It is a silent condition that affects millions and lurks in the background until it leads to fatal heart attacks and strokes. Yet few have ever heard of it.
Lipoprotein(a), or Lp(a), is a type of “bad” cholesterol that creates fatty deposits in the arteries, causing inflammation and blood clots.
But unlike other forms of bad cholesterol, such as low-density lipoprotein (LDL), doctors rarely test for it and it doesn’t appear on standard panels.
About one in five Americans – 63 million – have elevated Lp(a), a largely hereditary condition that often goes unnoticed because those affected may be slim, fit and otherwise healthy.
Many people only discover they have high Lp(a) after having a heart attack or stroke – sometimes with little or no warning.
In 2017, The Biggest Loser coach Bob Harper was the epitome of maximum physical fitness when he suffered a heart attack while exercising at the age of 51. He claimed doctors gave him only a six percent chance of pulling through.
“I was in complete cardiac arrest,” he said at the time. ‘My heart stopped. Not dramatic, but I was dead. I lay dead on that ground.’
Harper later discovered that the cause was high Lp(a) passed down in his family. His mother and maternal grandfather had both suffered heart attacks before his near-death experience.
In 2017, The Biggest Loser coach Bob Harper suffered a heart attack while working out. He later learned that he inherited high levels of lipoprotein(a) or Lp(a), which doctors believe caused his near-death experience.
Studies estimate that less than one percent of Americans have their Lp(a) levels tested, and there is no drug that can treat this.
Instead, doctors believe screening is the best way to detect Lp(a) before a devastating heart attack.
And although it is genetic, lifestyle changes such as reducing alcohol consumption and exercising regularly can prevent heart disease and diabetes, which further narrow blood vessels.
Here, doctors reveal to the Daily Mail everything you need to know about high Lp(a), how to know if you have it and what new drugs are in the pipeline.
What is Lp(a) and what does it do?
Lp(a) is a cholesterol-carrying particle made by the liver.
“Scientists believe it may play a role in wound healing and fighting infections,” Dr. Ryan Smith, a cardiologist at Orlando Health Heart and Vascular Institute, told the Daily Mail.
But about one in five Americans is genetically predisposed to produce too much of it.
While LDL, or “bad” cholesterol, is influenced by diet, weight and exercise, Lp(a) levels are determined almost entirely by the genes we inherit.
And having too much can be dangerous. Like LDL, Lp(a) can build up in the artery walls, forming fatty plaques that restrict blood flow and increase the risk of heart attacks and strokes.
It can also cause the blood to clot, further increasing the risk.
Is this the same as high cholesterol?
High cholesterol usually refers to high levels of LDL, or “bad” cholesterol, which can be affected by diet, exercise and being overweight.
About 37 percent of Americans, about 86 million, have elevated LDL levels, one of the strongest long-term predictors of heart disease and stroke.
“With LDL, you can lower its levels through diet changes, exercise, or with statins,” Dr. Wesley Milks, a cardiologist specializing in lipid disorders at Ohio State Wexner Medical Center, told the Daily Mail.
‘But that is not the case with Lp(a). We see that high values strongly run in families, often in addition to premature heart disease.’
Lp(a) can also be particularly harmful because it contains an extra protein called Apo(a), which promotes inflammation and the buildup of plaque in the arteries.
And because people with genetically high Lp(a) have elevated levels from birth, the damage can accumulate over decades, potentially leading to heart attacks and strokes at a younger age.
High Lp(a) is also linked to aortic stenosis, a potentially serious narrowing of the valve that controls blood flow from the heart.
How do I know if I have a high Lp(a)?
Like high LDL, elevated Lp(a) usually causes no symptoms – meaning many people have no idea they are at risk.
The only way to know is through a blood test.
The CDC recommends testing for people who have had a heart attack or stroke, or developed coronary artery disease at an unusually young age — before age 55 in men or age 65 in women — without obvious risk factors such as smoking, diabetes, obesity or high LDL.
Screening may also be recommended for people with a family history of early heart disease, poor circulation in the legs, the hereditary familial hypercholesterolemia with high cholesterol, or certain forms of aortic stenosis.
Bob Odenkirk suffered a heart attack on the set of Better Call Saul in 2021. He is pictured at the annual Critics’ Choice Awards in 2023.
Can I have a heart attack?
Having a high Lp(a) doesn’t guarantee you’ll have a heart attack, but it can significantly increase your risk.
High levels contribute to atherosclerosis – the build-up of fatty deposits in the arteries – which can lead to coronary heart disease, stroke and peripheral vascular disease.
Lp(a) is also linked to aortic valve disease and heart failure.
Studies show that the higher your Lp(a), the greater your risk, with very high levels potentially more than doubling the risk of cardiovascular disease.
However, that risk must be placed in context.
For example, for someone who is otherwise young, fit and healthy, doubling the risk could mean that the lifetime risk of a heart attack or stroke increases from five percent to ten percent.
For someone who already has high LDL levels, diabetes, high blood pressure or other cardiovascular risk factors, the same increase in Lp(a) can be much more concerning.
How do I get tested?
Dr. Wesley Milks of the Ohio State Wexner Medical Center told the Daily Mail that people with high Lp(a) may be able to lower their risk of heart attack by addressing other risk factors, such as LDL cholesterol.
Testing for high Lp(a) requires a simple blood draw, but this must be specifically requested as it is not usually included in a standard cholesterol panel.
The exact cost depends on insurance, but patients can also order tests themselves through direct laboratory services such as LabCorp, typically for between $24 and $100.
A doctor may also order the test, especially for people with cardiovascular risk factors or a family history of high Lp(a) or early heart disease.
Unlike regular cholesterol tests, most people only need to have their Lp(a) checked once – and Dr. Milks recommends that every adult do this at least once in their life.
“It can be done in addition to a standard lipid profile,” he said.
That’s because Lp(a) levels are largely determined by your genes and remain relatively stable throughout your life.
Dr. Smith said repeat testing may occasionally be recommended if the first test was taken during pregnancy or during an illness that can temporarily alter Lp(a) levels.
How can I stay safe if I have a high Lp(a)?
There are currently no drugs specifically approved for the treatment of 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. Trials showed it reduced LDL by more than 50 percent and also reduced Lp(a) by about 28 percent.
Meanwhile, several experimental drugs specifically designed to target Lp(a) are in clinical trials. These work by preventing the liver from producing the harmful particle in the first place.
For a small number of extremely high-risk patients, doctors may also use a treatment called lipoprotein apheresis, which is a bit like dialysis, filtering LDL and Lp(a) from the blood.
However, the procedure is generally reserved for people with hereditary high cholesterol who already have cardiovascular disease and meet strict criteria.
For now, doctors say the best way for people with high Lp(a) to protect themselves is to aggressively address the heart disease risks they can control.
That may mean lowering LDL with statins or other cholesterol medications, controlling blood pressure and diabetes, not smoking, exercising regularly and eating a healthy diet.
“Because Lp(a) is largely genetic, the goal for most people is not to change the Lp(a) level itself, but rather to be aware of whether Lp(a) is elevated, which affects the overall picture of cardiovascular risk factor reduction,” said Dr. Milks.
In some cases, he added, the discovery of high Lp(a) could convince a doctor to start cholesterol-lowering drugs earlier than would otherwise be the case.
“The message with Lp(a) is clear: it is important to screen for Lp(a), especially in individuals with a family history of heart disease,” said Dr. Smith.
“If someone’s Lp(a) is high, understand that this is also a piece of information that people can discuss with their healthcare provider to come up with an individualized plan.”
