Millions of Americans are born genetically predisposed to extremely high levels of a type of cholesterol that cause deadly heart attacks and strokes by middle age, yet they are almost always unaware of their risk.
The cholesterol is called lipoprotein(a), or Lp(a). Like low-density lipoprotein — LDL, or the “bad” cholesterol — it leads to plaque buildup in arteries. But Lp(a) has a second nasty trick that makes it even more dangerous: it causes blood clots. And unlike LDL, it’s entirely genetic, which means diet and exercise have no effect on Lp(a) levels.
The result is a high likelihood of life-threatening heart disease that runs in families, killing parents, aunts, uncles and siblings in their 40s and 50s.
“Everybody in their family has had a heart attack or stroke or bypass surgery or stent in their 40s,” Dr. Steven Nissen, chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, said of his patients with high Lp(a). “They’re scared to death.”
As many as 64 million Americans have elevated Lp(a) levels. Anyone can have it, though it is most common among people of African and South Asian descent.
Routine blood cholesterol tests could look for Lp(a) but do not — largely because there is no effective treatment for it. Similar to other forms of high cholesterol, there are no symptoms with high Lp(a).
But with several promising drugs making their way through clinical trials, doctors say people should be aware of their risk.
Dr. Erin Michos said screening for Lp(a) is part of her preventive care for patients.
“To me, it doesn’t make any sense that I’m not going to measure it just because I can’t bring the number down,” said Michos, an associate professor of medicine and director of Women’s Cardiovascular Health Research at Johns Hopkins University School of Medicine in Baltimore. “I measure it in all my patients at least once to just find out who’s high because we can do things to lower their risk.”
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