Cardiologists highlight genetic heart risk marker lipoprotein(a)

 With heart disease cases rising globally, cardiologists are urging people to go beyond traditional risk checks like blood pressure and cholesterol and pay attention to lipoprotein(a), or Lp(a)—a genetic and independent risk factor for cardiovascular disease and stroke.

A silent but serious risk

Doctors warn that elevated Lp(a) often shows no symptoms but can lead to blood clotting, blocked arteries, and reduced blood supply to vital organs. Research indicates that one in five people worldwide has high Lp(a), while its prevalence among Indians is estimated at 25%, making it a significant driver of premature coronary artery disease (CAD).

“In my clinics, roughly 15–25 new patients a month are found to have elevated Lp(a); across the broader service, it is several dozen monthly. As the prevalence in India is high, these numbers are unsurprising,” said Dr Deepak Padmanabhan, senior consultant and strategic lead – Cardiac EP Collegium, Narayana Health.

Low awareness, high prevalence

Despite the risks, awareness remains poor. Few patients proactively ask for Lp(a) tests unless doctors specifically recommend them. Cardiologists emphasise that adults with risk factors—especially those with a family history of premature heart disease—should be screened.

Doctors also advise that patients diagnosed with high Lp(a) should inform close relatives to enable cascade testing, which can help detect the condition in family members early.

When to test for Lp(a)

“We recommend patients test for Lp(a) when other parameters, including LDL cholesterol, are under control but cardiac events recur. Lifestyle modifications cannot directly reduce Lp(a), but they can lower cholesterol levels and reduce the associated risks,” said Dr Girish B Navasundi, senior consultant interventional cardiologist, Apollo Hospitals, Bannerghatta.

Currently, there are no approved medicines to directly lower Lp(a). “Dedicated Lp(a)-lowering drugs are in late-stage trials, but we are awaiting definitive results and approvals. You cannot prevent inheriting high Lp(a), but you can neutralise much of its risk by controlling everything else,” Dr Deepak explained.

Other cholesterol checks remain vital

Apart from Lp(a), cardiologists underline the importance of regular lipid profile testing, as high LDL cholesterol remains a leading cause of heart attacks, including among younger adults.

“If someone already has a cardiovascular risk, they should start testing at 20 years of age. Fitness alone is no guarantee—recently I performed a bypass on a very fit patient who ignored high cholesterol,” said Dr Vivek Jawali, chairman, Cardiac Sciences, Fortis Hospitals.

Doctors also recommend advanced tests such as Carotid Doppler scans and CT coronary calcium scoring for those with elevated cholesterol levels.

General heart health tips

• Exercise at least 150 minutes weekly, including strength training

Conclusion

While high Lp(a) cannot be prevented, cardiologists stress that its risks can be managed with regular testing, timely diagnosis, and lifestyle changes. With India’s high prevalence, awareness and proactive screening are key to reducing premature heart disease.