A silent cardiovascular condition, Lipoprotein(a) or Lp(a), is affecting an estimated one in five Americans, placing millions at increased risk for heart attacks and strokes, even among individuals who are otherwise healthy, slim, and fit. Unlike common cholesterol, Lp(a) is primarily inherited and often goes undetected because it does not appear on standard blood panels, experts told the Daily Mail.
Lp(a) is a cholesterol-carrying particle produced by the liver. While it may play a role in wound healing and infection fighting, a genetic predisposition causes about 20% of the population to produce excessive amounts. This excess Lp(a) can accumulate in artery walls, forming fatty plaques that restrict blood flow and increase the likelihood of blood clots, similar to LDL cholesterol but potentially more harmful due to an associated protein that promotes inflammation. This accumulation can lead to atherosclerosis, increasing the risk of coronary heart disease, stroke, and peripheral artery disease, as well as aortic valve disease and heart failure.
Unlike LDL cholesterol, which can be managed through diet, exercise, and medication, Lp(a) levels are almost entirely determined by genetics. Consequently, damage from elevated Lp(a) can accumulate over decades, sometimes leading to heart attacks and strokes at younger ages. The risk is amplified for individuals who also have other cardiovascular risk factors such as high LDL cholesterol, diabetes, or high blood pressure.
Celebrities like Bob Harper, a fitness coach, and actor Bob Odenkirk have publicly shared their experiences with severe heart events linked to high Lp(a). Harper suffered a "widowmaker" heart attack at age 51 despite being in peak physical condition, later learning his condition was inherited. Odenkirk experienced a near-fatal heart attack on the set of "Better Call Saul" in 2021.
Detecting and Managing Lp(a) Risk
The only way to identify high Lp(a) levels is through a specific blood test, which is not part of routine cholesterol screening. The Centers for Disease Control and Prevention (CDC) recommends testing for individuals who have experienced a heart attack or stroke, or who have developed coronary artery disease before age 55 for men or 65 for women, particularly without other apparent risk factors. Screening is also advised for those with a family history of early heart disease, familial hypercholesterolemia, or certain forms of aortic stenosis.
Testing for Lp(a) requires a specific request from a doctor or can be self-ordered through direct lab services, typically costing between $24 and $100 depending on insurance. Medical professionals recommend that most adults have their Lp(a) levels checked at least once in their lifetime, as levels tend to remain stable. Repeat testing might be necessary only in specific circumstances, such as during pregnancy or illness.
Currently, there are no medications specifically approved to treat high Lp(a). However, new treatments are in development. The FDA has approved drugs like Lipfendra, a PCSK9 inhibitor, which has shown to lower both LDL and Lp(a) levels. Experimental drugs designed to reduce Lp(a) production by the liver are also in clinical trials. For a small number of high-risk patients, lipoprotein apheresis, a procedure that filters the blood, can be used.
In the absence of targeted treatments, healthcare providers emphasize aggressively managing other controllable cardiovascular risk factors. This includes lowering LDL cholesterol, controlling blood pressure and diabetes, maintaining a healthy weight, exercising regularly, and not smoking. Awareness of high Lp(a) levels can inform individualized treatment plans and potentially lead to earlier initiation of cholesterol-lowering therapies.