A Silent Killer in Our Genes: Why Parsi and Iranian Families Must Test for Lp(a)
Have you heard unsettling stories of young, seemingly healthy individuals—especially within the Iranian and Parsi communities—suffering premature heart attacks and strokes? Did you wonder why this happens, often without the typical risk factors like high blood pressure or diabetes?
The answer may lie in a dangerous, often-missed genetic marker: Lipoprotein(a), or Lp(a). This simple blood test could be the key to saving lives in your family.
What Exactly is Lp(a)?
Lp(a), pronounced “L-P-little-a,” is a type of cholesterol particle that is genetically inherited, meaning its level is determined by your genes at birth and is largely unaffected by diet or exercise.
Imagine the LDL (“bad” cholesterol) particle, but with an extra, sticky protein cap called apolipoprotein(a)
- Atherogenic: It drives the buildup of plaque in the arteries (atherosclerosis).
- Pro-thrombotic: It promotes inflammation and blood clot formation, dramatically increasing the risk of a sudden heart attack or stroke.
The Urgent Need for Screening in Iranian & Parsi Communities
Recent scientific data strongly suggests that elevated Lp(a) is a major, independent risk factor for premature Coronary Artery Disease (CAD) in the Iranian population.
Key Findings from Research:
- Independent Risk: Studies (like those from Rajaie Cardiovascular Center) found that Lp(a) levels were significantly high in Iranian patients with early-onset CAD, even when common risk factors weren’t present.
- High Prevalence: In one comparison, the mean Lp(a) level in the CAD group ($41 \text{ mg/dL}$) was nearly double that of the healthy control group ($25.5 \text{ mg/dL}$).
- Enhanced Prediction: Including the Lp(a) test in standard risk calculations (like the Framingham Risk Score) improved the prediction of heart disease by about 20% in a long-term Iranian study. This shows Lp(a) provides crucial information that standard lipid panels miss.
The Genetic Connection
Lp(a) is inherited in a codominant fashion. If one parent has an allele that produces high Lp(a), you have a significant chance of inheriting elevated levels. If both parents carry high-risk genes, the levels can be even higher.
For close-knit communities, such as many Parsi and Iranian families, the risk is theoretical, yet plausible: if there’s a higher frequency of high-Lp(a) genes in the community, could theoretically increase the chance of inheriting the most dangerous, high-risk combinations.
Action Plan: Cascade Screening is Key
Since Lp(a) levels are set by your genes and remain stable from childhood, this is not just an individual test—it’s a family test.
Who in the Family Should Be Tested?
- The Index Patient: Anyone who has had a heart attack, stroke, or severe aortic stenosis without clear, common causes.
- First-Degree Relatives: Parents, siblings, and children of a person with elevated Lp(a) have a 50% chance of inheriting it.
- Children: Testing can be done as early as age 5, as adult levels are typically established by then.
Ethnic Risk & Key Numbers
Among South Asian groups, including some Iranians and Parsis, Lp(a) is particularly concerning.
| Lp(a) Level (mg/dL) | Associated Risk | Estimated Prevalence in Indians |
| >30 mg/dL | Elevated Risk Begins | $\sim25\%$ |
| >50 mg/dL | Strong Association with Premature CAD | $\sim28\%$ |
| >90 mg/dL | Very High Risk | $\sim26\%$ |
Source: Adapted from population studies on Indian and South Asian cohorts.
Current Management & Future Hope
Currently, there are no FDA-approved drugs that specifically target and lower Lp(a). However, the focus is on aggressive risk reduction:
Current Strategies
- Aggressive LDL-C Lowering: Drugs like PCSK9 inhibitors (e.g., Repatha, Praluent) are commonly used and have the added benefit of lowering Lp(a) by about 20–30%.
- Lifestyle Optimization: A plant-based diet, regular exercise, and avoiding smoking won’t lower your Lp(a) number, but they improve overall vascular health and counteract the other risk factors.
The Horizon of Hope
The good news is that we are on the cusp of a breakthrough. Several revolutionary drugs (including Pelacarsan, Olpasiran, and Muvalaplin) that directly target the LPA gene are in late-stage clinical trials. These could dramatically lower Lp(a) and change the landscape of prevention.
The takeaway is clear: Don’t wait. Lp(a) is a crucial part of your genetic heritage that you need to know about. Ask your doctor for an Lp(a) test today and consider cascade screening for your family.
………… Dr. Rajendra Prasad, MD, FRPC
Highly respected and extremely humane, Dr. Rajendra Prasad, MD, FRCPC. Practiced Oncology for over 45 years in CA, USA. He is known for his compassionate approach to patient care and his dedication to advancing cancer treatment. His work has significantly contributed to the field, earning him respect among colleagues and patients alike. Despite his achievements, he remains humble and focused on his mission to improve lives.
Dr Prasad’s commitment to humanity is commendable.
Rammohan
I am proud of Dr.Rajendraprasad,my class mate in the medical school in India and my intimate friend.He is lending noble services to the poor in need both in India and in USA.He deeply thinks about contributing for the suffering humanity and offers his medical knowledge for the betterment of the society.