reducing the amount of the lipid particles in the blood and presumably the risk of contracting cardiovascular diseases,” says Børge Nordestgaard.

The first results showing that a reduction of lipoprotein(a) will reduce cardiovascular diseases are expected to be published in 2026.