A drug under trial reduces risk of heart attack, stroke

NEW YORK: As many as one in five people – about 64 million in the US – have elevated levels of a tiny particle in their blood that can greatly increase the risk of heart attacks and strokes. But few know about it, and few doctors test for it, because there was not much to be done. Neither diet nor exercise help. There have been no drugs.
But that may soon change.
On Sunday, at the annual meeting of the American College of Cardiology, cardiologists announced that an experimental drug made by Eli Lilly, lepodisiran, could lower levels of the particle, Lp(a), by 94% with a single injection. The effects lasted for six months and there were no significant side effects, said the article simultaneously published in the ‘New England Journal of Medicine’.
At least four other companies are also testing drugs that block the body’s production of Lp(a), a mix of lipids and a protein. The first will be a study of a Novartis drug, injected monthly, with results expected in 2026. However, these drugs are still in phase 2 clinical trials and are years away from making it to the market.
Moreover, it isn’t yet confirmed that reducing Lp(a) levels also reduces the risk of heart attacks. Cardiologists are cautious as they remember a lesson learned from assuming that altering a risk factor can alter risk: They once were enthusiastic about drugs that raised levels of HDL – the “good cholesterol” associated with lower rates of heart disease – but the drugs didn’t help.
Treatments targeting Lp(a) have been a long time coming. It was identified in 1974 as a risk factor for heart disease that is controlled by genes rather than lifestyle or environment.
People with elevated levels of Lp(a) have a 25% increased risk of a heart attack or a stroke; the risk doubles at very high levels.
Cardiologists say patients with no obvious reason for having a heart attack – non-smoker, normal blood pressure and cholesterol-have high levels of Lp(a). The same goes for young people having heart attacks, said Cleveland Clinic’s Dr Steven Nissen, the academic leader for the Lilly trial. “If you go into the coronary care unit and see someone who is 40 years old with an acute myocardial infarction, you need to know the level of their Lp(a),” he said. It’s likely to be over 250 nanomoles per litre instead of 75.