High Lipoprotein Poses as a Serious Heart Disease Risk Factor, Say Experts

New Delhi: India accounts for around one-fifth of the deaths caused by cardiovascular disease (CVD), which is nearly 18 million lives globally each year. This is larger than all cancers combined. What is even more shocking is that about 25 per cent of the Indian population has a critical genetic risk factor for heart disease that remains largely invisible. This is an elevated lipoprotein(a) or Lp(a), which is rarely tested and is often overlooked in heart health conditions.

Ahead of World Heart Day on September 29, international experts convened for the educational media webinar titled 'Introducing the Little (a) with Big Consequences', to spotlight elevated Lp(a) as a critical, underrecognised inherited condition that independently increases risk of cardiovascular disease, such as heart attack or stroke.

Lp(a) is a lipoprotein particle that is structurally similar to low-density lipoprotein (LDL) but distinguished by its apolipoprotein(a) component. This added protein makes Lp(a) particularly ‘sticky’, which can contribute to the build-up of plaque in the arteries.

Elevated Lp(a) levels play a significant role in the development and progression of atherosclerotic plaque, which causes arterial blood vessels to narrow and harden, restricting the blood flow and oxygen supply to vital organs. It can also increase the risk of formation of arterial blood clots that can block the flow of blood, thus leading to cardiovascular events such as heart attacks, peripheral artery disease or stroke.

“About 90 per cent of elevated Lp(a) cases are genetically determined, are established mainly by the age of five and remain relatively consistent over a lifetime. Consequently, lifestyle modifications such as diet and exercise have minimal impact on Lp(a) concentrations. Hence, awareness of risk factors such as elevated Lp(a) is critical," said Dr A Sreenivas Kumar, Director, Cardiology.

In the Asia Pacific and Middle East region, two in three individuals (66 per cent) skip routine heart tests, while nearly half (45 per cent) do not recognise genetics as a risk factor of heart disease, according to the results of a recent survey. Awareness of Lp(a) is even lower, with just 22 per cent of respondents reporting they had heard of a test for the biomarker, while only seven per cent had taken it.

“South Asians are particularly vulnerable — in fact, 34 per cent of Indian acute coronary syndrome patients have high Lp(a). When combined with common risk factors such as diabetes, obesity and hypertension, the likelihood of heart attack or stroke increases dramatically. Lp(a) testing is essential to identify high-risk individuals early and help prevent avoidable cardiac events,” Dr Kumar added.

Ram Khandelwal, now the founder of Heart Health India Foundation, himself survived a heart attack at age 33, caused by an elevated Lp(a). A high-functioning corporate employee, he collapsed in his office suddenly after experiencing a heart attack. He was rushed to the hospital within the 'golden hour' (60-90 minutes) of having a heart attack and was saved. He underwent two major surgeries after that aimed at removing the blockages in his arteries.

Sharing the incident and how it led to his advocacy work for India’s first heart patient support group, said, "People across India are unaware that a simple blood test can reveal their genetic risk from elevated Lp(a). Early testing becomes a natural part of heart health and not just something people consider after a significant cardiac event.”

While there is no treatment for it yet, experts suggested that early testing and detection can help with risk assessment and management. Existing therapies can help in 25-30 per cent reduction and management of certain modifiable factors such as LDL and BP.

Prof Gerald Watts, an expert in Cardio-Metabolic Medicine, University of Western Australia, explained the genetic science behind elevated Lp(a) and its impact on cardiovascular health.

Nicola Bedlington, senior policy advisor, Lp(a) International Taskforce, FH Europe Foundation (FHEF), urged policymakers to embed Lp(a) testing into national CVD guidelines to close critical care gaps. Supporting this, Prof. Zanfina Ademi, professor, health economics, Monash University highlighted the cost-effectiveness of Lp(a) testing. Further, experts from India, Korea, Australia and the Middle East addressed the challenges in diagnosing and managing elevated Lp(a).