High Lipoprotein(a) Levels and the Risk of Coronary Diseases

Elevated lipoprotein(a) levels can slowly block the arteries, increasing the likelihood of cardiovascular disease. Since no treatment is currently available for this condition, it is essential to understand how individuals can manage their lipoprotein(a) levels and protect themselves from unwanted cardiac events.

In this Innovation Spotlight, Katherine Wilemon, founder and chief executive officer of Family Heart Foundation (FHF), shares the story behind establishing the FHF and how the organization supports patients with inherited lipid disorders. She also discusses the factors that increase lipoprotein(a) levels in the blood, diagnostic methods, and potential strategies to alleviate the condition.

What is lipoprotein(a), and what role does it play in cardiovascular events?

Lipoprotein(a), which is often referred to as Lp(a), or “L-P-little A”, is a particle that carries cholesterol in the blood. It is similar to LDL particles that also carry cholesterol, but Lp(a) includes an extra apolipoprotein(a). Elevated Lp(a) levels are associated with an increased risk of cardiovascular events, including heart disease and strokes related to the buildup of plaque in the arteries, the development of blood clots, and inflammation.

Which factors could lead to an increase in Lp(a) in the blood, and how do clinicians measure Lp(a) levels?

Lp(a) levels are primarily determined by genetics and are minimally impacted by diet or exercise. There are currently no approved drug treatments for elevated Lp(a), but several investigational drugs are currently in late-stage testing. There are steps that can be taken to offset the risks of elevated Lp(a), including aggressively treating other cardiovascular risk factors, especially LDL-C.

Clinicians can measure Lp(a) levels with a simple blood test. However, Lp(a) screening is not typically part of standard blood work panels in the US, so most patients need to inquire about testing with their primary care provider.

How does the Family Heart Foundation help people with high Lp(a) levels and other inherited lipid disorders?

The Family Heart Foundation (FHF) is a patient-centered nonprofit organization focused on supporting research, advocacy, and education surrounding common but underdiagnosed genetic disorders and factors, including familial hypercholesterolemia (FH) and elevated Lp(a) that can significantly increase the risk of early cardiovascular problems such as stroke and heart attack.

Although approximately 1 in 5 people have elevated Lp(a), only about 1 percent of Americans have been screened for this condition. Our work aims to fill gaps in the diagnosis and management of this condition. We offer free at-home Lp(a) screening kits in most US states.

For individuals who learn that they have elevated Lp(a), we provide care navigation services that help them find appropriate care providers, navigate health insurance, connect with others affected by the condition, and share information with their family members.

The Family Heart Foundation also performs research that aims to fill gaps in the diagnosis and management of Lp(a).

How did your research on Lp(a) begin and what have you learned from your ongoing investigation?

I founded the FHF in 2011 after experiencing a heart attack caused by complete artery blockage. I was only 39 years old at the time and the experience drove me to investigate the deeper physiological issues that contributed to my cardiac event.

I learned that I have both familial hypercholesterolemia (FH) and elevated Lp(a), and I passed these conditions down to one of my daughters as well. After spending years researching lipid disorders, I learned that millions of people are living with these conditions and the cardiovascular risks associated with them without even knowing.

In 2014, we created the Family Heart Database^®, which helps characterize patterns of real-world medical encounters by US individuals with lipid disorders and cardiovascular risk. We use the database to identify gaps in care and develop strategies to drive changes in patient care policies.

Our recent study, presented at the European Atherosclerosis Society Congress in Glasgow, Scotland, and published in the European Heart Journal, used data from our database.¹ This was the largest study of people living with cardiovascular disease who have a confirmed measurement of Lp(a) ever conducted. Researchers tracked the health histories of a diverse group of nearly 275,000 individuals in the US for a median of 5.4 years to determine whether they experienced another cardiovascular event, such as a myocardial infarction or ischemic stroke, or underwent a procedure like percutaneous coronary intervention or coronary artery bypass grafting.

The data from this study showed that any increase in Lp(a) levels is associated with an increased risk of cardiovascular events. Individuals with the highest levels of Lp(a) (>300 nmol/L) were more than 40 percent more likely to have a cardiovascular event compared to people at lower levels (<15 nmol/L). While some smaller studies have indicated that the risk of cardiovascular events increases within certain ranges of Lp(a), our study is the first to demonstrate that the risks of events such as heart attacks, strokes, and cardiac surgeries continue to rise across all ascending levels of Lp(a), without any indication of a plateau in risk.

Which individuals are more susceptible to increased Lp(a) levels and why?

The study revealed that women and Black individuals are more likely to have elevated levels of Lp(a). In our study, more than 40 percent of Black women had elevated Lp(a) levels. Specialized efforts are needed to increase screening in these groups, which are most likely to have elevated Lp(a).

According to your research, what are the most effective strategies for treating patients with high Lp(a) levels?

During our research, we also completed a novel analysis to determine whether or not it was beneficial to aggressively treat LDL-C if Lp(a) levels are elevated. Since there are no drugs approved to treat high Lp(a), the current strategy is to optimize other cardiovascular risk factors, such as managing elevated blood pressure and cholesterol levels. Our data demonstrated that the risk of experiencing another event related to Lp(a) can be mitigated by using high-impact LDL-C lowering medications, in comparison to using lower-impact LDL-C lowering medications or none at all.

What are the future prospects of Lp(a) in testing and alleviating cardiovascular conditions?

Our recent study has confirmed key theories surrounding the importance of Lp(a) screening and its role in alleviating cardiovascular conditions. The data emphasizes the importance of measuring Lp(a) in all adults and accounting for elevated levels when evaluating an individual’s risk of future cardiovascular events. Our hope is that Lp(a) screening becomes part of standard primary care testing.

This data also supports the need for continued research into Lp(a)-lowering treatments. If ongoing trials of investigational Lp(a)-lowering agents demonstrate safety and efficacy, our hope is that they will be included in the range of treatment options available to patients.