The Science of Longevity: Challenges and Breakthroughs in Heart Disease Treatment
A new weekly column explores the science of longevity and recent setbacks in cardiovascular research, including clinical trials targeting Lipoprotein(a) and inflammation.
Longevity clinics are opening at a dizzying pace, and billionaires are pouring fortunes into new treatments, but what does science actually know about longevity and quality of life? A new weekly column will explore this industry from research to the money driving it.
The Setbacks in Cardiovascular Research
Last week, pharmaceutical giant Novartis lost $34 billion in market value following failures in two clinical trials, one of which shattered major hopes. Novartis sought to target Lipoprotein(a)—known as LP(a)—a substance similar to "bad cholesterol" (LDL) that increases the risk of heart attacks when elevated. In fact, it raises the risk even more than LDL, and high levels affect roughly one in five people.
This marker is driven more by genetics than lifestyle and poses risks even to young people. The Israel Atherosclerosis Society recommended testing LP(a) at least once in a lifetime in a 2024 position paper, a guideline also adopted by the Israel Association of Family Physicians. Although the Novartis treatment successfully lowered LP(a) levels in the blood, heart attack rates and mortality remained unchanged.
This setback impacted other companies developing LP(a) therapies, such as AstraZeneca and Eli Lilly, following another recent failure by Novo Nordisk to reduce heart attacks by lowering arterial inflammation. While inflammation decreased, heart attack rates did not drop correspondingly, raising questions about whether developing cardiac drugs is becoming increasingly difficult.
Progress and Future Horizons in Cardiology
Over the past 50 years, average life expectancy has increased by three to four years largely due to reductions in heart disease. Experts note that while cardiovascular threats remain significant—with hundreds of thousands of first-time heart attacks annually in the US—the medical community understands heart disease mechanisms much better than other leading causes of mortality like cancer or neurological conditions.
Clinical Perspectives and New Treatments
Prof. Michael Shechter, head of the Clinical Research Unit at the Sheba Medical Center's Heart Center, points out that despite recent setbacks, notable successes exist. Novo Nordisk's Wegovy has proven beneficial for the heart beyond its weight-loss effects, and SGLT2 inhibitors have achieved strong results in treating heart failure.
"Eli Lilly, for instance, reduces LP(a) using a different protocol, achieving a 95% reduction instead of 70%. Such reductions might be necessary to make a real difference," Shechter explained.
Researchers are also exploring gene therapy to lower cholesterol in cases where traditional drugs are insufficient, alongside advancements in medical devices such as transcatheter valve repairs and heart-support technologies.
