New blood marker “cannot be overlooked” in detecting heart disease risk, despite lack of reimbursement

The standard comprehensive lipid panel of total, LDL- and HDL-cholesterol along with triglycerides are well-known, as is the role of LDL-cholesterol as a key cardiovascular risk factor and target for risk-reducing therapy.

Leading cardiologists are calling for doctors across Australia to start testing for a new marker of cholesterol.

Professor Jason Kovacic, Executive Director of the Victor Chang Cardiac Research Institute, said there needs to be far greater awareness of the dangers of Lipoprotein(a) or Lp(a), which can be detected in a blood test. He said that up to 20% of the population might have at least mild elevated levels of Lp(a).

Professor Kovacic said “It is very worrying that there could be many tens of thousands of Australians who are at increased risk of developing heart disease but are completely oblivious to it. We could find these people with a one-off blood test.”

Lp(a) is now known to be a major risk factor for atherosclerosis, which is the hardening and narrowing of the arteries in the heart caused by a build-up of plaque and is the major driver of heart disease. Lp(a) is strongly associated with a person’s genetics, but it is not yet routinely tested for despite recent evidence showing that people with raised Lp(a) levels are 2-4 times more likely to develop atherosclerosis.

On this basis alone, some international guidelines have recommended that Lp(a) should be tested at least once in every adult’s lifetime. Others advocate testing Lp(a) in patients with other risk factors including premature atherosclerotic disease.

Professor Kovacic, who is leading research into atherosclerosis at the Institute and is also a cardiologist at St Vincent’s Hospital Sydney, said Lp(a) cannot be overlooked any longer.

Whether therapeutically lowering Lp(a) reduces cardiovascular risk will first be answered in 2024 by the results of a large randomised controlled trial of pelacarsen, licensed by Novartis in 2019 for exclusive worldwide development, manufacturing and commercialisation. Given subcutaneously once per month, it persistently lowers Lp(a) concentrations by about 80%. The results of the final trial data are keenly awaited. 

In Australia, there is not currently a Medicare rebate for the measurement of Lp(a). The out-of-pocket cost for the test is typically less than $50.

While reimbursement for the test has still not been resolved, Professor Kovacic and other cardiologists are calling for Lp(a) testing to be conducted on males below 55 or women below 60 years with a history of heart attack, stroke, angina, coronary stent or coronary bypass surgery, which is not explained by other risk factors. Or, if there is a family history of these heart diseases in males below 55 or women below 60 without obvious risk factors.

Professor Kovacic added “We have long wondered why healthy people with low cholesterol levels and seemingly no other major risk factors like smoking or diabetes can suffer heart attacks. But, we now understand that high levels of Lp(a) could be responsible for many of these events.

“If we were able to diagnose people with high levels of Lp(a) far earlier in their lives, we could not only help prevent them from developing life-threatening complications, we could also test their family members too as this is genetic.”

Associate Professor Peter Psaltis, who leads the Heart and Vascular Program at the South Australian Health and Medical Research Institute, agreed it’s time to take a proactive approach to test for high Lp(a) in patients with early heart disease and those considered at increased risk.

A/Prof Psaltis, cardiologist at the Royal Adelaide Hospital, said “While we’re waiting for these new treatments to arrive, there is still a lot we can do to make sure that people with high Lp(a) levels have their other risk factors managed more aggressively. We can also monitor these individuals more closely, but we can only do that if we identify them in the first place.”

The call for greater awareness and a rollout of testing has been backed by Sarah Beale, whose partner Ben died of a heart attack aged 47 while jogging.

Ben’s death was originally described as a ‘one-off catastrophic event’ but Professor Kovacic was able to identify that Ben likely had increased levels of Lp(a). This means that Ben’s five children can now be tested for their levels of Lp(a) and be monitored closely.

Sarah said “It’s heart-breaking to think that a simple blood test could potentially have helped save Ben’s life. But at least our family now knows his history and what likely contributed to his heart attack. It’s also a huge relief that we can now test his children and identify if they are at risk. It’s high time that this test becomes mainstream so we can protect other families from losing their loved ones.”

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