Pharmaceutical companies are betting on a lesser-known form of cholesterol, Lp(a), to develop potentially blockbuster heart drugs. This focus marks a significant shift in cardiology. Traditionally, the emphasis has been on lowering LDL cholesterol to prevent heart attacks. Yet, recent studies reveal that Lp(a) poses a greater risk.
Lp(a) was first discovered in 1963. Research shows that individuals with high levels of Lp(a) have more than double the risk of heart attack compared to those without elevated levels. Alarmingly, an estimated one in five people worldwide has elevated Lp(a). Despite this, less than 1% of adults were tested for it in the U.S. in 2024.
Recent developments have changed the landscape. Novartis, Amgen, and Eli Lilly are now conducting late-stage trials to evaluate whether drugs that lower Lp(a) can protect against heart attacks. Novartis’ drug pelacarsen aims specifically to reduce Lp(a) levels. In tests, these companies have shown their experimental drugs can cut Lp(a) by more than 80%.
These promising results have caught the attention of experts. Dr. Steve Nissen remarked, “We thought raising HDL would be beneficial and that didn’t work, so I think we have to keep an open mind.” The potential for these drugs is substantial—experts predict annual sales could reach $5.6 billion by 2032 if successful.
However, uncertainties remain. The exact threshold of Lp(a) reduction necessary to prevent heart attacks is still unknown. Additionally, the timeline for results from Novartis’ trial has faced delays due to slower-than-expected occurrences of heart attacks.
Experts like Jay Bradner emphasize the importance of this research: “The clarity of the signal from population genetics and the encouraging signs from earlier trials render this a very smart bet.” Asad Haider added that Novartis’ trial will be crucial for shaping perceptions about this emerging area in cardiology.
This focus on Lp(a) represents a paradigm shift in how cardiovascular disease may be treated in the future. If these drugs prove effective, they could change treatment protocols significantly and save countless lives.
The next key data point is expected from Lilly’s Phase 3 trial of lepodisiran in 2029. Until then, the medical community watches closely as these developments unfold.
