The Heart of the Matter

In March 2025, when Eli Lilly announced positive results of an experimental drug, lepodisiran, that could significantly lower levels of the lipoprotein Lp(a) and thereby lower the risk of a heart attack for thousands, if not millions, of people, prominent cardiologists called the news “thrilling” and “a huge new frontier in cardiovascular medicine.” According to data presented by Eli Lilly at the 2025 meeting of the American College of Cardiology and cited in a New England Journal of Medicine article, some 20 percent of all Americans have elevated levels of Lp(a). Phase two of the trial involved 320 participants, all of whom were over the age of 40 (the mean age was 62.7). According to Martha Gulati, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, just 0.8 percent of Americans have ever tested for Lp(a)—even though it was identified as a risk factor for heart disease back in 1974. Gulati urged all adults to test for this lipoprotein. If levels are found to be high—Lp(a) is controlled by genes, not by lifestyle or environment—doctors should look at other risk factors to help prevent cardiovascular events.

Researchers at Eli Lilly believe that lepodisiran could lower levels of Lp(a) by 94 percent; a large clinical trial, now underway, will conclude in 2029. And what if the trial confirms the drug’s efficacy? How many Americans with elevated Lp(a) levels will be tested and receive the new drug, and how many will have access to doctors who have the time to work with them to treat the other risk factors?

As I read the news about this potential breakthrough, I thought again of how fortunate I am to still be here, for in 1999, when I was 60 years old, I nearly experienced cardiovascular death. One day, when I found myself suddenly short of breath while swimming, I got out of the pool, went home, called my family doctor, and spoke with his nurse. She reminded me that I had not seen the doctor for more than two years and scheduled me for an appointment two and a half weeks later. At that checkup, my doctor thought the problem might be gastrointestinal—in addition to shortness of breath, I reported an occasional burning sensation in the middle of my back—but he recommended I undergo a stress test.

Two weeks later, I saw a cardiologist who talked with me briefly, looked at my EKG, thought I’d had a heart attack, canceled the stress test, and performed an echocardiogram. The results, he said, indicated a viral cardiomyopathy, and he told me to schedule an angiogram. The first appointment I could get would take place in three weeks.

In the meantime, I’d been talking almost every day with Rich Helfant, a high school friend who had recently retired as chief of cardiology at Cedars-Sinai. Although I had no conventional symptoms or risk factors—no chest pain, no high cholesterol, no high blood pressure, no worrisome family history—and had been swimming a mile a day and also regularly playing tennis and full-court basketball, I kept telling Rich that “I just didn’t feel right.” And when I called and told him the cardiologist’s diagnosis, he shouted into the phone, from 3,000 miles away, “It’s not viral, goddammit—I want you in the hospital as soon as possible!”