An experimental drug developed by Eli Lilly may offer a breakthrough in managing lipoprotein (a) or Lp(a)—a sticky, dense form of cholesterol that clings to artery walls and raises the risk of heart attacks. In a recent trial, a single injection of the drug, lepodisiran, reduced Lp(a) levels by an impressive 94%, with the effects lasting for six months and no major side effects reported.
Promising Results from Early Trial
As reported by indianexpress, the trial involved 141 patients who received a 400 mg dose of lepodisiran, while 69 patients were given a placebo. Although the study didn’t confirm whether lowering Lp(a) levels directly reduces heart attack risk, larger clinical trials are underway to establish that connection. These promising findings were unveiled at the American College of Cardiology’s annual meeting and published simultaneously in the New England Journal of Medicine.
Why This Matters: Lp(a) Is a Stubborn Genetic Risk
Currently, no approved medication—including statins—can specifically target Lp(a), which is primarily genetically inherited. Dr. Nishith Chandra, Principal Director of Interventional Cardiology at Fortis Escorts Heart Institute, Delhi, commented,
“This finding offers hope, but we need to wait for the results of Eli Lilly’s larger trials, expected in 2029, to be sure of the drug’s preventive potential.”
Other pharmaceutical companies are also in the race. Notably, Novartis is developing a monthly injectable drug for Lp(a), with results expected by 2026. Eli Lilly is also testing an oral version of the drug in advanced stages of clinical trials.
What Exactly Is Lp(a)?
Lp(a), a dangerous sub-type of cholesterol, consists of fat and protein. It builds up on artery walls and accelerates plaque formation. It increases the risk of recurrent heart attacks and aortic valve narrowing. According to Dr. Balbir Singh, Chairman of Cardiac Sciences at Max Healthcare,
“It works through LDL (bad cholesterol), causing inflammation that makes plaque more likely to rupture.”
He warns that Indians are particularly vulnerable due to genetic links to high Lp(a). This risk is especially high for those with diabetes or high blood pressure. Even younger patients who undergo procedures often experience re-blockages due to elevated Lp(a) levels.
How Can You Test for Lp(a)?
To check your Lp(a) levels, you need an extended lipid profile test. Dr. Singh explains that Lp(a) levels should ideally be below 25 mg/dL. He adds that patients with a family history of heart disease should consider testing for Lp(a), especially if they have other risk factors like diabetes, low HDL (below 35 mg/dL), or high triglycerides (above 250 mg/dL).
Do Any Current Drugs Work?
While PCSK9 inhibitors, a class of injectable cholesterol-lowering drugs, may lower Lp(a) levels slightly, they are not enough to prevent heart attacks, says Dr. Chandra.
Dr. Singh stresses the need to aggressively target small, dense LDL particles, which are more harmful to blood vessels. “Although total LDL levels in Indians are lower than in Caucasians, the proportion of toxic, small-dense LDL is much higher. That’s why we aim to lower LDL cholesterol to below 50 mg/dL in high-risk patients,” he adds.