America’s hidden heart attack crisis: 1 in 5 now have silent ‘widowmaker’ condition that DOUBLES risk even if you’re slim and fit… yet doctors rarely test for it. Here’s how to find out if you’re in danger
It’s a silent condition affecting millions, lurking in the background until it leads to deadly 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, triggering inflammation and blood clots.
But unlike other forms of bad cholesterol like low-density lipoprotein (LDL), doctors rarely test for it and it doesn’t appear in standard panels.
About one in five Americans – 63 million – have elevated Lp(a), a largely inherited condition that often goes undetected because those affected can be slim, fit and otherwise healthy.
Indeed, many people only discover they have high Lp(a) after suffering a heart attack or stroke – sometimes with little or no warning.
In 2017, The Biggest Loser coach Bob Harper was the picture of peak physical fitness when he suffered a widowmaker heart attack while working out at 51. He claimed doctors gave him only a six percent chance of pulling through.
‘I was in full cardiac arrest,’ he said at the time. ‘My heart stopped. Not to be dramatic, but I was dead. I was on that ground dead.’
Harper later learned the cause was high Lp(a) passed down in his family. His mother and maternal grandfather had both passed of heart attacks before his near-death experience.
In 2017, The Biggest Loser coach Bob Harper suffered a widowmaker heart attack while working out. He later learned he has inherited high lipoprotein(a), or Lp(a), which doctors believe caused his near-death experience
Studies estimate fewer than one percent of Americans gets their Lp(a) levels tested, and there is no medication that can treat it.
Instead, doctors believe screening is the best way to detect Lp(a) before a devastating heart attack.
And though it’s genetic, lifestyle changes like cutting back on alcohol and implementing regular exercise can ward off heart disease and diabetes, which further narrow the arteries.
Here, doctors reveal to the Daily Mail everything you need to know about high Lp(a), how to know if you have it and the new drugs coming down 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, cardiologist at the 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 almost entirely determined by the genes we inherit.
And having too much can be dangerous. Like LDL, Lp(a) can build up inside artery walls, causing fatty plaques that restrict blood flow and increase the risk of heart attacks and strokes.
It can also make the blood more likely 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 influenced by diet, exercise and excess weight.
About 37 percent of Americans, roughly 86 million, have elevated LDL, one of the strongest long-term predictors of heart disease and stroke.
‘With LDL, you can reduce levels through changes to diet, exercise, or with statins,’ Dr Wesley Milks, a cardiologist specializing in lipid disorders at The Ohio State Wexner Medical Center, told the Daily Mail.
‘But that’s not the case with Lp(a). We see high levels run strongly in families, often alongside premature heart disease.’
Lp(a) may also be particularly harmful because it carries an extra protein, called Apo(a), that promotes inflammation and plaque build-up inside arteries.
And because people with genetically high Lp(a) have elevated levels from birth, the damage can accumulate for decades – potentially triggering heart attacks and strokes at younger ages.
High Lp(a) is also linked to aortic stenosis, a potentially serious narrowing of the valve that controls blood flow out of the heart.
How do I know if I have 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 with a blood test.
The CDC recommends testing for people who have 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 people with a family history of early heart disease, poor circulation in the legs, the inherited high-cholesterol 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
Could I have a heart attack?
Having high Lp(a) does not guarantee you’ll suffer a heart attack, but it can significantly raise the 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 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, with very high levels potentially more than doubling the chances of cardiovascular disease.
However, that risk needs to be put into context.
For someone who is otherwise young, fit and healthy, for example, 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.
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 heart attack risk by tackling other risk factors like LDL cholesterol
Testing for high Lp(a) involves a simple blood draw, but it 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 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 people only need to have their Lp(a) checked once –and 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’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 an illness that can temporarily alter Lp(a) levels.
How can I stay safe if I have high Lp(a)?
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. Trials found it reduced LDL by more than 50 percent and also lowered Lp(a) by about 28 percent.
Meanwhile, several experimental drugs designed specifically to tackle 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 can also use a treatment called lipoprotein apheresis, which works a little like dialysis, filtering LDL and Lp(a) from the blood.
However, the 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 way for people with high Lp(a) to protect themselves is to aggressively tackle the heart disease risks they can control.
That can mean lowering LDL with statins or other cholesterol drugs, controlling blood pressure and diabetes, not smoking, exercising regularly and eating a healthy diet.
‘Because Lp(a) is mostly genetic, for most people, the goal is not to change the Lp(a) level itself, but rather to be aware of whether Lp(a) is elevated as impacting the overall picture of cardiovascular risk factor reduction,’ Dr Milks said.
In some cases, he added, discovering 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.’
