Heart disease is the number one killer of adult Texans, according to the state health department.
To avoid that, some people take medication to lower bad cholesterol.
There’s a genetic part, though, that’s harder to treat when it becomes elevated. Some injectable drugs now available can help, but a clinical trial in Australia found a new oral drug called muvalaplin lowered levels of Lp(a) or lipoprotein-A by more than 50%.
KERA’s Sam Baker talked with cardiologist Dr. Ashesh Parikh of Texas Health Plano and Texas Health Physicians Group about why this finding is important.
What is Lp(a)?
When you break down the actual cholesterol, what makes it stick to the arteries, your brain, and your heart is the actual chemical compound, Lp(a) or lipoprotein-A. There are other chemicals, but that's the basis of how we see cholesterol building up in our arteries.
How do you determine when the Lp(a) is getting out of hand?
The very first sign is your initial level of your LDL. If it's above 190 in your first check on your cholesterol level, that is usually a doctor’s first chance to say that you might have higher circulating Lp(a) levels.
But Lp(a) is harder to treat because it's genetic?
It’s genetic, and it's harder to treat because there's really been no true medications that target what's typically Lp(a). And so usually the concept was you treat the LDL with the standard medications that we have currently.
And there are some injectable medicines that have been available now. So, we've come a long way in treating and lowering your LDL.
But if you have a genetic predisposition, you have what's called genetic familial hypercholesterolemia that standard medications will not even touch.
So, when we brought you news about clinical trial results for the first oral medication being developed for Lp(a), you called this a game changer. Why?
Primarily because I would say about maybe 20% or so of some of the patients we see and treat for high cholesterol, we can't get anywhere with just our standard medications in terms of lowering their cholesterol levels.
And these patients, unfortunately, are diabetic, which is a very high-risk population of patients where they’ve already had open heart surgery or stents put in because they've had a heart attack.
For those patients, we want to be very aggressive and a lot of times we just reach a dead end. So, seeing this trial and that there's a 50% reduction in Lp(a), it could really reduce one's incidence of heart disease if you can really target the Lp(a) and lower that because that, in essence, will lower your overall cholesterol burden all over your body.
The new drug could be five years away from consumer use. So what can those with Lp(a) do in the meantime?
We still keep you on all the standard medications. There is a medicine that has been out for several years now that a lot of us use called Repantha or Praluent. The medications help, from an injection form, really dramatically reduce your Lp(a) levels.
There's another medication that's come out and is used only twice a year called Leqvio that can also help reduce the LDL burden. So, there are medicines out there, but a lot of it also goes out to the patient just trying to be aggressive in terms of their diet and just try to exercise as much as they can.
How much risk is there with Lp(a)?
If they have high levels of Lp(a) circulating, then patients with that genetic abnormality are at least 15% to 20% higher risk than the general population for developing atherosclerotic disease.
RESOURCES:
- Dr. Stephen Nicholls and Dr. C. Michael Gibson Discuss: Muvalaplin, a Potent Small Molecule Inhibitor of Lipoprotein(a)
- First oral drug for genetic bad cholesterol lowers levels by over 50% in clinical trial
- Study in JAMA
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