"Lipoprotein(a) is a genetic variant of LDL cholesterol that explains the extreme prematurity and severity of heart disease in Indians, which standard risk factors cannot fully account for," said Dr. Enas A. Enas in a conversation with Dr. P.C. Manoria at the World Congress Cardio Kidney Metabolic (WC CKM) Medicine 2026. Top 5 Key Takeaways: 1 Lp(a) Prevalence: Present in 25% of Indians; drives premature, severe heart attacks unexplained by standard risk factors. 2 Unexplained Severity: Standard factors (smoking, BP, diabetes) fail to account for the extreme prematurity and diffuse disease seen in Indian patients. 3 Stringent Targets: High-risk patients must aggressively lower LDL to 40–60 mg/dL, starting as early as age 20 or 30. 4 Selective Aspirin Use: Aspirin reduces heart attack risk by 40–50% specifically in those with high Lp(a). 5 siRNA Revolution: New RNA therapies (Pelacarsen, Lepodisiran) can lower Lp(a) by up to 98%; availability expected this decade. Dr. Enas A. Enas is a global pioneer in the study of heart disease among South Asians. As the founder of the CADI Research foundation, he led the landmark CADI study involving 2,000 Indian physicians, which first identified the fourfold higher rate of CAD in this ethnic group. His decades of research have established Lipoprotein(a) as a primary determinant of premature cardiovascular mortality in Indians. Dr. Professor P.C. Manoria is the Executive President for the World Congress Cardio Kidney Metabolic (WC CKM) Medicine. He is a distinguished cardiologist and a leading figure in South Asia for integrating cardio-renal-metabolic care to address the epidemic of non-communicable diseases.