The Deadly Cholesterol You May Not Know You Have

There’s a type of cholesterol serious enough to cause a life-threatening heart attack or stroke by middle age, and the scariest part is most who have elevated levels of it have no idea. The culprit is called lipoprotein(a), or Lp(a). Like LDL (low-density lipoprotein), the “bad cholesterol,” Lp(a) causes plaque buildup, but it’s unique because it increases blood clots and inflammation, significantly increasing the risk of a host of cardiovascular issues. Lp(a) is also purely genetic, which means no amount of diet or exercise can lower your levels.

It’s estimated that about 20-30% of people in the world have elevated levels, which usually starts at 30-50 mg/dL. While cholesterol checks are part of most wellness exams, Lp(a) is not typically included. The standard blood test called a lipid panel or profile measures your total cholesterol, LDL and HDL (high-density lipoprotein) or “good cholesterol,” and triglycerides.

So, how do you know if you should get your Lp(a) level tested? A preventive screening is recommended if:

• You are younger than 65 and have had a heart attack
• You have a family history of premature heart disease (under 60 for women and under 55 in men)
• Your LDL cholesterol is high but hasn’t responded to medication (statins)
• You’ve been diagnosed with familial hypercholesterolemia (FH), an inherited condition that causes the body to poorly recycle LDL cholesterol

There isn’t an effective treatment for high Lp(a) just yet, but there are promising clinical trials under way, like the drug pelacarsen, which so far has shown to significantly drive down Lp(a) levels in 98% of people taking it. As that important research continues, knowing your levels now is important, as doctors can treat other heart disease risk factors and look at statins to lower other forms of cholesterol.