Eli Lilly’s experimental drug cuts heart attack risk factor by 94 per cent: What does it mean for Indians?

Even statins don’t work on risk factor called lipoprotein (a) that quickly clings to arteries and narrows them

The Lilly research was presented at the annual meeting of the American College of Cardiology and simultaneously published in the New England Journal of Medicine.

An experimental drug may be able to tame the sticky and dense cholesterol, called lipoprotein (a) or Lp(a), that quickly clings to arteries and triggers a heart attack. A trial showed that US drug manufacturer Eli Lilly’s lepodisiran could lower levels of Lp(a) by 94 per cent with a single injection. The effects lasted for six months without significant side effects.

 

There were 141 patients in the combined 400 mg phase of the study while 69 received a placebo. Although the pilot trial doesn’t confirm whether the reduction in Lp(a) levels can also reduce the risk of heart attacks, larger clinical trials are now looking into the link to assess the drug’s preventive efficacy. The Lilly research was presented at the annual meeting of the American College of Cardiology and simultaneously published in the New England Journal of Medicine.

“This finding offers hope because currently no drug, not even statins, can target Lp(a), which is mostly genetically inherited. But for more convincing results, we have to wait for Eli Lilly’s larger clinical trial results, expected in 2029. Larger trials of other drugs targeting Lp(a) will conclude sooner. We are expecting the results of Novartis’ monthly injectable drug by 2026. Lilly itself is testing an oral drug for LP(a) in advanced clinical trials,” says Dr Nishith Chandra, Principal Director, Interventional Cardiology, Fortis Escorts Heart Institute, Delhi.

 

What is Lp (a)?

It is a stubborn sub-variety of cholesterol, made of fat and protein, that sits on heart vessels, leading to an aggressive build-up of plaque. It is also the reason for recurrent heart attacks. “It works through low-density lipoprotein (LDL), or the bad cholesterol. It causes inflammation, which increases the likelihood of plaques rupturing and can narrow the aortic valve,” says Dr Balbir Singh, Chairman, Cardiac Sciences, Max Healthcare. “This is concerning for most Indians as those suffering from high blood pressure and diabetes have genes linked to Lp(a),” he adds. He has seen high levels of Lp(a) in younger patients who underwent procedures and still developed blockages again.

 

How does one test for Lp(a)? What’s its upper limit?

An extended lipid profile test is needed. “It shouldn’t be higher than 25mg/dL,” says Dr Singh. If your markers include diabetes, HDL (high density lipoprotein or good cholesterol) below 35, and triglycerides above 250, then chances are you have small dense LDL. “Since this risk marker is genetically linked, we ask patients with a family history of heart disease to take this test,” says Dr Chandra.

 

Can no drugs help?

“Injectable cholesterol-lowering drugs known as PCSK9 inhibitors may lower their levels but aren’t enough to prevent heart attacks,” says Dr Chandra.

“Since Lp(a) is a marker, the only way to lower it is to lower the way it functions, through LDLs, particularly the small density LDLs. While the total LDL counts of Indians are lower than Caucasians, the proportion of small density LDLs is higher. These are more toxic for the walls of blood vessels. So, we need to get our LDL levels down aggressively, to less than 50 mg/dL,” says Dr Singh.

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