43. Lipoprotein (a) | Inherited, Overlooked & Finally Understood

Send us Fan Mail In this episode of Mohivate, Dr Mohi Sarawgee explores Lipoprotein(a), a tiny particle carried in the blood, inherited almost entirely through our genes, and largely unchanged by diet, exercise, or most current cholesterol-lowering treatments. For more than sixty years, medicine knew it was there but rarely spoke about it. Now, that is beginning to change. We look at what Lipoprotein(a) is, why high levels can raise the risk of heart attack, stroke, and aortic valve disease, who may be more likely to carry it, and why a single blood test can sometimes reveal something important about an entire family. The conversation also turns to what “high” really means, whether you should be tested, and why the guidelines have suddenly shifted, with the 2026 US guidelines now recommending Lipoprotein(a) be measured at least once in every adult. I share whether I’d test myself, and why knowing a number you can’t change can still be a kind of power. And finally, the hopeful horizon: a new generation of medicines designed to switch Lp(a) down at the source, and the landmark trials, unfolding right now, that may finally tell us whether lowering it saves lives. This is also an episode about inheritance, uncertainty, and the difference between what we are given and what remains within our hands. Because we may not choose every card we are dealt, but we can still choose how we play the rest of the hand. References: **1.** Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia. *Journal of the American College of Cardiology.*2026 May 19;87(19):2624–2757. (The guideline that, for the first time in the US, recommends measuring Lp(a) at least once in every adult — a Class I recommendation.) https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016 **2.** American Heart Association newsroom summary of the 2026 guideline (plain-language overview, March 2026). https://newsroom.heart.org/news/accaha-issue-updated-guideline-for-managing-lipids-cholesterol 3\. HEART UK — Lipoprotein(a): what it is, why it matters, and testing. https://www.heartuk.org.uk (search “Lp(a)”) **4.** British Heart Foundation — Lipoprotein(a) and your heart. https://www.bhf.org.uk 5\. Lp(a) HORIZON trial (pelacarsen) — design and rationale. *American Heart Journal,* 2025. The first-ever cardiovascular outcomes trial for an Lp(a)-lowering drug (~8,300 patients). https://www.sciencedirect.com/science/article/pii/S0002870325001012 **6.** OCEAN(a)-Outcomes trial (olpasiran) — ClinicalTrials.govlisting. https://clinicaltrials.gov (search “OCEAN(a) Outcomes olpasiran”) **7.** ACCLAIM-Lp(a) trial (lepodisiran) — ClinicalTrials.gov listing. https://clinicaltrials.gov (search “ACCLAIM-Lp(a) lepodisiran”) 8\. Enas EA, et al. Lipoprotein(a) and its role in the disproportionate burden of cardiovascular disease in South Asians. (Reviews the ~25% high-Lp(a) prevalence and earlier-onset heart disease.) Search via PubMed: https://pubmed.ncbi.nlm.nih.gov Just a gentle reminder: this episode is for information, education, and inspiration only. It’s not a substitute for your doctor’s advice. For any personal health concerns, always seek guidance from your doctor.