When we check our cholesterol, we usually only look at the "good cholesterol" (HDL) and "bad cholesterol" (LDL), right? But did you know that there is a very important type of cholesterol that many people don't talk about, but is hidden in between? This is Lipoprotein(a), or Lp(a) for short. The special thing about this is that it is determined by our genes, which means it is passed down from generation to generation, rather than by what we eat and drink or exercise. You may be a very healthy person, but your Lp(a) level may be very high.
What exactly is Lipoprotein(a)?
Simply put, this is also a cholesterol-containing particle in our blood. But the problem with this is that its level is largely determined by our genes. This means that if your mother, father, or someone in your family has this condition, you are more likely to have it too. It is said that about one in every five people in the world has high Lp(a) levels.
The danger of this is that having high Lp(a) levels significantly increases the risk of heart attack and stroke at a young age. Most of the time, people only find out about this after they have had a heart attack or stroke. This is because a standard lipid panel does not show this Lp(a) value. It requires a separate test.
For example, take the story of Bernadette, a 66-year-old woman who walks about 10 miles a day and eats a plant-based diet, including vegetables and tofu. Her cholesterol levels were generally in the good range, but her Lp(a) level was five times higher than the risk level. This was due to her genetics. Both her mother and grandmother had died of heart disease.
"The biggest challenge for me is the stress of living with this. Even though I feel a little sick, I think, 'Is this the heart attack I'm going to have?'" Bernadette says.
The problem and new hope
Until now, there has been no specific drug approved to lower Lp(a) levels. This means that even though they know it exists, many people have had to live in fear, with nothing they can do about it. It's like having a time bomb in their body that could explode at any time.
But, now that situation is going to change!
Medical researchers are currently investigating five new drugs that have been shown in early studies to significantly lower Lp(a) levels. This is a great hope for the millions of people with high Lp(a) levels. As lead researcher Dr. Steven Nissen says, " Don't worry, solutions are coming. "
The latest drugs that are in the research stage
These new drugs are still in the final stages of research (clinical trials). If they are successful, they could be on the market in the near future. Let's see what those drugs are and how successful they are.
| Drug Name | Feature / How to provide | Expected result |
|---|---|---|
| Pelacarsen | An injection given once a month | Lp(a) levels can be reduced by about 80%. |
| Olpasiran | A vaccine given every 3 months | Lp(a) levels can be reduced by more than 95%. |
| Lepodisiran | A single vaccine that remains active for almost a year | Lp(a) levels can be reduced by about 94% and maintained for a long time. |
| Zerlasiran | A rarely administered vaccine | Lp(a) levels can be reduced by about 86%. |
| Muvalaplin | A daily pill | Lp(a) levels can be reduced by about 86%. |
What is special about a Muvalaplin tablet?
Of these, researchers have high hopes for a drug called ``(Muvalaplin)'' because while the other four drugs have to be given as injections, this one can be taken as a daily pill . Therefore, it could be more convenient for patients, and it could also be less expensive.
Other drugs work by silencing the gene responsible for Lp(a) production. But this pill works in a different way. It stops the production of Lp(a) particles in the middle. This allows it to work without affecting the liver and to be eliminated from the body quickly if any side effects occur.
Why do we need to test Lp(a)?
As you read this article, you may be wondering, 'Should I get this checked too?' The answer is, yes! You should definitely consider this, especially if someone in your family has had heart disease or stroke at a young age .
The National Lipid Association now recommends that everyone get their Lp(a) level checked at least once in their lifetime . Because it's a genetic thing, the level doesn't change much throughout life. Just getting it checked once is enough.
This is a very simple blood test. However, since it is not included in a standard cholesterol report, you should ask your doctor specifically about this before getting this test done.
Knowing your Lp(a) level is the first step. If it's high, don't panic. With these new medications coming soon, you'll be able to control your risk of heart attack and stroke. Until then, it's important to keep other risk factors, such as high blood pressure, diabetes, smoking, and LDL cholesterol levels, well under control.
Take-Home Message
- Lipoprotein(a), or Lp(a), is a type of cholesterol that is genetically controlled and increases the risk of heart disease.
- This is not included in a regular cholesterol test (lipid profile), so you should ask your doctor about this and have it checked specifically.
- If anyone in your family has had heart disease at a young age, it is very important to get this test done.
- Although there is currently no specific drug for Lp(a), several drugs that are showing very promising results are in the final stages of research. This is very promising.
- If you find out that your Lp(a) level is high, don't panic, discuss it with your doctor, and get other heart disease risk factors under control.
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