Cholesterol: Pharmaceutical Companies Bet on ‘s Lp(a) for Heart Drugs
Pharmaceutical companies are betting on a lesser-known form of cholesterol, Lp(a), to develop potentially blockbuster heart drugs. This shift comes as research reveals that people with high levels of Lp(a) face more than a twofold higher risk of heart attack compared to those without elevated levels. An estimated one in five people worldwide have elevated Lp(a), yet less than 1% of adults were tested for it in the U.S. in 2024.
Historically, cardiology focused heavily on lowering LDL cholesterol as the primary means to prevent cardiovascular disease. However, this approach has not always yielded the expected results. As Dr. Steve Nissen noted, “We thought raising HDL would be beneficial and that didn’t work, so I think we have to keep an open mind.” The realization that Lp(a) plays a significant role in heart health marks a decisive moment in treatment strategies.
Currently, Novartis, Amgen, and Eli Lilly are progressing through late-stage trials to test drugs that target Lp(a). These experimental drugs have shown remarkable potential—they can slash levels of Lp(a) by more than 80%. Novartis’ drug pelacarsen is specifically designed to lower these levels. If successful, these treatments could reshape how healthcare addresses heart attack prevention.
The financial implications are substantial; analysts project that these new therapies could generate up to $5.6 billion in annual sales by 2032. This potential market reflects the urgency and importance of addressing elevated Lp(a) levels, especially given its association with severe cardiovascular risks.
However, uncertainties linger around the exact levels of Lp(a) that need reduction to definitively prevent heart attacks. Moreover, timelines for results from ongoing trials have faced delays due to slower-than-anticipated occurrences of heart attacks in study participants.
Experts emphasize the significance of this shift in focus. Jay Bradner remarked, “The clarity of the signal from population genetics and the encouraging signs from earlier trials render this a very smart bet.” The hope is that at least one treatment will successfully navigate regulatory hurdles and become available for patients.
This emerging landscape underscores the importance of cholesterol testing—particularly for Lp(a)—in identifying individuals at risk for heart attacks. As Asad Haider pointed out, “That’s why this Novartis trial is going to be so important in how people think about the unlock.”
As pharmaceutical companies continue their research into Lp(a), the future of cardiovascular health may hinge on these developments. With promising trial results anticipated soon, stakeholders await data from Lilly’s Phase 3 trial of lepodisiran set for release in 2029.