Lipoprotein(a): The Heart Risk Hiding in Plain Sight
Most people know their cholesterol numbers. We’re told to watch the “bad” LDL and raise the “good” HDL. But there’s another particle in the blood that rarely shows up on routine tests.It’s called Lipoprotein(a), or Lp(a). For some individuals, knowing their Lp(a) number could be a key to understanding their true heart risk.
Think of Lp(a) as LDL with an extra attachment, a sticky protein that makes it more dangerous. High levels are inherited, passed down like eye color, and they don’t respond to diet or exercise the way other cholesterol markers do. That’s why a person with healthy habits and normal cholesterol can still face premature heart disease or stroke.
“In clinic, Lp(a) can be the missing puzzle piece,” says Kaitlyn Walsh, Clinical Research Nurse Practitioner at Capital Cardiology. “If someone has a strong family history or an early heart attack without obvious risk factors, testing once can reveal what’s been hiding in the background.”
A simple blood test is all it takes. Unlike cholesterol, which we track regularly, most people only need to check their Lp(a) level once. If it’s elevated, it can change how doctors approach prevention.
“When we see elevated Lp(a), our role as cardiology providers is to double down on every factor we can control,” says Dr. Lance Sullenberger of Capital Cardiology. “There’s no FDA-approved therapy yet that directly lowers Lp(a), so we concentrate on what we can modify — driving LDL as low as possible, optimizing blood pressure, eliminating smoking, and managing diabetes or weight. You can’t rewrite your genes, but you can take charge of the risks that amplify them. We also make patients aware of ongoing clinical trials testing new therapies designed to directly target Lp(a), given its clear impact on cardiovascular risk.”
The encouraging news is that medicine is catching up. Several new treatments are in development, many of them injections that silence the gene behind Lp(a). Early studies show that these therapies can dramatically lower Lp(a), sometimes by 80% or more. The key question, whether lowering it reduces heart attacks and strokes, will only be answered by ongoing outcome trials.
And for those who worry about injections, there’s promising news: once-daily oral pills designed to lower Lp(a) , have shown striking success in early phase clinical trials . In a Phase II trial, higher doses of muvalaplin, which inhibits Lp(a) formation, lowered Lp(a) levels by up to about 85% over 12 weeks. While still preliminary , these findings suggest that patients could one day manage Lp(a) risk with a daily tablet rather than an injection.
“The pipeline is real,” Chris Chapman, Clinical Research Manager adds. “We finally have therapies designed specifically for Lp(a) being tested. Capital Cardiology is proud to participate in these groundbreaking clinical research trials to bring the most current and powerful treatments directly to our community. These trials will tell us whether lowering it can improve patient outcomes, and if they do, it could change the way we manage heart disease prevention for millions of people.”
For now, the message is simple: ask about the Lp(a) test. If your Lp(a) is high, it doesn’t mean you’re powerless, it means you have vital information to guide your care. Knowing your number opens the door to earlier action today and better options tomorrow.
If you have questions or want to learn more about participating in clinical trials, including Lp(a) studies, please visit Capital Cardiology’s Clinical Research page at capitalcardiology.com/research.
Medical Disclaimer
The information provided in this article is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, cardiologist, or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Do not disregard professional medical advice or delay in seeking it because of something you have read here.
If you think the Lipoprotein(a) test may be right for you — especially if you have a personal or family history of early heart disease — speak with your cardiology team. A simple blood test could provide valuable insights into your heart health and help guide your care.
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Evidence Highlights
The 2022 European Atherosclerosis Society (EAS) consensus statement identifies Lp(a) as a causal risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis, independent of LDL-C and other traditional factors. It recommends measuring Lp(a) at least once in adulthood, pubmed.ncbi.nlm.nih.gov/36036785.
Lp(a) levels are predominantly ( > 90 % ) genetically determined, with limited effect from lifestyle change | academic.oup.com.
Pelacarsen, an antisense oligonucleotide therapy targeting Lp(a), has shown strong reductions in trials; a large Phase 3 outcome trial (HORIZON) is underway, nejm.org.
Muvalaplin, an oral small molecule inhibitor, reduced Lp(a) by up to ~65% over 14 days in early studies. pubmed.ncbi.nlm.nih.gov/39556768 source. In the Phase II KRAKEN trial, it reduced Lp(a) by 47.7% (10 mg) to 85.7% (240 mg) over 12 weeks, acc.org.
Lepodisiran, a long-acting siRNA injectable, has demonstrated large reductions in Lp(a) and is in further study | acc.org.
Works Cited
Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-3946. PubMed
Tsimikas S, et al. Small Interfering RNA to Reduce Lipoprotein(a) in Cardiovascular Disease. New England Journal of Medicine. NEJM
Nissen SE, et al. Muvalaplin, an Oral Small Molecule Inhibitor of Lipoprotein(a). JAMA. 2023. PubMed
ACC. KRAKEN Trial Summary: Oral Muvalaplin for Lowering Lp(a). American College of Cardiology
ACC. Lepodisiran: Novel siRNA to lower Lp(a). American College of Cardiology
Clarke R, et al. Consensus and Guidelines on Lipoprotein(a). Atherosclerosis. 2022. PMC
European Atherosclerosis Society. Lp(a) Awareness Day / Measurement Recommendations. EAS Society
