Commentary in The Lancet explores role of lipoprotein(a) in cardiovascular disease risk

By Emily Leighton, MA'13

Lipoprotein(a) may be entering its prime time moment. Called a “heart risk factor even doctors know little about” by The New York Times earlier this year, the medical community is now starting to pay attention to this mysterious fatty particle in the blood.

Lipoprotein(a), or Lp(a), is considered a leading inherited risk factor for cardiovascular disease, but its clinical significance is still misunderstood. Few doctors test for it, despite the dramatically increased risk of heart attack or stroke at an early age that it brings. And scientific studies continue to show that at least one-fifth of the global population has Lp(a) levels high enough to increase their risk of cardiovascular disease by more than 50 per cent.

Michael Boffa, PhD, associate professor in Biochemistry, recently co-authored a commentary article in The Lancet responding to a landmark paper on Lp(a) published in the same journal this month.

The paper, authored by a team of international researchers, showed that elevated levels of Lp(a) are a risk factor for cardiovascular disease events, such as heart attacks, even in patients treated with statins.

In their follow-up commentary, “Lipoprotein(a): lodestar for future clinical trials,” Boffa and co-author Gerald Watts, from the University of Western Australia, conclude that the paper provides the strongest evidence yet of Lp(a)’s role in cardiovascular disease risk and treatment.

“This puts wind into the sails of the research teams developing Lp(a)-lowering therapy,” Boffa said. “It is crucial to now show that specifically lowering Lp(a) reduces the occurrence of cardiovascular events.”

Due to the lack of hard data on the benefits of lowering Lp(a), current guidelines by the Canadian Cardiovascular Society remain conservative, and stop short of recommending measurement in the general population.

“We hope that this paper brings us closer to demonstrating the benefit of lowering Lp(a),” Boffa said. “Until now, Lp(a) has not been routinely measured, even in high-risk patients, and there is no effective treatment to lower it.”

Boffa’s own research focuses on the basic mechanisms controlling Lp(a) levels, and how Lp(a) causes cardiovascular disease. “As lipoprotein(a) has begun to attract more notice from clinicians and pharmaceutical companies, we have become increasingly interested in its emerging epidemiology, as well as the design and interpretation of clinical trials involving the lowering of Lp(a),” he explained.