How Do Genetics and Lp(a) Shape Your Heart Attack Risk?
High levels of Lp(a) can increase your risk of heart attack, but there's a catch: the amount of risk associated with high levels of Lp(a) depends on your ethnicity.
Who Is at Risk?
The impact of high Lp(a) levels on heart attack risk is highly correlated by ethnicity. For example, South Asians who have elevated Lp(a) levels will more than double their risk of experiencing a heart attack. In contrast, White Europeans experience a much more modest increase in risk, only 36% when their Lp(a) levels are high.
Exceptions: High Lp(a) but Low Risk
Individuals of African and Arabian descent present a unique paradox. Despite having the highest Lp(a) levels among all groups, these populations appear to be largely protected from the heart attack risks associated with elevated Lp(a). In fact, the data reveals no statistically significant link between high Lp(a) levels and increased heart attack risk for these groups.
This doesn't mean that individuals from these ethnicities are somehow immune. While Lp(a) may pose less of a threat compared to other ethnicities, it's still critical to focus on optimizing other heart health biomarkers.
If You Have High Lp(a), What Should You Do?
Knowing your Lp(a) levels is the first step and is as simple as taking an at-home blood test. As indicated above, lifestyle changes like diet and exercise or even cholesterol-lowering medications are ineffective in lowering Lp(a) levels. Instead, it's critical to focus on reducing other heart health markers, such as ApoB. Managing other risk factors may help offset the heart attack risk associated with elevated Lp(a) levels.
What the Science is Saying Today
Medications like Pelacarsen have remarkable potential, with clinical trials indicating that a weekly 20 mg dose can reduce Lp(a) levels by up to 80%. While promising, it remains undetermined whether taking this medication is correlated to a reduction in heart attack risk for ethnicities at high risk.
The ongoing HORIZON trial is actively investigating this, with results expected later this year. If the trial confirms a causal link between Lp(a) reduction and improved heart health, our medical team at Instalab will develop guidelines for recommending this medication to those with cardiovascular risk.
